Treating Posttraumatic Stress Disorder in Children

What looks like ADHD can be signs of childhood trauma.

What looks like ADHD can be signs of childhood trauma.
Illustration of prescription pills
Credit: Mark Wagoner

If a child acts inattentive and hyperactive in school, chances are very good he (it's usually a boy) will be diagnosed with ADHD. Attention-deficit hyperactivity disorder affects an estimated 8-12 percent of children worldwide. The designation is so common, it's become a casual synonym for being scatterbrained ("I'm totally ADHD today"), and its prevalence is self-propagating -- the more people are aware of the disorder, the more likely they are to claim it as the cause of a problem.

Beyond the overdiagnosis of kids who are hyper but healthy, there's a graver consequence to this attention-deficit bandwagon. A small but growing body of research confirms what is, so far, a little-known fact -- that the symptoms of posttraumatic stress disorder (PTSD) can look exactly like those of ADHD.

In other words, a distractible, impulsive, irritable child who looks to a teacher or caregiver like a classic ADHD case may actually be struggling to cope with abuse, divorce, natural disaster, or another serious trauma. It can be hard to tell the difference; in a 1994 study by researchers at the Medical College of Pennsylvania, trained interviewers assessed a group of troubled children and, not knowing the children were sexually abused, diagnosed 46 percent of them with ADHD.

"ADHD is not only the diagnosis du jour, it's also the diagnosis of the decade," says behavioral pediatrician Lawrence Diller, author of three books on psychiatric drugs and children. "It represents, with medicine, a quick fix for the main manifestations of ADHD, but these are also manifestations of a half dozen other problems. It's sad the amount of antipsychotics and anticonvulsants prescribed to children to suppress their acting out, which may be occurring because they're living in an intolerable environment."

Consider what happened to Julio, a 14-year-old in Massachusetts who entered high school distractible and inattentive, performing poorly in classes. Lisa Fortuna, a psychiatrist at Harvard Medical School, recalls how his parents struggled to get him to do his homework and complained that he acted impulsively, intruding on adult conversations at home.

Julio was prescribed stimulants for ADHD. Soon after, however, he revealed two significant traumas in his past: As a child in the United States, he heard about war atrocities in El Salvador while his parents still lived there, and, later, he saw a friend shot and killed. Nightmares plagued him. Through therapy and medication for PTSD, Julio's symptoms and schoolwork improved, even when he stopped taking drugs for treating ADHD.

Now, before teachers go recommending all their hyperactive students for a local Department of Social Services intervention, it's important to keep the problem in perspective. Inattentiveness and hyperactivity do often signify ADHD, anxiety, or simply a child acting his or her age. However, for children who silently suffer abuse or grief, the leap to label them with ADHD can leave them without the help they truly need, and may even aggravate their symptoms.

A graph showing the rising percentage of children prescribed stimulants

Children 18 and Younger Who Are Prescribed Stimulants (Typically for ADHD)

Source: American Journal of Psychiatry

Credit: Mark Wagoner

Regrettably, teachers and parents assessing kids' behavior have limited measures to go on, and busy pediatricians often have little time to weigh other explanations when seeing a child with possible ADHD. As Diller says, "Checklists were meant to be used only in schools as assistance, but they have become a sign of diagnosis. They give you a fake sense of science."

To curb the problem, Annan Paterson, a school psychologist in Novato, California, suggests that those in her position "work collaboratively with fellow educators, parents, physicians, and mental health professionals to do a comprehensive assessment." Jerome Schultz, codirector of the Harvard Medical School's Center for Child and Adolescent Development, says the key is to take a complete family history and assess the child's behavior across multiple classes and settings. Pediatrician Lawrence Diller adds that doctors must work with schools to coordinate all aspects of a child's treatment.

Most simply, though, the lesson in these caregivers' experience is this: When we think we spot ADHD, we serve the child best by taking the time to look a little deeper.

