Transcript RISK FOR POSTTRAUMATIC STRESS DISORDER ASSOCIATED …

THE ROLE OF TRAUMA IN ADHD
AND SUBSTANCE ABUSE AMONGST
CHLDREN AND ADOLESCENTS
Debra Kaminer
Department of Psychology / Child Guidance Clinic
University of Cape Town
COULD PSYCHOLOGICAL TRAUMA BE THE COMMON
PATHWAY FOR ADHD AND SUBSTANCE ABUSE AMONG
A SUB-GROUP OF CHILDREN AND ADOLESCENTS WITH THE
DUAL DIAGNOSIS?
SOME CASES OF ADHD MAY BE MIS-DIAGNOSED
POSTTRAUMATIC STRESS DISORDER (PTSD)
LEFT UNTREATED, THE TRAUMATIC STRESS THEN RESULTS
IN A SUBSTANCE ABUSE DISORDER
THE RELATIONSHIP BETWEEN
ADHD AND TRAUMA
 Children with trauma histories are more likely to be
diagnosed with ADHD than children without trauma
histories

Fumularo et al. (1996): 35% of maltreated children met
criteria for ADHD (vs. 3-5% of general population)

Weinstein et al. (2000): 25% of sexually abused children met
criteria for ADHD (vs. 3% of non-abused children)

Merry & Andrews (1994): children who had sexual abuse
histories had double the rate of ADHD than children in a
community sample
THE RELATIONSHIP BETWEEN
ADHD AND TRAUMA
 High rates of comorbidity between ADHD and PTSD

23% - 37% of children with PTSD also meet criteria for
ADHD, with higher comorbidity rates amongst sexually
abused children (Famularo et al., 2996; McLeer et al., 1994)

Husain et al. (2008): 66% of war-traumatised children with
clinically significant attention problems also met criteria for
PTSD
POSSIBLE EXPLANATIONS FOR
RELATIONSHIP BETWEEN TRAUMA / PTSD
AND ADHD

ADHD and PTSD share a common vulnerability (e.g.
dysregulation of noradregernic system implicated in both
disorders)

ADHD may be a risk factor for trauma exposure

Trauma exposure may act as a catalyst for ADHD or move
the child from a pre-existing subclinical syndrome to disorder

Traumatic events may reduce caregiver coping which may in
turn result in an increase in adult reporting of children’s
behaviour dysregulation (while families who have not
experienced trauma may be less likely to report children’s
behavioural dysregulation)
POSSIBLE EXPLANATIONS FOR
RELATIONSHIP BETWEEN TRAUMA / PTSD
AND ADHD
 Symptoms of PTSD mimic ADHD and are therefore
misdiagnosed as ADHD (Cuffe et al., 1994; Weinstein et al.,
2000; Wozniak et al., 1999)
 PTSD includes:



Intrusive symptoms (memories, nightmares, flashbacks of
traumatic event)
Avoidance symptoms (avoiding reminders of the trauma)
Hyperarousal symptoms:





Poor concentration
Exaggerated startle response
Irritability
Sleep difficulties
Hypervigilance
May resemble an
ADHD-like
syndrome involving
hyperactivity,
inattention and
impulsivity
POSSIBLE EXPLANATIONS FOR
RELATIONSHIP BETWEEN TRAUMA / PTSD
AND ADHD
 Complex Post Traumatic Stress (Courtois & Ford,
2009) or Developmental Trauma Disorder (van der
Kolk, 1995)


Result of prolonged child abuse by a close attachment
figure
Symptoms of inattention, distractibility, poor planning,
impulsivity
 Both PTSD and complex traumatic stress are
characterised by chronic biological, emotional and
behavioural hyperarousal and an inability to selfregulate this hyperarousal
POSSIBLE EXPLANATIONS FOR
RELATIONSHIP BETWEEN TRAUMA / PTSD
AND ADHD
 If trauma history is not specifically explored in clinical
interview, it is possible to mis-diagnose PTSD as
ADHD, or to miss the trauma-based etiology of
clinically significant attentional, hyperactivity and
impulsivity problems
 Treatment may therefore not be trauma-focused,
resulting in poor treatment outcomes, chronic
hyperarousal and, in the longer term, attempts to
‘self-medicate’ or ‘self-soothe’ through substance use
TRAUMA AND SUBSTANCE ABUSE
 High comorbidity between PTSD and substance abuse
disorders in adult trauma survivors:
 52% of men with PTSD have an alcohol use disorder, and
35% a drug use disorder
 28% of women with PTSd have an alcohol use disorder and
27% have a drug use disorder
 Similarly, children exposed to trauma (especially abuse and
maltreatment) are at higher risk than non-traumatised children
for developing alcohol and drug use disorders in late childhood
and adolescence (Clark et al., 1997; Giaconia et al., 1995)
TRAUMA AS ONE POSSIBLE PATHWAY TO
ADHD AND SUBSTANCE ABUSE
COMORBIDITY?
TRAUMA EXPOSURE
PTSD OR COMPLEX
TRAUMATIC STRESS
THAT MIMICS ADHD
TRAUMA REMAINS
UNTREATED
SUBSTANCE ABUSE