The answer is “yes!” However, many individuals are often misdiagnosed as having either one or the other, not both. The reason for this confusion is that these disorders have overlapping symptoms and often coexist in a bidirectional relationship, meaning that each one can impact the other. Many research studies have found that those with ADHD are four times as likely to also have PTSD, and those with PTSD are twice as likely to meet the diagnostic criteria for ADHD. In fact, those with ADHD and PTSD have evidenced very similar struggles in their academic and professional pursuits, their social interactions, and their effectiveness in managing daily activities. These struggles have been correlated with the shared symptoms of difficulties with concentration, memory, emotional regulation, decision-making skills, impulse control, communication skills, and thought organization. When an individual has experienced a severe trauma or chronic trauma, the diagnosis is typically PTSD. However, trauma debilitates the same brain areas which cause ADHD symptoms. Therefore, ADHD symptoms can actually result from trauma and, if undiagnosed or misunderstood, can also be a form of ongoing trauma, such as social embarrassment, poor academic or work performance, and a constant fear of making mistakes.
COMMONALITIES IN BRAIN DYSFUNCTIONS
Scientists have found that both ADHD and PTSD cause changes in the prefrontal cortex, an area of the brain which controls attention span, impulse control, emotional regulation, long-term goal achievement, and other personality-defining executive functions. Both PTSD and ADHD have been found to cause a heightened “fight-or-flight” response to daily stressors, causing a surge of epinephrine (adrenaline) from the body’s adrenal glands and hypervigilance of one’s environment. The amygdala, which is responsible for managing fearful situations and controlling anger reactions, does not function effectively in those with PTSD and ADHD, resulting in exaggerated anger and fear responses. The crisis -focused amygdala communicates disorganized information to the hippocampus, the brain’s memory storage structure, resulting in decreased ability to retain short-term memories and increased vulnerability to further trauma.
SENSORY HYPERAROUSAL
Individuals with ADHD have extreme difficulty with organizing and responding appropriately to sensory information. Those with PTSD also have heightened sensory sensitivity, but it is typically tied to trauma cues. Being in situations with too many stimuli can trigger extreme anxiety in both PTSD and ADHD individuals. ADHD and PTSD together can create extreme hyperarousal, impulsive behaviors, and heightened emotional responses to traumatic reminders, in those with PTSD, or shameful reminders in those with ADHD. Those with ADHD exhibit a consistent pattern of excessive physical movements or a feeling of restlessness that can impede functioning in various situations. Hyperarousal in PTSD, however, is a state of heightened alertness as a reaction to trauma, leading to vigilance for potential threats and an exaggerated startle response. The external reaction looks much like ADHD and may look like being unable to relax, or a need to be constantly “trying to get things done.”
DIFFICULTY WITH EMOTIONAL REGULATION
Challenges in regulating emotions can occur in both ADHD and PTSD. With ADHD, individuals might experience quick mood changes and difficulty managing their emotional responses. In PTSD, emotional dysregulation is often a reaction to trauma triggers, resulting in intense anxiety, anger, or sadness that can become overwhelming in current situations. In ADHD, many individuals experience a form of trauma when undiagnosed. This trauma includes a chronic sense of being negatively perceived or rejected, low self-esteem, struggles in academic or social settings, and, in some cases, engaging in impulsive and self-destructive behaviors. Negative thought patterns can cause emotional “stuckness,” which occurs when fearful, painful, and insecure thought patterns interfere with one’s motivation toward any meaningful action, ranging from simple self-care tasks to self-empowering actions in one’s career and relationships. Those with PTSD and ADHD often stay in a cycle of past-oriented emotional pain, shame, and identity confusion.
Self-regulation allows an individual to think about and to evaluate one’s motives, values, and life goals. Using self-regulation is key to both cognitive movement and to purposeful actions. Self-regulation is demonstrated by cognitive choices and behavioral acts aimed at either achieving or avoiding one’s “possible self.” Self-regulation is an important motivating force and a source of internal control over one’s environment. Self-regulatory behaviors create an internal locus of control which can serve as a protective factor in the face of adverse circumstances. Managing the multitude of PTSD or ADHD symptoms actually requires the development of self-regulatory coping strategies in order to function at work, home, and within significant relationships. However, over time, an individual’s defenses gain control over these coping strategies. Therapy can assist these individuals with working through the memories of past experiences by talking about how and why these experiences have caused so much emotional dysregulation in one’s present-day life.
MEMORY DISTURBANCES
The hippocampus is the brain’s memory structure and receives the most severe damage from traumatic events, in that it loses the ability to store and process information correctly. After experiencing a traumatic event or even ongoing emotional abuse, a person’s hippocampus often cannot separate safe events in the present from the dangerous or painful events which have occurred in the past. Due to having a poor memory, those with PTSD and ADHD may forget work project deadlines or become easily confused when given lengthy instructions. Poor short-term memory in both disorders can cause an individual to become easily overwhelmed by even simple tasks and to forget work project deadlines and other crucial life responsibilities. For example, due to one’s chaotic thoughts and frequent difficulty with following a conversation, an individual with PTSD or ADHD may appear uncaring or insensitive to one’s friends, romantic partners, or children.
DIFFERENCES BETWEEN PTSD AND ADHD
ADHD usually begins in early childhood and involves consistent challenges with attention, behavioral control, and emotional regulation. In contrast, PTSD symptoms occur after a traumatic event, may be less consistent, and may vary in intensity. Both ADHD and PTSD can lead to difficulty concentrating, but the root causes are different. In ADHD, inattentiveness is a consistent trait that affects the ability to stay focused on tasks. With PTSD, inattentiveness may be a symptom of dissociation, which is a mental escape from trauma triggers. Dissociation can manifest as daydreaming, spaciness, or detachment from one’s surroundings, which can be mistaken for inattentiveness. Another difference is that both disorders can lead to sleep problems but for different reasons. ADHD may disrupt sleep patterns due to an inability to calm one’s thoughts or difficulty sticking to a sleep schedule. In PTSD, sleep disturbances often stem from anxiety, nightmares, or night terrors related to the traumatic event.
HOLISTIC TREATMENT OPTIONS FOR BOTH DISORDERS
The most effective PTSD and ADHD treatment includes Trauma-Informed Therapy, such as EMDR, Narrative Therapy, Psychodynamic Therapy, and Prolonged Exposure Therapy, with the main goal of holistically revising different aspects of the individual’s life. Trauma-Informed Therapy seeks to work with the individual’s emotional and behavioral responses as they relate to their broader social context. Eye Movement Desensitization and Reprocessing (EMDR) uses eye movements to assist the brain in reprocessing the unprocessed memories of trauma, aiming to alleviate the associated fears and distress. Psychodynamic Therapy explores how past experiences, especially early ones, have contributed to current emotions, behaviors, and relationship patterns. Narrative Therapy can assist individuals with PTSD and ADHD in “rewriting their story” to redefine their experiences and self-perception. Prolonged Exposure Therapy (PE) helps individuals to confront and to diminish the anxiety associated with fear-inducing or shame-inducing memories by gradually and safely exposing themselves to these visions and related physiological sensations. A holistic therapeutic approach must help the individual to identify and to utilize one’s strengths in the new narrative of self-discovery and empowerment.
