With the school year just starting and the possibility of students being screened for ADHD, it is important to also consider the possibility of a trauma diagnosis. Here’s why. Childhood trauma is fairly common and is not only caused by abuse but can also be caused by natural disasters, being separated from a parent long term, medical procedures, car accidents, death of a loved one, hearing about school shootings, or witnessing violence. In addition, Post-Traumatic Stress Disorder (PTSD) is sometimes misdiagnosed in children as Attention Deficit Hyperactivity Disorder because some symptoms of both disorders are similar, and a trauma assessment may not be conducted, leading to an inaccurate diagnosis. Symptoms of both disorders include difficulty concentrating, fidgeting, angry outbursts, difficulty making friends, learning and comprehension problems. As treatment for each disorder is different it is important a correct diagnosis is made.

Fight, Flight, Freeze and Feigned Death Responses

In people who have been traumatize, the body may become trapped in the fight/flight/freeze/feigned death cycle. Human bodies retain somatic memories of traumatic events that have been experienced as a means of alerting one to future danger. When this body memory is triggered by one of the senses, the vagus nerve quickly activates the autonomic nervous system and the body chemistry changes as stress hormones such as cortisol and epinephrine are produced. This enables the body to react by fighting, fleeing, freezing or feigning death.

When the body enters these states, the neocortex, the place in the brain where learning occurs goes offline and the subcortical brain, which is responsible for the fight/flight/freeze/feigned death response is activated. When this system occurs, a child may have difficulty speaking, understanding what is said to them or learning.

The fight/flight response may be perceived as hyperactivity. A child with a trauma history becomes hypervigilant to the environment meaning the child is always on high alert scanning external stimuli for warning signs of danger. The senses may pick up on any minor noise or other distraction in the classroom, causing the child to appear hyper, anxious, jumpy or angry.

The freeze/feigned death response may be perceived as the inattentiveness or daydreaming often seen in ADHD. However, this freeze response is a form of dissociation which enables one to detach from trauma while it is happening. When a classroom stressor occurs, a child may appear to be daydreaming who has dissociated or “checked out” as a means of escaping perceived harm. Still another form of dissociation is a child who is having a flashback. Flashbacks may be perceived as someone daydreaming but in reality, the child is gripped with reliving the memory and terror of a traumatizing event. Some children when experiencing a flashback may not freeze but lash out in anger (fight response).

Treatment Approaches

Just as a sore throat due to a virus is treated differently than strep throat, it is best to determine the origin of inattentive and hyperactive symptoms to ensure the correct diagnosis is made and proper treatment is given. Trauma therapy for children consists of body/mind and play therapies and other creative approaches making its treatment very different from the behavioral and pharmacological treatments used with ADHD. It is important when a child is being considered for the diagnosis of ADHD, that a trauma assessment is also conducted. Even if a parent believes the child could never have been traumatized, many children who are abused keep it a secret from their parents for years.