A Guide To Understanding The Connection Between PTSD And ADHD

Overview: What are PTSD & ADHD? 

PTSD

Post-traumatic stress disorder (PTSD)¹ is a mental health disorder that occurs in response to a traumatic event. Such events include war, natural disaster, sexual assault, abuse, or a serious accident. 

Those diagnosed with PTSD have a pathological stress response to this event. It’s natural to feel heightened nervousness after a traumatic event. However, people who develop PTSD experience prolonged anxiety that negatively impacts their life, and they often require professional treatment.  

ADHD

​​Attention-deficit/hyperactivity disorder² (ADHD) is a common and chronic neurodevelopmental disorder. 

Often diagnosed in childhood, people with ADHD have myriad symptoms concentrated around hyperactivity, impulsivity, and difficulty paying attention. 

ADHD can present when the child undergoes a significant change, such as attending a new school or moving to a new house. Some people with ADHD, however, won’t be diagnosed until adulthood. 

This disorder is more common in boys than in girls. However, some researchers³ suggest this is due to different presentations of symptoms between the genders and ADHD being underdiagnosed in girls and women. 

Comparing ADHD & PTSD symptoms

While ADHD and PTSD are different diagnoses, they share many symptoms. Symptoms that are common to both PTSD and ADHD include:

• impulsive behavior

• difficulty concentrating or inattention

• Irritability

• hyperactivity/increased motor activity

• poor self-esteem

While these two disorders sometimes present similarly, a few symptoms are present in ADHD that isn’t part of the PTSD diagnosis and vice versa. 

For example, people with ADHD often exhibit difficulty staying organized, have trouble following instructions, interrupt others frequently, and talk excessively, while those with PTSD don’t struggle with these symptoms. 

PTSD also involves intrusive memories/flashbacks, dissociation, avoidance of traumatic stimuli, and negative beliefs, which aren’t typical of ADHD. 

How are ADHD & PTSD diagnosed? 

The similarities between these two disorders can make them difficult to distinguish. However, some clear differences exist that aid in diagnosis. 

For someone to be diagnosed with PTSD, they must be exposed to a traumatic event that prompts intrusion symptoms, avoidance, negative thoughts/mood, and arousal/reactivity symptoms for at least one month.

Diagnosis often occurs in young or middle adulthood, with a median age of onset of 23 among adults.⁴ 

Individuals diagnosed with PTSD are also 80% more likely⁵ to be diagnosed with another mental health disorder, including substance abuse or depression. 

ADHD diagnosis, however, requires the presence of at least six inattentive symptoms or six hyperactivity/impulsivity symptoms occurring for at least six months. 

The median age of diagnosis for ADHD is six years old, with symptoms usually presenting before the age of 12. 

It’s important to note that ADHD progresses into adulthood in about one-third of individuals.⁶ These people are also more likely to experience at least one other mental health disorder in adulthood.  

Comorbidity in these cases is rather common, with children who have experienced trauma (and developed PTSD) much more likely to be diagnosed with ADHD. 

This is an important issue as children and adults with comorbid PTSD and ADHD often suffer greatly, experiencing more severe deficits and psychosocial dysfunction than those with only one of the two disorders. 

What causes these disorders?

With an ever-expanding body of research suggesting a relationship between ADHD and PTSD, it’s important to look at their causes to explain this link.

PTSD, in its most basic sense, is caused by a traumatic event that triggers prolonged symptomatology. While everyone will likely exhibit some PTSD-like symptoms after a traumatic event, not everyone will develop PTSD. Certain risk factors, including ADHD, may make it more likely that an individual will develop PTSD.

While research is not conclusive on the cause of ADHD, genetics⁷ seems to play a significant role alongside other risk factors such as substance use during pregnancy, brain injury, and low birth weight. 

Trauma has also been indicated as a factor that might change the development and functioning of the brain, increasing the risk for ADHD development. 

Can ADHD cause PTSD and vice versa?

With such a clear PTSD–ADHD relationship, researchers are investigating which one comes first. 

Many studies have presented differing theories,⁸ one being that ADHD is acquired before PTSD. This is supported by the fact that ADHD symptoms typically have a much earlier onset than those of PTSD. 

Researchers have theorized that as ADHD involves impulsivity, this may heighten the risk for exposure to traumatic events and, therefore, PTSD. Even more, researchers propose that ADHD is a risk factor for PTSD due to people with ADHD having differences in neurological fear circuitry compared to neurotypical people.⁹ 

In simple terms, people with ADHD respond to fear abnormally because of how  their brain is “wired.” This may predispose a person with ADHD to develop PTSD if exposed to a traumatic event.

However, this relationship may sometimes occur the other way around. Retrospective studies¹⁰ of adults with ADHD have indicated that they’re much more likely to have experienced trauma in childhood than those who don’t have ADHD. 

These traumatic events often occur in the form of neglect, sexual abuse, and emotional abuse. Such traumatic events may trigger a prolonged stress response, which can change the structural framework of the brain. This can then produce ADHD-like symptoms.

Adding to the complexity, meta-analyses¹¹ suggest the relationship between ADHD and PTSD is bidirectional. According to the research, people with ADHD are four times more likely to have PTSD than neurotypical controls. 

Also, people with PTSD are twice as likely to have ADHD than neurotypical controls. The same meta-analysis that produced these findings also demonstrated that increases in PTSD and ADHD symptom severity were highly positively correlated, meaning that as the symptoms of one disorder worsen, so too do the symptoms of the other disorder. 

How are PTSD & ADHD treated?

Despite some similarities between ADHD and PTSD, they are often treated very differently. ADHD treatment usually involves stimulant medication and behavioral therapy. 

Stimulants are widely used and effective in 70-80% of cases.¹² However, the use of both behavioral therapy and medication is often the most effective treatment. Stimulants in the case of PTSD (without ADHD) can increase anxiety and hypervigilance, exacerbating the person’s symptoms. 

Psychotherapy, however, is often helpful for people with PTSD, and medication can also have a positive effect. However, effective medications in treating PTSD symptoms don’t relieve symptoms of ADHD.

While treatments vary between the two disorders, treating one may help with treating the other. 

The treatment of ADHD with stimulants or psychotherapy can aid in PTSD treatment. This means that a person with ADHD, when being effectively treated, will be more attentive to therapy sessions to treat their PTSD. 

The lowdown

ADHD and PTSD can severely affect a person's ability to function and weaken their quality of life. These consequences are worse in cases of comorbid PTSD and ADHD. Unfortunately, the similarities in their symptoms can sometimes make it challenging to differentiate between the two disorders. 

With more research and a better understanding of their link, clinicians and patients may be able to better treat and cope with these disorders.