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Reviewing Sources on ADHD

Attention Deficit Hyperactivity Disorder is a mental disorder impacting 8.4% of children and

2.5% of Adults. There are three types of ADHD, inattentive type, hyperactive/impulsive type or

combined type. For each individual, the disorder presents in different ways and at different times. Is

ADHD trauma-induced, genetically based, or both? The World Federation of ADHD documented in

their 2021 consensus statement that both environmental and genetic risk factors play a role in the

disorder. It’s the age-old question of what comes first, the chicken or the egg? Are those affected with

ADHD carrying a specific gene, or are we all one step away from experiencing a traumatic event leading

to dysregulation?

The symptoms of ADHD have been acknowledged for over two hundred years. The early

documentation of ADHD described the children and their impairments. The consensus states that in

“1775 the German physician, Melchior Adam Weikard, wrote the first textbook description of a

disorder with the hallmarks of ADHD (Faraone SV et al).” In 1917 ADHD was recognized as a “brain

disorder with genetic origins(Faraone SV et al)”. In the 60’s Ritalin was approved by the FDA to treat

and manage behavioral disorders.

The implementation Resource Center for Trauma-Informed Care defines trauma as a “pervasive

problem resulting from exposure to an incident or series of events that are emotionally disturbing or

life-threatening.” This has a dynamic impact on a persons ability to function; mentally, socially,

physically, socially, etc. Statistics show that 62% of adults have at least one ACE (adverse childhood

experience) and 25% of US adults are said to have three or more ACEs. That is a hefty number of our
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population dealing with the potential side effects of trauma. This alone makes a great case of the need

for trauma-informed care and proper diagnosis of ADHD.

ACEs are pinpointed stressors associated with a serious impact on the function of the brain and

have been proven to contribute to the development of mental andd medical illnesses. (Prahbhjot

Malhi1). There is evidence that points to these experiences mimicking the symptoms of ADHD and or

increasing the severity of existing ADHD symptoms. In a study of 6-8-year-old Australian children, they

assessed the connection between ACES and ADHD. This study showed that kids with ADHD who lived in

a low-income status, a home that was not cared for, or had insensitive parents may play a part in the

development of the child's ability to control their attention span. Further proving the connection

between ADHD, trauma, environmental, and demographic factors. (Springer) The most common theme

throughout noted the experience of a traumatic event was associated with increased severity in ADHD

symptoms. Children without exposure to trauma had less severity of symptoms and externalizing

behavior.

Mental Health weekly digest cites a study of the connection between early trauma and the

COMT (Catechol-O-methyltransferase) genotype. This particular study shows that the genetic

component combined with traumatic experiences increases the severity of symptoms in children with

ADHD. It seemed this would further drive home the argument of genetic predisposition. Reading on,

the study heavily leaned in the direction of exposure to PTEs (potentially traumatic events) strongly

predicting the development of ADHD. It also showed that PTEs played a role in disrupting neurological

development, which could increase the chances of a specific type of ADHD.

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A 2016 article from The National Child Traumatic Stress Network called “Is it ADHD or Child

Traumatic stress?” They state that “trauma can make ADHD worse and ADHD can complicate the

effects of trauma. Which is a common result noted in each study that I read. Another interesting fact

throughout each study is the overwhelming impact of environmental factors. I have found many

variables to my initial research question. I did not expect there to be such high indicators of premature

death in those with untreated ADHD. ADHD is a debilitating disorder, laying claim to a large number of

people and causing families and communities a large financial burden. Further research has raised the

question, Influenced by ACEs and socioeconomic status, has the severity of ADHD become a Public

Health Crisis? What are the costs of ADHD for a person over time? What kind of impact has this had on

the population that battles addiction? How many of them have gone undiagnosed?
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Works Cited

