Diagnosis: ADHD-or Is It Trauma?

Diagnosis: ADHD-or Is It Trauma? Hyperactive, yes. Attention problems, check. But it's not ADHD.
By Maia Szalavitz for MSN Health & Fitness Medically Reviewed By: George T. Grossberg, M.D.

...In Chemtob's 9/11 study, even children who saw people jump from the towers tended not to have lasting problems. But preschoolers who had experienced multiple traumatic events were 16 times more likely to have attention problems-and 21 times more likely to be overly emotionally reactive and/or to show symptoms of depression and anxiety-than children who had not had such experiences.

But, if other studies of similar children are a guide, many of these severely affected children would probably not meet criteria for post-traumatic stress disorder. Studies following children with known trauma exposure find that they are much more likely to suffer other anxiety disorders or depression than classic PTSD.

Indeed, despite the high prevalence of potentially traumatizing experiences, less than half a percent of the children followed in the North Carolina study could be diagnosed with PTSD. However, 40 percent of those who had had such experiences qualified for at least one diagnosis, often depression or anxiety disorders.

As a result, many traumatized children whose behavior has clearly been affected by their experiences aren't diagnosed with PTSD-or diagnosed at all. Chemtob notes that "virtually none" of the children in his study were getting any kind of treatment, despite symptoms severe enough to warrant it.

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...Trauma can also produce what's known as a "dissociative" reaction. When a threat is physically inescapable, the body prepares for injury by slowing heart rate and breathing. The brain is flooded with endogenous opioids-the brain's own painkillers-which cause numbness. In extreme cases, the person feels like he has "left his body" and is watching events from outside.

A sight, sound, smell or memory can trigger a return to this state. "Children may space out and appear to be daydreaming," Putnam says. "They lose contact with reality and become involved in an internal world. Teachers see a child who is never paying attention. They still have their math book out when the teacher has moved on to history."

Many children who are diagnosed with ADHD, Putnam believes, may actually be suffering from trauma. "There is probably a significant group of kids with traumatic hypervigilance or dissociation that interferes with attention and increases arousal and activity levels," who are misdiagnosed, he says.

What's worse, children suffering trauma symptoms actually have higher than normal levels of neurotransmitters like adrenaline and noradrenaline (norepinephrine), according to Putnam. These same transmitters are raised even further by stimulants like Ritalin that are commonly prescribed for ADHD.
http://health.msn.com/health-topics/adhd/articlepage.aspx?cp-documentid=100191637