To most children, the picture of Davy Crockett's rifle in their history book is like many aspects of school: boring. For a child who saw his father threaten his mother with a shotgun, however, the picture can trigger traumatic memories—and the resulting fidgeting and jumpiness can look to teachers and doctors like attention-deficit hyperactivity disorder (ADHD). In such cases, standard treatment with stimulants (which help to focus the ADHD brain) may do more harm than good. And according to some experts, misdiagnosis of trauma-related attention problems may not be uncommon: in children, trauma produces different symptoms than it does in adults.
Recent research by Duke University psychiatrists found that by age 16, more than two thirds of children are exposed to at least one potentially traumatic event, such as abuse or a natural disaster. But fewer than 1 percent of the 1,420 children studied met the criteria for post-traumatic stress disorder. In childhood, trauma was more likely to lead to depression, anxiety and behavior problems.
Frank Putnam, a professor of psychiatry at Cincinnati Children's Hospital (who uses the Davy Crockett example in teaching), notes that diagnostic guidelines do not require doctors to rule out trauma when considering ADHD. And yet research shows that trauma profoundly affects attention and activity. Putnam found that abused kids were far more active than their nonabused counterparts—and because potentially traumatic events are common, he believes misdiagnosis may be, too.
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Psychiatrist William E. Copeland, lead author of the Duke study, disagrees. He thinks that the rate of such misdiagnosis is “overall extremely low.” ADHD criteria require some symptoms to start before age seven, so if an older child's behavior suddenly changes, the diagnosis would not fit. But, he concedes, “there are certain settings where kids are exposed to multiple traumatic events [like foster care], and that's going to be an issue.”
Experts such as Putnam are calling for more research to determine how widespread trauma-related ADHD misdiagnosis really is and to figure out how to better help traumatized kids—less than one third of whom, according to Putnam's research, actually need medication.