An Inside Look at ADHD & PTSD
Orlando Therapist With An Inside Look at ADHD & PTSD
Do you experience anxiety, sleep problems, and feeling overwhelmed? How about the inability to focus or mood swings? Did you know these are symptoms of both PTSD and ADHD?
Talk about feeling overwhelmed… trying to suss out the difference between both of these diagnoses can be overwhelming. Is it PTSD? Is it ADHD? Or is it both?
At Mindful Living Counseling Orlando, almost all of our clients struggle with some form of PTSD, whether it be from a single life-threatening event, from years of not having their emotional needs met in childhood or some variation of the two.
Over time, we’ve had a trend of clients with overlapping PTSD and ADHD. We also noticed that with this group of people, our standard way of working with PTSD has not been as effective.
So, I decided to reach out to Dr. Brady Bradshaw, a psychiatrist that I have been referring to for years, to help me understand a bit more on how to differentiate between PTSD and ADHD and how best to support our clients.
Dr. Bradshaw was kind enough to consult with me for almost an hour. The information she provided was so helpful, that I asked her if she would like to come to Orlando's EMDR study group and share her wonderful information with Orlando’s EMDR therapist. I was ecstatic when she agreed!
This blog post on PTSD and ADHD comes from my notes from both our personal conversation in March and her presentation in July at the Orlando EMDR Study Group when she spoke to the group.
Dr. Brady Bradshaw
First, a bit about Dr. Bradshaw. She is a phenomenal person and a very caring doctor. She spends a great deal of time getting to know her patients and understanding their symptoms. She is board certified in both child and adolescent psychiatry and adult psychiatry. Her specialties include medication management, individualized treatment, psychotherapy, and telepsychiatry. Dr. Bradshaw provides comprehensive and expert psychiatric care to children. adolescents and adults.
Before we look at the overlap of PTSD and ADHD, let’s first look at the symptoms of ADHD. Next, we’ll explore PTSD and then how they overlap.
ADHD
ADHD impacts executive functioning in the brain and creates problems with attention and intensity. According to Understood.org, when executive functioning is impaired, people have a hard time with:
Working memory
Cognitive flexibility (being flexible in the way they think)
Inhibitory control (self-regulation)
The following is a list of adult ADHD symptoms:
Problems with memory
Anxiety
Inability to focus
Procrastination
Trouble with time management
Disorganization
Problems multi-tasking
Problems completing projects
Trouble prioritizing tasks
Poor planning
Sleep disturbances
In the DSM-5, ADHD is divided into three subtypes: characterized by inattention, impulsivity, and/or hyperactivity and is divided into three types.
The Inattentive type is someone who does not have the ability to stay focused. They are often getting distracted, having difficulty concentrating, and have poor organization skills.
The Hyperactive-impulsive type is someone who does not have the ability to stay still or control their behavior. They have difficulty slowing down, they are fidgety, they have difficulties staying on task, they interrupt often, and take many risks.
The Combination type is some who would experience inattention and hyperactive-impulsivity.
PTSD
PTSD (Post Traumatic Stress Disorder) can occur for people that have experienced or witnessed a single traumatic event or multiple traumatic events where they feared for the physical safety of themselves or others. Some examples of this are natural disasters, physical violence, car accidents, or combat,
Complex Post Traumatic Stress Disorder (C-PTSD) occurs when there is prolonged exposure to unsafe environments. In this case, the nervous system will swing from being on high alert, geared up and prepped for danger to being on low alert so the person can dissociate. In this case, dissociation is likely the person's only defense to tolerate an intolerable situation.
Some causes of C-PTSD are childhood abuse or neglect, violent home environment, bullying, torture, or being a prisoner of war.
When the brain and the body experience a threat to the body or to a sense of self, the brain moves into survival mode and floods the body with stress hormones. Sometimes the brain and body don’t realize the threat is gone or the danger is over and continues to perceive danger even when the person is safe.
