ADHD and mental health therapy

Looks Like ADHD, Feels Like ADHD, but Guess What… it isn’t ADHD!

Everyone knows that when they have a headache, it could be for any number of reasons, from the innocuous to something quite serious. A good doctor will ask many detailed questions in her quest to determine the exact cause of the headache.

Without a thorough examination and assessment, it would be irresponsible for the doctor to declare a diagnosis of either the flu or a life-threatening brain tumor, either of which may be the culprit.

Mental illness and psychological disorders are no different. Entirely different diagnoses can easily explain the identical symptoms. That’s why a qualified, responsible mental health professional will submit your child to an exhaustive examination before declaring any conclusive determination.

Understanding what is causing a particular behavior is crucial as the diagnosis will drive the treatment in one direction or another. Medications designed to alleviate ADHD symptoms won’t work if the reason for the child’s inattention is something else entirely.

ADHD is the Common Diagnosis for Inattention

Teachers are generally the first to observe the child’s inability to focus or pay attention. She may notice that the child is susceptible to daydreaming, is unable to follow directions, or is easily distracted. While young children have shorter attention spans than their older counterparts, nonetheless a significant inability to focus stands will stand out.  

The marked inability to focus or pay attention, along with hyperactivity and impulsivity is one of the three symptoms of ADHD. So naturally, when a child is easily distracted, the first thing the clinician or parent jumps to is to proclaim it ADHD.

However, there is another, a perhaps, more chilling explanation that can explain these symptoms just as well.

Post-Traumatic Stress Disorder

Just a few years ago Dr. Nicole Brown, then a resident at Johns Hopkins Hospital in Baltimore, became quite frustrated by the ineffectiveness of standard ADHD treatments for many of the children she was observing. She hypothesized that perhaps the behavior, classically considered ADHD, was rather the result of some trauma.

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Dr. Brown performed a study to test this link between trauma and ADHD diagnosis. She found the following correlation: children who endured four or more adverse childhood events were three times more likely to use ADHD medication. From this study, Dr. Brown concluded that what she was actually seeing in these children may very well not have been ADHD but trauma.

What often seem to be classic ADHD symptoms; impulsivity, hyperactivity, and inability to focus could be masking hypervigilance, dissociation, and impulsivity that might be the result of exaggerated stress response due to some traumatic experience.

It is estimated that over 10% of American children, 6.4 million kids currently carry an ADHD diagnosis! However, some parents and mental health experts have begun to question if this growing epidemic of ADHD is more a function of hasty evaluations, the massive investment of pharmaceutical companies, and increased pressure on educators to produce high-performing students than ADHD.

Other researchers following in Brown’s path have pointed out a seeming eagerness to lean towards and ADHD diagnosis over PTSD. There is far more involved in diagnosing PTSD in a child than observing impulsive and hyperactive behavior. To discover the trauma more time needs to be spent in the evaluation going deeper into the child’s experience.

It’s unclear how many kids are misdiagnosed with ADHD annually. A 2010 study estimated that the number could be close to one million!

To make matters worse, the medications prescribed for ADHD patients are stimulants that increase levels of neurotransmitters in the brain associated with pleasure, movement, and attention. Mental Health professionals are concerned about the detrimental effect these medications will have on children who have PTSD and already feel agitated or hyper-vigilant.

One clinician who has accepted Dr. Brown’s findings is urging her colleagues to abandon the “all-knowing clinician” persona and replace it with the persona of the “really curious practitioner.” Instead of asking, "What is wrong with the child?”, it would be better to ask, “What happened in his or her life?”

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