ADHD & Trauma

Welcome to Thriving with ADHD, presented by Animo Sano Psychiatry, where we explore valuable strategies for living well with ADHD. In this episode, host Nada Pupovac introduces Cherry Noor, a new physician assistant at Animo Sano Psychiatry, who brings a wealth of experience and fresh insights to our discussion. Together, they delve into the complex relationship between ADHD and trauma, a topic that has not been covered before on our podcast. 

Join us as Cherry sheds light on the overlapping neurobiological pathways that intertwine ADHD and trauma, making diagnosis challenging yet critical. She discusses the increased susceptibility of individuals with ADHD to traumatic experiences due to impulsivity and inattentiveness, and how these conditions can exacerbate each other if not addressed comprehensively. 

Cherry shares effective strategies for treatment, emphasizing an integrative approach combining ADHD medication with trauma-focused therapies such as EMDR and cognitive behavioral therapy. Hear about the crucial role of family and caregivers in providing a stable, supportive environment and the importance of psychoeducation to empower both individuals and their support systems.

Whether you're a provider or someone navigating life with ADHD and trauma, this episode is packed with insights and resources, from specialist support networks to practical at-home strategies. Discover how comprehensive care can pave the way for a brighter future, fostering resilience and well-being for those affected by these intertwined challenges. Tune in for a conversation that promises to be both enlightening and empowering.

Thank you for listening to Thriving with ADHD. This show is produced by Animo Sano Psychiatry. For more information about our clinic, please visit animosanopsychiatry.com.

Animo Sano Psychiatry has introduced new services for enhancement of our patients' mental health - ASP Concierge and Health & Wellness Program. Please visit our website to learn more.

Animo Sano Psychiatry is constantly looking for the talent in behavioral health. If you are a psychiatrist, nurse practitioner, physician assistant, or mental health therapist, we'd love to hear from you. Visit our Careers pages to learn more about the available positions. https://animosanopsychiatry.com/careers/

Transcript

Welcome to Thriving With adhd, a podcast we'll share every day practical tips to thrive in life as an adult with adhd.  This podcast is brought to you by Animo Sano Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host Nada Pupovac.

Welcome to Thriving with ADHD, dear ADHD community. Today, we discuss ADHD and trauma. This episode is special because we are bringing a new face, or better said, a new voice to our podcast. That's Cherry Nhor, a new physician assistant. at Animo Sano Psychiatry. Although she might be new to our team, Cherry brings with her a wealth of experience, so here is a bit more about her before we dive into this very important conversation. 

Cherry is dedicated to reducing the stigma surrounding mental health while increasing access to care as she is deeply aware of the profound impact mental health has on overall well being. She practices  positive psychology, believing in a collaborative, multi system approach to crafting personalized treatment plans.

She is passionate about treating patients suffering from depression, as well as women's health and hormonal imbalances.

Cherry, welcome to the thriving with ADHD and we are talking about. ADHD and trauma. We didn't have this topic so far on the podcast, so I'm very excited to welcome you to talk about this topic. And I just want to acknowledge that this is your first time. You're also a new member with Animal Sanal Psychiatry.

So I hope you're settling in, uh, with the team, that you're finding it well. And I really appreciate that you  came to the pod and talk about this important topic.  Yeah. Thank you. Thank you for having me. I'm very excited to be here. Um, so yeah, again, you're very, very welcome. And let's start with the first question.

 So  how do trauma and ADHD intersect and what are some common ways that trauma can influence ADHD symptoms?  Yeah, that's a really good question. Um, so trauma and ADHD intersect primarily through overlapping neurobiological pathways related to stress regulation, um, executive functioning and emotional control.

Uh, when someone experiences a traumatic event, the body's stress response system, um, particularly involving the hypothalamic pituitary adrenal, we know it as the HPA axis, can be over activated. Um, this heightened physiological arousal influences neurotransmitter systems like dopamine and norepinephrine, which are also central to ADHD.

Um, as a result, a person with ADHD who undergoes trauma may see an intensification in restlessness, impulsivity, and difficulty focusing because both conditions disrupt similar neurological circuits.  And what would you say, are people with ADHD more susceptible to experiencing trauma or vice versa?  Yeah.