Symptoms of PTSD and C-PTSD are:
Intrusive thoughts, memories, dreams, images, or flashbacks of the event
Avoidance of things that remind the person of the distressing event(s)
Memory problems
Negative beliefs about self
Anxiety
Depression
Lack of motivation
Inability to focus
Mood swings
Sleep disturbances
Hypervigilance
Dissociation
Inability to trust in relationships
The Overlap of ADHD & PTSD
Before I get into the overlap of PTSD and ADHD, I will share that ADHD is comorbid with a few other mental health diagnoses. Comorbid is a fancy word that means that two or more conditions are existing at the same time. So here is what I found in listening to Dr. Bradshaw about people who have ADHD:
¼ of them live with no other disorder
¼ - ½ of people diagnosed with ADHD also have Anxiety or PTSD
¼ have depression
¼ - ½ struggle with substance abuse.
These statistics show that a person living with ADHD will more than likely be living with another disorder whose symptoms can overlap making the diagnosis of ADHD difficult in adulthood.
In regards to PTSD specifically, I learned that the most prominent overlap of PTSD and ADHD symptoms are:
Memory problems
Anxiety
Inability to focus
Intense mood changes
Sleep disturbances
Trouble with life transitions
Is it ADHD or PTSD?
When discerning whether symptoms are ADHD or PTSD it is helpful to ask the question: are these symptoms part of dissociation or are they a distraction? Dissociation is an automatic way of checking out to keep the nervous system regulated (PTSD) and distraction is about the inability to stay focused and engaged in something (ADHD).
Memory Problems
The memory problems that are related to trauma are a result of what happens in the brain during traumatic and stressful events. The parts of the brain that engage are the limbic system and brain stem, which are geared for survival. The part of the brain that records memory is offline. Additionally, when severe abuse or neglect occurs, the brain will compartmentalize the trauma and keep the trauma out of conscious awareness as an attempt to keep the person psychologically safe.
Memory problems that occur with ADHD or are more centered around not being focused or engaged.
Anxiety
Anxiety that is related to trauma is again resulting from a dysregulated nervous system. It’s like the gas pedal of the nervous system is stuck on ‘on.’
People with ADHD tend to get anxious when they know they have deadlines or things they need to complete, but they can’t focus so they can complete the tasks. Additionally, people with ADHD can have anxiety that goes with self-defeating thoughts, such as, “What’s wrong with me?” or “Why can’t I just get these things completed like everyone else?”
Dr. Bradshaw did mention that in some cases anxiety can help people with ADHD cope with the inability to focus. As the anxiety mounts it gives them the energy and motivation to push through and complete the task.
Attention
As it relates to trauma, the inability to focus and pay attention relates to being dissociated. As mentioned above, dissociation is a tool the brain uses to keep folks psychologically safe and to keep the nervous system regulated.
People with ADHD not only have trouble staying focused, but they can also become hyper-focused, as well. It's difficult for someone with ADHD to remain focused when they are not interested in what they are doing. Their brain lacks the ability to stay engaged when the task is monotonous or uninteresting. The ability to stay focused seems to putter out even though they know they need to finish the task. This inability to tackle daunting tasks is also what leads to procrastination.
People tend to think that folks with ADHD can’t focus, but they actually can focus if they are interested in the task or the topic. They can become hyper-focused and get lost in doing something they love or researching a topic of interest. They tend to lose track of time and become completely immersed in things they find fascinating. This is why people with ADHD can become entrepreneurs.
The reason people with ADHD tend to be entrepreneurs is because of their tendency to hyper-focus. Being hyper-focused creates an environment of extreme dedication to learning and mastering a skill. Because of the skill mastery, they are able to become experts and make money from their knowledge and skill.
Mood Swings
In our conversations, I found it particularly interesting that mood changes were a symptom of both ADHD and PTSD. Intense mood changes related to a dysregulated nervous system are common in folks that struggle with PTSD.
Until listening to Dr. Bradshaw, I was unaware that mood swings are characteristic of ADHD, as well. As I understand it now, this relates to the inhibitory control that is impaired in executive functioning. People with ADHD have a hard time internally turning their emotions down. People with ADHD tend to feel things very intensely and have difficulty self-regulating the intense emotions. This is not currently a criterion in the DSM-V, however, Dr. Bradshaw says this is especially common in women and that women can often be misdiagnosed with a mood disorder.
