How Childhood Trauma Could Be Mistaken for ADHD

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In many physical illnesses, there is an absolute diagnosis. This involves blood or laboratory tests that can definitively point to a specific problem. ADHD, and other mental illnesses, do not have a blood test that provides a definitive diagnosis. It is instead based on observation, by parents, teachers and caregivers.

Often when caregivers bring the child in, it is because they already suspect ADHD. When a caregiver comes in and says, “I think my child has ADHD” or, “My child’s teacher says I should get my child tested for ADHD”, the therapist is already primed to look for ADHD.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:

Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

If the therapist can pull together enough symptoms of ADHD, BINGO! Your child has ADHD. All too often the therapist stops looking for any other diagnosis because, they quite honestly believe they have made a correct diagnosis and they begin developing a treatment plan.

Some experts say the normal effects of severe adversity may be misdiagnosed as ADHD; for example, poverty or living in a high-crime area.

Disorganized attachment can also be mistaken as ADHD especially because there is usually no “large T” trauma.

Have a child with ADHD? Make sure to get a thorough evaluation first. It could be something else, and very often is.

For an evaluation, email InnerConflicts@Hushmail.com or text/call 818-648-5605

http://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328/

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Fireworks, PTSD, and the 4th of July.

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While not many of us here in the United States do not give fireworks and the 4th of July a second thought, there are many of those among us who are significantly distressed by the sudden loud bangs (which can sound like gun shots) associated with celebrating the birthday of this country.

Fireworks can trigger anxiety attacks and panic attacks in combat veterans. In my neighborhood, neighbors have been shooting of smaller fireworks two or three at a time since last weekend. These smaller neighborhood fireworks are particularly frightening for those with combat PTSD because the fireworks are not expected and cannot be prepared for as you have no idea at what time neighbors will light them off or how many they will light off at a time.

A 2012 report from the Department of Veteran Affairs found that 30 percent of the 800,000 veterans of Afghanistan and Iraq are suffering from PTSD. This figure does not take into consideration combat veterans from other wars such as Vietnam.

So, what exactly is an anxiety attack or a panic attack? 

A panic attack is characterized by four or more of the following symptoms:

  1. palpitations, pounding heart, or accelerated heart rate
  2. sweating
  3. trembling or shaking
  4. sensations of shortness of breath or a smothering feeling
  5. feeling of choking
  6. chest pain or discomfort
  7. nausea or abdominal distress
  8. feeling dizzy, unsteady, lightheaded, or faint
  9. feelings of unreality (derealization) or being detached from oneself (depersonalization)
  10. fear of losing control or going crazy
  11. fear of dying
  12. numbness or tingling sensations (paresthesias)
  13. chills or hot flushes

An anxiety attack  generally builds over a period of time and is related to excessive worry. The symptoms of anxiety are very similar to the symptoms of panic attacks and may include:

  • Muscle tension
  • Disturbed sleep
  • Difficulty concentrating
  • Fatigue
  • Restlessness
  • Irritability
  • Increased startle response
  • Increased heart rate
  • Shortness of breath
  • Dizziness

While these symptoms are similar to the symptoms associated with panic attacks, they are usually less intense. An anxiety attack is more like an overwhelming sense of dread, such as the dread of knowing Independence Day is coming and knowing (for days or weeks in advance) that the days leading up to the 4th will be very difficult to manage. Also, unlike a panic attack, the symptoms of anxiety may be persistent and very long lasting — days, weeks or even months.

So what can combat veterans and their families do in order to cope?

Some veterans will be able to face what is going on. Practice mindfulness as you watch the fireworks. Focus on the fireworks to try to help keep themselves grounded to present time and place.

Some will stay inside to avoid the smells fireworks produce. Some will stay inside to avoid the bright flashes of light produced by fireworks, some may also keep the curtains shut to block the light.

If the sound is a trigger, play music or watch a movie to help drown out the unexpected bangs. Ear buds or headphones are also really helpful in these cases.

Having someone to talk to and focus on can help. Conversation can also help keep you grounded to the here and now.

Finally, using coping skills developed with a professional can help.