Some experts say the normal effects of severe adversity may be misdiagnosed as ADHD. Inattentive, hyperactive, and impulsive behavior may mirror the effects of adversity, and many doctors don’t know how—or don’t have time—to tell the difference.
When speaking to traumatized children inappropriately diagnosed with ADHD, Dr. Heather Forkey, a pediatrician at University of Massachusetts Memorial Medical Center, offers them a reassuring explanation of their behavior. The body’s stress system, she says, developed long ago in response to life-or-death threats like a predatory tiger. The part of the brain that controls impulses, for example, shuts off so that survival instincts can prevail.
“What does that look like when you put that kid in a classroom?” Forkey asks. “When people don’t understand there’s been a tiger in your life, it looks a lot like ADHD to them.”
Forkey’s goal is to remind doctors that inattentive and hyperactive behavior can be traced back to any number of conditions—just like chest pains don’t have the same origin in every patient. Ideally, the AAP will offer pediatricians recommendations for screening tools that efficiently gauge adversity in a child’s life. That practice, she says, should come before any diagnosis of ADHD.
While there are few recommendations now for clinicians, that will likely change in the coming years. The American Academy of Pediatrics is currently developing new guidance on ADHD that will include a section on assessing trauma in patients, though it won’t be completed until 2016.