Is it ADHD or PTSD?

One question that often puzzles clinicians is whether the symptoms that a child is exhibiting are due to ADHD (Attention Deficit Hyperactivity Disorder) or PTSD (Posttraumatic Stress Disorder). Children with both presentations display similar symptoms, including being disorganized, hyperactive, easily distracted, restless, disruptive, and having difficulty sleeping. Since treatments for these two disorders are quite different, it is important to be as informed as possible on how they differ and how they are similar.

PTSD
Some children witness or experience traumatic events (events where a child’s sense of safety is compromised by an unpredicted and scary event). Events such as community violence, domestic violence, physical and sexual abuse, car accidents, natural disasters, or the unexpected death of a parent, can be overwhelming for a child to process and make sense out of. Their brains release cortisol, adrenaline, and other stress hormones, as their fight or flight response is triggered. As a result, childrens' brains may feel hijacked and disorganized. They can become easily dysregulated, both physically and emotionally, or appear hypervigilant. If children experience chronic traumatic stress, such as in households or neighborhoods where violence is ongoing, they can even experience permanent changes in how their brain is wired to respond to everyday stress. A brain that thinks it is in constant danger has trouble organizing itself, which can manifest as difficulty with paying attention, sitting still, and following instructions.

ADHD
ADHD is a neurological disorder that involves a problem in the brain’s prefrontal cortex. This part of the brain controls attention, behavioral organization, goal-directed behavior, inhibiting impulses, and following directions. Children with ADHD have a hard time staying on task, and are often moving about when they shouldn’t be and disrupting others. Because they have difficulty with impulse control, they struggle to keep their hands to themselves, remember to follow rules, keep their bodies still, or consider the consequences of their actions (think before they act). Like children with PTSD, these children also become easily dysregulated, both physically and emotionally, and they appear disorganized and distracted.

TREATMENT FOR PTSD:
What does treatment for PTSD look like? Treatment should include some or all of the following: Promoting safety and stable/predictable routines, learning how to identify feelings and express them effectively, learning skills for regulation, learning skills for distress tolerance and managing stress, identifying and correcting distorted ideas about what happened and why (cognitive distortions), and talking about (or playing about) traumatic events in ways that enable children to master painful feelings and promote a sense of competency.

TREATMENT FOR ADHD:
Treatment for ADHD can certainly involve learning all of the skills mentioned above. However, if a child truly has ADHD, they might need medication in order to slow their brains and bodies down enough to focus on learning the skills. Medication is always a personal decision for you and your family, and I would never tell you that you need to medicate your child. If you are interested in exploring this as an option, you will need to speak to your PCP or a psychiatrist that sees children. Therapy can definitely take place without medication, it just might progress at a much slower pace. Other options include behavioral therapy to help shape targeted behaviors through reward and response costs (losing something desired), parenting education to improve communication, relationships, and behavioral management strategies, and family therapy to help the child with self-esteem, social skills, problem-solving skills, and improving relationships in the home setting.

CAN A CHILD HAVE BOTH?
Yes, a child can have both. In this case, it is important to develop a treatment plan that is tailored to both. Children with both will have a unique set of challenges, and face a higher likelihood of experiencing school failure and development of mood disorders, so knowledgeable treatment is especially important to lower these risks.


Want to talk more about how symptoms of ADHD or PTSD  are creating challenges in your life or the life of your child?  I can help! Give me a call at Dandelion Counseling (413) 825-9300 or send a message to admin@dclongmeadow.com​