Why Childhood Trauma Can Look Like ADHD

Have you ever wondered why some children struggle with focus, impulsivity, or hyperactivity, yet traditional ADHD treatments don’t seem to hit the mark? It’s a question many parents and caregivers face, and increasingly, researchers are finding a powerful answer: trauma.

As a recent attendee of both the Psychotherapy Networker’s Trauma Conference 2024 and the 36th Annual Trauma Research Foundation conference in Boston (2025), I dove deeply into the cumbersome and often complex relationship between childhood trauma and symptoms that mimic or even influence ADHD. The insights from leading experts like Dr. Martin Teicher and Dr. Nadine Burke Harris shed crucial light on why understanding a child’s history is paramount for effective support.

The Blurry Lines: Why Trauma and ADHD Symptoms Overlap

Imagine a child who has experienced significant stress or adversity in their early life. Their brain and body are constantly on high alert, scanning for potential threats. This hyper-vigilance, a natural response to trauma, can manifest as behaviors that look remarkably like ADHD. They might struggle to concentrate because their attention is constantly being pulled to perceived dangers, or they might seem restless and fidgety because their fight-or-flight system is overactive.

Dr. Nadine Burke Harris, a pediatrician and the first Surgeon General of California, has been a leading voice in this area. She emphasizes that children who’ve experienced Adverse Childhood Experiences (ACEs) may exhibit symptoms such as inattention, hyperactivity, and impulsivity. However, for these children, these are often adaptive responses to their traumatic experiences, not necessarily a primary neurodevelopmental difference. Misdiagnosing trauma as ADHD can lead to treatments, like stimulant medications, that don’t address the root cause and may even worsen anxiety or distress.

This isn’t to say that trauma causes ADHD in every case, but rather that the symptoms can be strikingly similar, making a thorough, trauma-informed assessment absolutely essential.

Martin Teicher’s Four Subtypes: A Nuanced Understanding

Dr. Teicher’s model helps us understand ADHD in a new way, especially when a child has experienced trauma. He describes four different presentations of ADHD with specific symptoms and behavioral presentations

Type I ADHD: a situation where ADHD symptoms are present, but the child hasn’t experienced early neglect; instead, their trauma history might involve other forms of abuse later in childhood, which layers on top of existing ADHD-like behaviors. 

Type II ADHD: means the child has a history of early neglect, and while they might have independent ADHD tendencies, this early neglect significantly contributes to how their ADHD symptoms show up.

Simplex Presentation of ADHD: refers to ADHD where the symptoms are relatively straightforward and less complicated by a history of trauma, essentially ADHD without significant trauma influencing the presentation. 

Complex Presentation of ADHD means the ADHD symptoms are deeply intertwined with a history of trauma, requiring an approach that addresses both the ADHD and the trauma simultaneously. This framework emphasizes that understanding a child’s specific trauma history is essential for accurate diagnosis and effective treatment, moving beyond a one-size-fits-all view of ADHD.

ADHD Subtypes: Simplex vs. Complex

In summary, each type (I, II, and III) can present as either a “simplex” form (less complicated trauma history) or a “complex” form (more layers of trauma exposure). This table shows a snapshot of how Teicher’s subtypes break down. 

Neglect Has Larger Impact

In reviewing the table above, note the interesting difference in the type of trauma. Early neglect seems to have a much more significant impact on a child’s symptoms than other forms of trauma. It is possible that had the early neglect not have occurred the ADHD symptoms would not have surfaced either.

Teicher’s work consistently emphasizes that maltreated patients often present earlier, with greater severity and comorbidity, and may show a poorer response to treatment if their trauma history isn’t considered. He even developed the “Maltreatment and Abuse Chronology of Exposure” (MACE) scale as a tool to map the type and timing of maltreatment during development, a valuable asset in clinic intakes.

Marginalized Children and Misdiagnosis

It’s important to acknowledge that children from marginalized populations, particularly Black and Brown children, face additional challenges. Research indicates that these children are often diagnosed with ADHD at higher rates, but what appears to be ADHD could frequently be a response to chronic stress or trauma stemming from their environment and systemic inequalities. This underscores the critical need for thorough, trauma-informed evaluations that consider the full context of a child’s life, rather than just surface-level symptoms. These communities also face disparities in accessing consistent, high-quality, and culturally sensitive ADHD care.

Dr. Teicher’s model categorizes ADHD presentations into three main types (Type I, Type II, and Type III), each of which can appear in either a “Simplex” or “Complex” form based on the individual’s trauma history. The “Simplex” presentation generally indicates a less complicated history of trauma, such as no early neglect and minimal exposure to abuse in later adolescence for Type I, or early neglect without significant later abuse for Type II, and a less hyperactive presentation often linked to early neglect for Type III. 

