This is an immensely important article. Not because traumatized children cannot have ADHD–they can, and many do–but because children with ADHD must also be screened for trauma. They are already at a higher risk for maltreatment and overwhelm, and trauma may also lower their ability to manage stimuli and process information, exacerbating inattention.
Trauma and attention for learning are at cross purposes–this alone is a good enough reason to assess what part trauma may play in a child’s clinical presentation.
And of course–if there is trauma that is ongoing, we are all of us entrusted with doing all we can to identify it and stop it, so that children can be safe.
Until we ensure they are safe and FEELING safe, we cannot truly expect them to lower their hypervigilance or attend to what the teacher is saying in class. We cannot expect their brains to respond well to medications that are meant to treat inattention when their survival may feel as it hinges on remaining in hyper-vigilance mode and constantly scanning for danger.
I highly recommend reading this article.
[Photo credit: woodleywonderworks, Flickr]
Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.
Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).
These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.
When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.
“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,”…
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Na'ama Yehuda 