Sleep Issues
I also found the subtle overlap of sleep disturbance very intriguing. People with ADHD have difficulty falling asleep. A common reason for that is that they can get super engaged with what they are learning about so they have a hard time turning that off and then have difficulty going to sleep. However, once they get to sleep they can stay asleep.
People who have PTSD tend to have disrupted sleep for reasons related to a dysregulated nervous system or symptoms of PTSD, for example, high anxiety, additional life stress, flashbacks, or nightmares. Folks with sleep disturbances related to PTSD can have trouble falling asleep and staying asleep.
Life Transitions
For example, life transitions are difficult for people with both ADHD and PTSD. Transitions could look like going away to college or university, parenthood, starting a new career, or moving. The reasons that these transitions are difficult for people with ADHD and PTSD differ.
For people with ADHD, life transitions are difficult because they require a great deal of focus and attention to coordinate or navigate. Whereas, for people with PTSD, life transitions are difficult because of the amount of stress that comes with these big transitions that are compounded onto their already taxed nervous system. The ability to manage additional stressors becomes challenging.
Treatment for ADHD & PTSD
When treating ADHD and PTSD there are some options including medication, lifestyle modifications, and psychotherapy.
Medication
Because ADHD and PTSD impact the brain differently, determining the right medication will require your provider to discern whether your symptoms are from ADHD, PTSD, or both.
Dr. Bradshaw states that stimulants are the most effective medication for helping to treat ADHD. She adds that if her patients are struggling with both ADHD and PTSD, Alpha Agonists are used because they help settle the part of the brain that is involved in the survival response.
Lifestyle Changes
At Mindful Living Counseling Orlando, we have a ton of resources for trauma and anxiety on our blog. Some other helpful tips are listed below:
Learn natural ways to work with your anxiety.
Know what grounding tools your system responds to best.
Create a personalized self-care plan.
Create and maintain healthy boundaries.
Create healthy sleep patterns.
Develop mindfulness tools to work with anxiety.
Dr. Bradshaw suggests for people who do not want to take medication for ADHD because not everyone does, it’s helpful to do something that will externalize time like getting a digital clock where you can visually see the hour (or minutes) decreasing and setting alarms, finding workarounds, regularly exercising and establishing routines.
Additionally, having a strengths-based approach is super helpful for people with ADHD. For example, a strengths-based approach for someone who doesn’t like doing the dishes could look like eating off of paper plates. The key to a strength-based approach for people with ADHD is to accept the impact it has on their lives and to find an alternative that works better instead of forcing a behavior.
If you believe you’re struggling with ADHD, PTSD, or both, I recommend you reach out to your healthcare provider for further support.
If you’d like to learn more about therapy at Mindful Living Counseling Orlando, please reach out to us here.
To find out more about becoming a patient at Dr. Bradshaw’s office, visit her website here
More about trauma resources and PTSD Therapy Orlando
Is EMDR Therapy Right for you?
Types of Counseling: Trauma Counseling
Types of Counseling: Mind, Body, and Emotion
Types of Counseling: What The Brain Says About Therapy
Types of Counseling: A Bottom Up Approach
Guided Meditation for Anxiety: Breath and Body Grounding
Guided Meditation for Anxiety: Container and Storage
Guided Meditation for Anxiety: Relaxation Response
Additional ADHD Resources
The Boy Who was Raised by a Dog - By Bruce D Perry
Driven to Distraction - By M.D. Edward M. Hallowell M.D.
ADHD 2.0 - By Ned Hallowell
What Happened to you? By Bruce Perry and Oprah
ADHD For Smart Ass Woman Podcast by Tracy Otsuka
Taking Control: The ADHD Podcast with Nikki Kinzer & Pete Wright
Mindful Living Counseling Orlando is a trauma healing center. Our Orlando Therapy Services include anxiety therapy, trauma counseling, eating disorder recovery, teen counseling, and healing from toxic relationships. At Mindful Living Counseling Orlando, we use a down-to-earth approach infused with cutting-edge therapies that go beyond traditional talk therapy so clients can heal at the root level and experience lasting change. Feel free to access on of our Guided Meditations to help you feel settled and calm now.