In contrast, the “Complex” presentation signifies a more layered and severe trauma exposure, such as early neglect coupled with multiple types of abuse in adolescence for Type II, or the addition of trauma complexity to the characteristics of Simplex Type III. This framework highlights that ADHD symptoms can be heavily influenced by the presence, timing, and nature of childhood maltreatment, suggesting that a one-size-fits-all approach to ADHD may not be accurate and that understanding a child’s trauma history is crucial for effective diagnosis and treatment.

Can Neurofeedback Help?

Given the complex interplay between trauma and ADHD, many wonder about alternative and complementary treatments. Neurofeedback, a non-invasive technique that helps individuals learn to self-regulate their brain activity, has garnered interest.

For ADHD, a comprehensive meta-analysis of neurofeedback in children found no strong evidence of significant benefit on blinded symptom ratings, though some small positive effects were noted with specific protocols. It’s generally not considered a first-line treatment but can be an adjunct for some.

For trauma and PTSD, the evidence is still emerging but promising. Dr. Bessel van der Kolk, a renowned expert in trauma, has highlighted neurofeedback as a valuable tool for helping traumatized children learn to regulate their brain activity, which can reduce PTSD symptoms and improve emotional and executive functioning. A randomized controlled pilot study in children with developmental trauma reported reductions in PTSD and behavioral symptoms, along with improved executive functioning, after neurofeedback training. While more research is needed, especially in pediatric populations, systematic reviews suggest neurofeedback can reduce PTSD symptoms.

When your child is struggling with focus, behavior, or hyperactivity, it’s natural to look for answers. You might be wondering if it’s ADHD, but what if there’s another piece to the puzzle: a history of difficult or scary experiences, also known as trauma? If your child has experienced trauma, it’s really important to consider how that might be affecting their behavior. Start by sharing a detailed history with your child’s doctor or therapist, including any tough times your child has been through, and also look into other possibilities like sleep issues or learning challenges. 

For young children, working with parents on behavior strategies can be a great first step. If trauma is a factor, therapies specifically designed for trauma, like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or other trauma therapy, can be helpful in addressing the root cause of the struggles. Your child’s school can also be a strong partner in supporting them. While medication might be discussed, it’s often part of a broader plan. 

You might also hear about neurofeedback, which helps children learn to regulate their own brain activity. For trauma and PTSD, neurofeedback is showing real promise in helping children heal and improve their emotional and executive functioning. While it might not be a first-line treatment for ADHD, it can be a valuable addition for some children, especially those with a history of trauma. It usually involves a commitment of many sessions, but for families interested, it’s a complementary approach that can offer hope. By looking at the full picture of your child’s experiences and using comprehensive strategies, you can help them not just manage symptoms, but truly heal and thrive.

Ultimately, understanding that behaviors resembling ADHD can often stem from childhood trauma is crucial for ensuring children receive the most effective support. By looking beyond surface-level symptoms and delving into a child’s full history, including any traumatic experiences, parents and professionals can unlock pathways to deeper healing. While traditional ADHD treatments may play a role, integrating trauma-informed therapies and considering complementary approaches like neurofeedback offers a more holistic and hopeful path for children to not only manage their challenges but truly thrive by addressing the root causes of their struggles.

References

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Briscoe-Smith, A. M., & Hinshaw, S. P. (2006). Linking child abuse and attention-deficit/hyperactivity disorder in children: What evidence says and what it means for clinicians. Development and Psychopathology, 18(1), 77–92. https://doi.org/10.1017/S0954579406060054

Burke Harris, N. (2020). Addressing the Root Causes of Childhood Trauma: How Early Adversity Shapes Health and Development. Psychotherapy Networker Conference 2020 [Conference Presentation]. Retrieved from Psychotherapy Networker.

Cortese, S., et al. (2023). Efficacy and acceptability of neurofeedback in ADHD: A systematic review and meta-analysis of 38 randomized controlled trials. JAMA Pediatrics, 177(2), 134–142. https://doi.org/10.1001/jamapediatrics.2022.4764

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Stern, A., et al. (2023). ADHD and childhood maltreatment: A population-based longitudinal cohort study. The Lancet Psychiatry, 10(1), 25–36. https://doi.org/10.1016/S2215-0366(22)00309-0

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Teicher, M. H., Samson, J. A., Anderson, C. M., & Ohashi, K. (2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17(10), 652–666. https://doi.org/10.1038/nrn.2016.111

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