Yeah. So, um, people with ADHD often exhibit impulsivity, um, risk taking behaviors, and a tendency to overlook, uh, social cues, which can place them in circumstances with a higher likelihood of encountering trauma.  These behaviors can lead to involvement in accidents, um, conflictual situations, or other high risk environments.

Um, at the same time, uh, difficulties with sustained attention might prevent them from anticipating or avoiding potentially harmful events. Um, consequently, their vulnerability can stem from a mix of impulsivity and inattentiveness, making them more susceptible to traumatic experiences.  Oh, it seems like a vicious circle and  one condition feeding the other.

So, um,  I suppose to continue on that conversation, how can trauma affect the diagnosis of ADHD and what are some of the signs that providers can look for to differentiate between these two?  Yeah. Um, so that's a really good question as well, um, because as providers, it can be difficult, right? To. Um, so  the clinical presentation of trauma and ADHD can overlap in areas such as inattention, restlessness, and emotional dysregulation, making a differential diagnosis very challenging.

Um, post traumatic stress can manifest as flashbacks, hypervigilance, and avoidance behaviors that can appear like inattention or disorganization. Um, moreover, uh, emotional numbing or dissociation in trauma can could be mistaken for distract ability or daydreaming, often seen in ADHD. Um, so without a thorough clinical history, it's easy to conflate these symptom clusters.

Um, providers reliance, um, factors such as the onset and trajectory of symptoms.  Um, so typically ADHD is evident early in life, like before age 12 and persist across different settings, right? Like at the home, at school, social environments, um, traumatic stress. symptoms on the other hand may have a more acute onset correlated with a specific event or series of events. 

Um, a timeline that aligns changes in behavior with a traumatic experience point more toward trauma related pathology. Um, providers also look for hallmark trauma, trauma symptoms like re experiencing, um, manifested as nightmares or flashbacks, um, avoidance reminders. Um, and negative changes in thoughts and mood to distinguish trauma from purely attention related issue.

Um, more on that topic, because, you know, we're  providers here too, most of us. Um, another diagnostic consideration involves responses to interventions as well. Um, so if stimulants or other ADHD treatments have negligible effects or worsen stress related behaviors, it might indicate an underlying trauma issue. 

Conversely, um, this is the last point of this question, um, therapies targeting trauma like EMDR or trauma focused CBT may uncover or lessen attentional deficits if they were primarily driven by chronic stress.  Um, so finally, um, comprehensive assessment often involve psychological testing, interviews, and collateral information from family or partners to establish a clearer picture.

And avoid misdiagnosis.  Thank you for this clarification and thank you for these these great points and hopefully they're not  only available to other providers, but also to people with ADHD who are listening to this and might recognize themselves. So I wanted to talk more about some effective treatment strategies for individuals dealing with both ADHD and trauma.

You mentioned some of these, but maybe you would, you would want to elaborate. More. Yeah. Yeah. So I was just touching on that. Uh, yeah. An integrative, um, treatment plan is crucial for addressing the multifaceted needs of individual with co occurring ADHD and trauma. Um, in many cases, medication for ADHD, such as stimulants or non stimulants, um, can provide, can provide enough.

symptom management to improve focus and impulse control, thereby enabling the individual to participate more effectively in trauma focused therapies.  Simultaneously, addressing trauma with approaches like trauma focused cognitive behavioral therapy, um, eye movement desensitization and reprocessing, also known as EMDR.

or prolonged exposure therapy can help reduce the intensity of re experiencing, um, and hyperarousal.  Um, so just to kind of touch more on the physiological parts of those treatment options, um, they aim to normalize stress hormone levels and improve neural pathways related to executive functioning. and emotional regulation.

Uh, for example, um, consistent use of ADHD medication may improve dopamine and norepinephrine  levels in the prefrontal cortex, while trauma therapies aim to lessen the overactivation of the amygdala and the sympathetic nervous system  by reducing both sets of symptoms. Individuals stand a better chance of reestablishing healthy coping mechanisms and neural flexibility.

Mm hmm. Yeah.  , and because, as you said, , integration of multiple, , therapy approaches is important, but we also, uh, consider importance of, , support of family and caregivers in, uh, those, you know, suffering from trauma and ADHD. So what caregivers and family and friends should be mindful of?  Yeah, that's a really good question as well.

