ADHD and Early Trauma: Adopted vs Non-Adopted

If ADHD characteristic behaviors are resulting from early trauma, how is recommended treatment different than that for children living with their birth family and ADHD?

The incidence of Attention Deficit Hyperactivity Disorder (ADHD) is higher among adoptive children (see http://www.aaets.org/adoptarticle7.htm). Therefore, it would be difficult to substantiate that a child’s attention difficulties are resulting directly from early traumatic exposure. The generally accepted standard of care for children with ADHD is medication or behavioral intervention with or without medication. Alternative treatments have also been found to be effective in addressing attentional problems.

When we suspect that early traumatic exposure may be contributing to a child’s behavioral problems, we must consider the impact of these early experiences on the child’s feelings, thoughts, actions and physical reactions. We must not rush to treat symptoms without first considering the potential etiology, or cause of the problem. For example, the neglected, abandoned or abused adoptive child who is evidencing attention difficulties may be acting-out due to conflicted feelings and thoughts. Stimulant medication, or the implementation of behavioral techniques, may only serve to exacerbate this hidden conflict and result in additional problems (e.g., emotional, social, behavioral, academic, etc.).

If we know or believe that a child has experienced early traumatic exposure, our treatment should reflect this. For example, the establishment of a therapeutic relationship and the utilization of cognitive-behavioral intervention must be entertained. Whether a child is living with his/her birth family, or adoptive family, should not overshadow the need to consider what may be at the root of a child’s attention difficulties. In light of the fact that the incidence of both ADHD and traumatic exposure is higher among adoptive children, we must work to understand the factors that may be contributing to an adoptive child’s attention problems.

By Dr. Mark Lerner