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Differentiating Between ADHD and Complex Trauma in Assessment

Complex trauma symptoms can exacerbate symptoms of ADHD or ADD in children and adults, complicating the assessment of both disorders. Trauma affects the fundamental architecture of the brain in ways that mimic or aggravate ADHD symptoms. To further complicate their distinction or correlation, people with ADHD may have a higher risk of exposure to trauma and experience increased symptoms. Appropriate and timely ADHD assessment from a trauma-informed perspective, like the (Conners 3) Conners, Third Edition, helps children and adults deal with the effects of both issues.

Characteristics of ADHD and Child Traumatic Distress

Tell-tale symptoms and behaviors for ADHD so strongly mirror those of trauma that some people receive misdiagnosis with the former. Overlooking the influence of trauma as a source of behavioral challenges may result in the unsuccessful management of symptoms such as:

  • Memory difficulties
  • Lack of attention
  • Weak impulse control
  • Emotional dysregulation
  • Restlessness or hyperactivity

The overlap between complex trauma responses and ADHD is significant, and neurobiological and academic assessments often miss the latter. For instance, complex childhood trauma can train the brain to operate in a state of “hyper-vigilance,” resembling distractibility and hyperactivity. Inattention may be a dissociative response to avoid painful triggers, while impulsivity and aggression may arise from feelings of agitation and confusion caused by intrusive thoughts or memories about trauma.


Perspectives on Trauma-Informed Assessment

Trauma-informed assessments of children and adults with ADHD, like the Conners’ Adult ADHD Rating Scales (CAARS), reduce the potentially harmful effects of inappropriate treatment or misdiagnosis. Prescribing typical ADHD medications to a child with significant complex trauma may increase anxiety and nervousness, leading to worsening symptoms. A brief trauma screening for traumatic events or family history prevents incorrect or missed diagnoses and can help determine whether a more comprehensive mental health assessment is required.


Trauma-informed mental health assessments usually include several measures in addition to ADHD assessments for effectiveness. The process can include:


  • Clinical interview of patient and family members
  • Background information and medical history surveys
  • Standardized assessments for behavior
  • Behavioral observations

Effective assessors look for information about the nature, severity, and effects of traumatic experiences. A comprehensive analysis of these components, particularly of behaviors, is then compared to symptoms that are specifically one or the other.

For example, most people with ADHD without trauma do not experience disturbing intrusive thoughts or unusually aggressive behavior. On the other hand, people dealing with complex trauma don’t express behaviors such as excessive talkativeness or fidgeting. In other words, children and adults with ADHD are generally impulsive and hyperactive, while those with trauma tend to practice obvious avoidance strategies.


Best Practices in Differential Assessment

Because obtaining a diagnosis represents a significant challenge and the distinction between trauma and ADHD can vary with age, assessors must approach each situation and symptom as unique. Some people may also be dealing with both ADHD and complex trauma, especially since those with ADHD have a notably higher chance of developing PTSD. Additionally, those with co-occurring PTSD and ADHD may experience more intense symptoms of both.


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