Barkley, Ph.D., Russell A. “New Research Suggests Untreated ADHD Reduces Life
Expectancy.” CHADD, 17 Jan. 2019, https://chadd.org/advocacy-blog/new-research-
suggests-untreated-adhd-reduces-life-expectancy/.
Ellison, Katherine, and Ph.D. Stephen Hinshaw. “The Scandal of ADHD Diagnosis in the
U.S.” ADDitude, ADDitude, 21 Jan. 2022, https://www.additudemag.com/the-
scandal-of-adhd-diagnosis-in-the-u-s/.
CHADD. The Adverse Health Outcomes, Economic Burden, and Public Health
Implications of Unmanaged Attention Deficit Hyperactivity Disorder (ADHD): A
Call to Action to Improve the Quality of Life and Life Expectancy of People with
ADHD. 2019, https://chadd.org/wp-content/uploads/2021/08/CHADD-Health-
Outcomes-White-Paper_8-5-21-FINAL.pdf.
Faraone SV;Banaschewski T;Coghill D;Zheng Y;Biederman J;Bellgrove MA;Newcorn
JH;Gignac M;Al Saud NM;Manor I;Rohde LA;Yang L;Cortese S;Almagor D;Stein
MA;Albatti TH;Aljoudi HF;Alqahtani MMJ;Asherson P;Atwoli L;Bölte S;Buitelaar
JK;Crunelle CL;Daley D;Dalsg. “The World Federation of ADHD International
Consensus Statement: 208 Evidence-Based Conclusions about the Disorder.”
Neuroscience and Biobehavioral Reviews, U.S. National Library of Medicine, 4 Feb.
2021, https://pubmed.ncbi.nlm.nih.gov/33549739/.
“Laws and Legal Protections.” CHADD, 4 June 2021, https://chadd.org/for-adults/laws-
and-legal-protections/.
Llorens, Marta, et al. “Stress-Related Biomarkers and Cognitive Functioning in
Adolescents with ADHD: Effect of Childhood Maltreatment.” Journal of Psychiatric
Research, vol. 149, 2 Mar. 2022, pp. 217–225.,
https://doi.org/10.1016/j.jpsychires.2022.02.041.
Malhi, Prahbhjot, and Bhavneet Bharti. “Traumatic Stress or ADHD? Making a Case for
Trauma-Informed Care in Pediatric Practice.” Doi.org, The Indian Journal of
Pediatrics, 29 Aug. 2020.
Parekh M.D., M.P.H., Ranna . “What Is ADHD.” What Is ADHD? American Psychiatric
Association, 2017, https://www.psychiatry.org/patients-families/adhd/what-is-adhd.
Schilpzand, Elizabeth J., et al. “Trauma Exposure in Children with and without ADHD:
Prevalence and Functional Impairment in a Community-Based Study of 6–8-Year-
Old Australian Children.” European Child & Adolescent Psychiatry, vol. 27, no. 6, 30
Oct. 2017, pp. 811–819., https://doi.org/10.1007/s00787-017-1067-y.

Siegfried, C. B., Blackshear, K. “Is It ADHD or Child Traumatic Stress?”

Https://Www.nctsn.org/, National Child Traumatic Stress Network, with assistance
from the National Resource Center on ADHD: 2016,
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https://www.nctsn.org/sites/default/files/resources/is_it_adhd_or_child_traumatic_str
ess.pdf?source=post_page---------------------------.
Vincent J. Felitti, MD, FACP, Robert F. Anda, MD, MS, Dale Nordenberg, MD, David F.
Williamson, MS, Ph.D., Alison M. Spitz, MS, MPH, Valerie Edwards, BA, Mary P.
Koss, Ph.D., James S. Marks, MD, MPH. The Adverse Childhood Experiences (ACE)
Study. American Journal of Preventive Medicine, 1998,
https://www.ajpmonline.org/action/showPdf?pii=S0749-3797%2898%2900017-8.
“What Is Trauma? - Trauma-Informed Care Implementation Resource Center.” Trauma-
Informed Care Implementation Resource Center, Center for Health Care Strategies.,
2020, https://www.traumainformedcare.chcs.org/what-is-trauma/.