Attention deficit disorder with hyperactivity (ADHD) and post traumatic stress disorder (PTSD) are the most commonly diagnosed disorders in sexually abused children from the ages of 3-12. This results because there is a high degree of common symptoms that are found in both ADHD and PTSD. Determining the correct diagnosis can be very confusing for parents and mental health professionals. Because the treatment for each condition is considerably different, it is important for professionals to differentiate between the two diagnoses.
When researchers have studied the prevalence of ADHD diagnosis in children, they have found that ADHD is the most frequent diagnosis given to children regardless of whether they have been sexually abused or not. Why is this so?
It is important to understand that when children are exposed to a traumatic event, in most cases, it results in a persistent disturbance in conduct, emotion, and cognition. Children with PTSD present with a combination of problems such as: impulsivity, distractibility, attention problems, emotional numbing, social avoidance, school failure, and regressed or delayed development. Yet these symptoms are also common in children suffering from ADHD. So without a full account of the child’s history, ADHD is often the most common diagnosis.
Even if an evaluator is aware of ongoing or past trauma in a child’s life, there may also be a diagnosis of ADHD along with PTSD because the symptoms of both disorders are so prominent.
To make matters more complicated, when children are evaluated multiple times over several years, diagnostic confusion worsens. It is not unusual for the traumatized child to “accumulate” several diagnoses over the years as parents search out answers from different specialists. It is not uncommon for a traumatized child to be mislabeled as bipolar or manic depressive, or as having a conduct disorder, or as depressed. Unfortunately, there are often just as many treatment approaches, including changes in medication that accompany each new diagnosis. This can be tremendously frustrating for the parents, the child, and the mental health professionals who are trying to help these children.
There is no doubt that trauma causes a significant disruption in the developing brain of a young child and this damage can certainly lead to symptoms similar to ADHD. Brain scans performed on sexually abused children show fewer nerve cell connectors between the left and right hemispheres of the brain which may lead to a reduced ability to use thought and logic to control emotions. This in turn can lead to abrupt switches from rational behaviors to angry acting out behaviors. Damage to a child’s brain by exposure to the trauma of abuse can also lead to memory and concentration problems which can have long lasting implications for school performance. PTSD can also lead to depression in children and feelings of low self esteem and unworthiness. It is no wonder that so many diagnoses are given to children who have been exposed to trauma.
So what should a parent and professionals do in order to determine the etiology of a child’s symptoms. The following steps can help guide the professional in determining the correct diagnosis and treatment for a child.
• Professionals should obtain a full developmental history of the child and explore major life events within the family. Do not assume that parents are aware of what may be traumatizing to a child. Even infants are aware of stress in the family and can be traumatized by exposure to domestic violence (even if they are not the primary victim), sudden changes in environment, and unavailable parents. Mothers suffering from post partum depression and are thus unavailable to a developing infant can cause significant trauma to a developing psyche.
• The onset of symptoms is critical. If the child was developing in a normal fashion and following a traumatic incident, there was a sudden change in the child’s behavior and emotion, or in a case of a delayed reaction, there was a gradual worsening of conditions over a six to eight month period following a traumatic event, then a PTSD diagnosis should be considered.
• A full medical history and review is essential to rule out allergies, medical complications, brain injuries, etc. If there is any suspicion of medical complications, it is important to refer the parents for a medical evaluation. A medical evaluation can also help determine the presence of physical or sexual abuse, however, in the latter, physical evidence is absent in a majority of cases.
• Children suffering from PTSD will often engage in trauma play and it is important that the professional diagnosing the child understands and is able to identify trauma play. Evaluation of PTSD takes time and an observation of a child’s free play over three or four sessions can give the professional direction as to the diagnosis.
• While check lists for parents and teachers can help with the diagnosis remember that the behaviors of PTDS and ADHD are so similar that the can be interchangeable on a questionnaire. However, children suffering from PTSD, are more likely to engage in some form of repetition of the trauma in their play and behaviors. Whether that be in sexual play that mimics exposure to sexual abuse or to increased sexual behaviors that have recently emerged, these behaviors need to be understood in the context of re-enacting the trauma and the hyper arousal that comes from exposure to sexual abuse. While children with ADHD may act out in sexually aggressive ways, they are not likely to mimic sexual behaviors that are inappropriately for children their age. This type of behavior is a clear indication of exposure to sexual abuse.
For parents who are grappling with the diagnosis of their child it is important that if you suspect that your child has been exposed to any form of trauma, seek out a professional who is aware of the differential diagnoses of PTSD and ADHD and is able to ask the necessary questions in order to help you determine which if any of these diagnoses apply to your child. Getting the help your child needs is critical and in the case of PTSD, the sooner you bring your child in for an evaluation, the better the prognosis. Children who are treated soon after they have been exposed to a traumatic event fare much better than those that are left untreated.
If you suspect that your child has been exposed to a trauma, please contact us at the Trauma Treatment Center of Colorado at 303-790-5585. We can help you in a time of crisis. Leigh Baker
More than one million American families reported cases of sexual abuse in 2000. The perpetrators of these acts come in all shapes and sizes...