Mm hmm. Mm hmm. Families and caregivers can provide a stable and predictable environment, which is crucial when managing both ADHD and trauma symptoms.  Consistent routines, clear expectations, and structured problem solving methods can alleviate the stress for the individual's executive functioning system.

Um,  Moreover, uh, using positive reinforcement and celebrating small successes help maintain motivation, self esteem, um, both of which are often strained in individuals dealing with trauma and attention difficulties. Um, they must also be mindful of potential triggers and the emotional toll that trauma can exact.

Um, behaviors such as sudden anger, Withdrawal or intense restlessness may be signs that the individual is reliving or reacting to. Past traumatic events, rather than willfully choosing to be defiant or inattentive. So, um, recognizing these signs can help caregivers respond with empathy and supportive interventions rather than punishment or anger. 

Yeah, and this approach helps reduce shame and fosters a safer emotional space. One more thing too, um, another vital aspect is encouraging ongoing professional help.  Families should support attendance at therapy sessions, medication management, and other recommended treatments.  This might include facilitating transportation, providing reminders for appointments, or joining family therapy sessions when appropriate.

Yeah, and additionally, caregivers can benefit from their own support networks and psychoeducation about ADHD and trauma,  enabling them to stay informed and resilient in their supportive role.  And to continue to that conversation, so what would be resources of support and  systems that could, um, that you could recommend for individuals and families dealing with these challenges? 

Yeah. Um, so, uh, you know, specialized mental health professionals such as psychologists or psychiatrists experience in both ADHD and trauma are an invaluable resource.  They can provide integrated health care plans that address the neurological and psychological dimensions of both conditions. 

Organizations  like CHAD, which stands for Children's and Adults with Attention Deficit Hyperactivity Disorder. You know, they offer communication, or sorry, education, community support, and tools to navigate the complexities of ADHD.  Simultaneously, trauma focused resources like the National Center for PTSD, or the local sexual assault and domestic violence, violence crisis centers can direct individuals to specialized therapy and crisis intervention as well. 

And, um, and thank you for sharing those resources. So to wrap up this conversation, if  there is one thing that you would like our listeners to remember from this episode, piece of advice, anything that you think is important for people dealing with both ADHD and trauma. What that would be.  Yeah. Yeah. Um, so, uh, three things.

Um, firstly, uh, ADHD and trauma share overlapping  neurological and behavioral symptoms,  creating a risk for a mutual exacerbation left undressed. Yes. Um, yeah. Um, so recognition of this interrelationship underscores the importance of comprehensive evaluation and diagnostic clarity, um, as misdiagnosis can For lead to ineffective treatment interventions and prolonged distress.

Um, so it is crucial that clinicians and families alike understand how chronic stress and hypervigilance can mimic or worsen ADHD symptoms, um, and how ADHD is inherent impulsivity and inattentiveness might increase vulnerability to traumatic events.  Secondly, um, treatment works best when it is multifaceted, um, combining medication for ADHD to stabilize.

Attentional and impulsive symptoms with trauma focused interventions such as EMDR or trauma focused cognitive behavioral therapy can create a synergistic effect, um, addressing emotional dysregulation, improving stress tolerance, and facilitating safe exposure to traumatic memories all contribute to a more enduring recovery.

Um, psychoeducation and support strategies at home further strengthen these clinical efforts. And lastly, um, the long term outlook for individuals dealing with both conditions can be optimistic if they receive timely and integrated care. Um, understanding the physiological underpinnings and the developmental trajectory of these conditions help tailor a treatment and reduce stigma,  um, with the right support, uh, therapeutic medical, familial, and communal, uh, individuals can significantly improve their quality of life, achieve personal goals, and maintain healthy relationships despite the challenges posed by ADHD and trauma. 

Thank you so much, , Sherry. And I think this was  information, , packed session and we learned so much from you. So thank you so much for, , sharing advice and resources with us. Yeah, thank you for having me once again. It's been a pleasure. No problem. You're very welcome.

Thank you for listening to Thriving with adhd. This show is produced by Animo Sano Psychiatry. Please follow, rate or share our podcast on Spotify, Apple Podcast, or any other streaming app of your choice. Music is by Daddy's Music music from Pixabay. For more information about Animo Sano Psychiatry, please visit animosanopsychiatry.com