Can PTSD be mistaken for ADHD?

Can PTSD be mistaken for ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects around 3-5% children and 2% of adults in the UK. The number of people diagnosed with ADHD has escalated over the past few decades, prompting questions about overdiagnosis and misdiagnosis. ADHD’s major symptoms are hyperactivity, inattention and impulsivity – which can also be signs of PTSD. For this reason, PTSD symptoms are sometimes mistaken for ADHD. It can also mean a PTSD diagnosis is missed in someone who has both conditions, because the ADHD is seen to explain all their symptoms.

Here, we look at the symptoms of ADHD, whether PTSD might be misdiagnosed as ADHD, and what to do if you’re unsure about the diagnosis you or a loved one have been given.

What is ADHD?

The symptoms of ADHD are usually grouped in three categories: hyperactivity, inattention and impulsivity. People with ADHD often find it harder than most to concentrate, remember things and complete tasks. They may find it difficult to sit still and are constantly fidgeting and moving. They may be more likely to interrupt others, act without thinking, or have little sense of danger.

ADHD is thought to be caused by a combination of genetics, brain structure and brain chemicals. Some groups may be more at risk, including people with epilepsy or a brain injury and people born prematurely.

Treatment isn’t always necessary, but can include medicine, therapy or both.

Why might PTSD be misdiagnosed as ADHD?

Ref: The National Child Traumatic Stress Network, 2016

The crossover and similarity in symptoms and lack of awareness of PTSD can lead to PTSD being mistaken for ADHD. Both conditions can present in similar ways, with poor impulse control, irritability and anxiety. Someone with PTSD may struggle to follow instructions because they’re preoccupied with intrusive memories, but their behaviour looks like the distractibility of ADHD. Hypervigilance practised by someone with PTSD may look like inattention, typically associated with ADHD.

As traumatic stress and ADHD affect the same areas of the brain, it can complicate ADHD symptoms assessments in children. Areas of overlap include:

  • Difficulty concentrating and learning in school
  • Distractibility
  • Disorganization
  • Often doesn’t seem to listen
  • Difficulty sleeping
  • Restlessness
  • Hyperactivity

The difference is that in PTSD cases, these symptoms are triggered by a traumatic experience, which isn’t a cause of ADHD. ADHD is often diagnosed in childhood, and if the people around a child notice ADHD-like symptoms without being aware of a prior trauma, they may be more likely to assume the child has ADHD.

Since neither condition disappears completely if left untreated, many trauma survivors grow up with continuing ADHD-like symptoms, without the chance to address PTSD.

It’s actually thought that childhood trauma can actually lead to ADHD: ‘When confronted with an acute adverse stressor, the body releases adrenaline, triggering the fight or flight response. Cortisol, a stress hormone, is also released, helping to mobilize the body’s energy stores, activate the immune system, and even briefly enhance memory.

When this stress response is activated in children in the context of supportive adult relationships, these physiological effects are buffered. However, when these buffering relationships are unavailable, and when the stress response is long lasting, toxic stress may be the outcome.

Studies indicate that toxic stress can have an adverse impact on brain development in children. Regions of the brain involved in fear, anxiety, and impulsivity may overproduce neural connections, while areas dedicated to reasoning, planning, and behavioural control may actually produce fewer neural connections. This may lead to what we term maladaptive behavioural responses – they include ADHD and other conditions like anxiety and mood disorders.

Toxic levels of stress hormones can even cause neuronal cell death, especially in the prefrontal cortex (a region associated with executive function, self-regulation, and attention) and the limbic systems (associated with learning, memory, emotional regulation, and reactivity).’

Despite symptom overlap, there are real differences between ADHD and PTSD, the result of a traumatic event that causes brain changes (note: the majority of children exposed to trauma do not meet criteria for PTSD).

  • ADHD is widely considered a heritable condition, while PTSD occurs after experiencing trauma
  • ADHD is characterised by deficits in attention, behavioural inhibition, and regulation. PTSD is characterised by avoidant and hypervigilant behaviour, and re-experiencing of the trauma.
  • ADHD’s symptoms are pervasive and cause significant functional limitations. PTSD causes physiologic, cognitive, and emotional changes in how a person processes stressors.’

Is it possible to have both ADHD and PTSD?

Yes. Research suggests that up to 17% of children who have experienced trauma meet ADHD criteria. Adults with ADHD are nearly seven times more likely to have PTSD than those without.

It’s thought that ‘traumatic stress, apart from other factors like premature birth, environmental toxins, and genetics, is associated with risk for ADHD. The connection is likely rooted in toxic stress – the result of prolonged activation of the body’s stress management system.’

When someone has both conditions, it’s likely the symptoms for both will be worse than if they just had one condition. That said, there’s no evidence that one causes the other.

What to do if you think your ADHD diagnosis may be PTSD

We are not suggesting that all ADHD diagnoses are wrong. But we know that misdiagnosis happens sometimes. Getting an accurate diagnosis is essential, whether you think you or a loved one may have one or both of these conditions.

If you think you may have PTSD, please speak to your GP. Only an experienced professional should make your diagnosis, and once you have that diagnosis, you’ll be on track to get the right treatment.

It also really important that ‘clinicians… increase their understanding of trauma and adopt an informed approach when assessing and treating children for ADHD.’

Treating PTSD alongside ADHD

If you do have both conditions, you are encouraged to treat and manage them both at the same time, rather than address them separately.

PTSD is treatable, even many years after a traumatic event, and even if you are also experiencing another condition, such as ADHD. NICE guidance (updated in 2018) recommends trauma-focused psychological treatments for PTSD in adults, such as Eye Movement Desensitisation Reprocessing (EMDR) and trauma-focused cognitive behavioural therapy (CBT). You may also want to explore group and individual therapy, holistic non-pharmacological therapies, or talk to your doctor about treatment with appropriate prescription drugs.

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

To find out more about ADHD, please visit one of these organisations:

ADHD Foundation

ADHD UK

Mind

Young Minds

Photo by Tara Winstead from Pexels

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