Whitney Selfridge, a former George Lucas Educational Foundation intern, wrote her master's thesis on PTSD and ADHD in children at the Harvard Graduate School of Education.

This article originally published on 1/24/2007

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This resonates for me

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I was a child who suffered PTSD. I did not realize this until I read about the symptoms in an abnormal psychology class.

My mother, who was an LD teacher in another school district, fought my school to keep me in school. I was evaluated by 3 different psychologists and my mom ran some tests on me and they decided I had a distinctly cold and anti-social personality. And that I had auditory dyslexia. My mom helped me with my homework and I stayed at my school in the regular classroom. I had counseling sessions with 3 of my peers. (So I could understand how 'normal' people are supposed to behave?)

I have come to understand that I was a sometimes very difficult child who was well-liked in spite of these drawbacks. My mother's investment in ensuring I learn how to learn has made me successful at most of what I set out to accomplish.

Right now, I am raising a boy who has "auditory dyslexia" or what is recognized today as Central Auditory Processing Disorder, another challenge to learning frequently undiagnosed or whose symptoms are "recognized" as ADD or ADHD. At least my mom taught me what I need to do to teach my son how to learn how to learn.

Without pharmaceuticals.

Teenagers ADHD Disorder Recovery

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Attention deficit disorder is a serious psychiatric disorder. Teenagers affected from ADD, ADHD live stressed and dejected life. This neurological disorder usually starts from the childhood and become more severe according to age. It has been researched that there are few major causes of ADHD such as heredity, abnormal level of dopamine, chemical imbalance of norepinephrine and deep brain-injury. For treating the ADD problem of struggling children certified counselors recommend most effective approaches and medication treatments.

http://www.troubledteens.net/Problems-in-Teens/Youths-ADHD-Disorder.html

samanta (not verified)

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Matthew Dorry (not verified)

A brief word

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@anonymous Media does not breed violence and aggression. For all that was occuring during the time in which the Star Wars movies came out, you can't attribute violence to that. I'm a Star Wars nerd and I'm peaceful. Some of Humanity's most violent and savage ages existed long before visual projection technology. And 'increases' in violence is a loose term. Our population has increased in leaps and bounds over the past few decades. More people are born per minute than die. Meaning, violence is a given and it increases as the population does. As much as we dislike it, it is a human trait that exists in some form or another. And there are innumerable facotrs in determining whether a child grows up to be 'violent'. Parenting, environment, culture, peers.

That aside, I would say that there is a widespread hypocracy where people praise movies like Star Wars, but condemn violence in any other form. Might I add though, that physical action is not always violent. Violence is more like a state of mind. Likewise, violence is not always physical. It may come in the form of battery or peer rejection through jokes at another person's expense who is seen as 'not cool'. It's a feeling. Anakin Skywalker, for example, would be violent. Yoda would not be. Much in the same way that Bruce Lee wasn't violent, but you wouldn't have found a better fighter in his time. Perhaps even now.

The point is that the Edutopia idea and what GL is attempting to accomplish is far superior to that of standard public education and that violence can't be attributed to an obvious scapegoat like Star Wars. Not when the movies promote friendship, team work, self-improvement, acceptance, and perseverence, among other things.

Anonymous (not verified)

Star Wars, children, and violence.

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Studies since the 1930s have all confirmed that movies strongly affect children.

Mirror neurons in our brains are stimulated by the images we see and create imitative behavior, especially in children.

Social norms are established by visible role-models.

Every country that got television in the 1950s-1970s saw a marked increase in violence.

The Star Wars movies that George Lucas got rich on helped re-militarize American culture after the Vietnam war.

"Give peace a chance" was replaced with "May the Force be with You" while President Reagan's CIA carried out illegal wars in countries like El Salvador which was mentioned in the article above.

How ironic that Mr. Lucas is now spending a little money trying to repair the mental health of the world's children which he has helped to damage.

Mr. Lucas, if you really want to help America's children, stop making violent movies that condition young minds for aggression and war.

"May the Peace be with You."

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