Introduction
In recent years, the UK has seen a notable rise in Attention Deficit Hyperactivity Disorder (ADHD) diagnoses (Felt et al., 2014; McKechnie et al., 2023). While greater awareness and improved screening are undoubtedly positive developments, this surge also raises important questions—particularly about the role of trauma in shaping children’s behaviour.
Could it be that, in some cases, unresolved trauma is being mistaken for ADHD—leading to well-intended but misplaced support?
Many of its core symptoms of ADHD, such as inattention, impulsivity, and restlessness, can also be signs of trauma. This article explores the complex relationship between ADHD and trauma, especially in cases where a child's trauma history is unknown, overlooked, or misunderstood.
Differentiating ADHD and Trauma
Children and young people who have experienced trauma are significantly more likely to be diagnosed with ADHD. The overlap in symptoms between trauma-related responses and ADHD can complicate the diagnostic process, sometimes leading to misdiagnosis.
For example, children in care or those exposed to adverse childhood experiences (ACEs) often face difficulties with executive functioning—such as maintaining attention, regulating emotions, and controlling impulses. These are also core symptoms of ADHD (Fava et al., 2024; Perry & Pearson, 2024).
Felt et al. (2014) emphasise that an accurate ADHD diagnosis requires careful clinical judgement, as many behavioural signs associated with ADHD also appear in children who have experienced early adversity.
ADHD OR TRAUMA? UNDERSTANDING THE SIMILARITIES
Trauma can significantly affect a child’s brain development, nervous system, and emotional regulation—factors that all influence behaviour. Many of the symptoms commonly linked to ADHD also appear in children who have experienced trauma (Szymanski et al., 2011).
The key distinction is that ADHD is a neurodevelopmental condition present from birth, while trauma is a response to overwhelming or unsafe experiences. Despite this difference, the outward behaviours can appear remarkably similar.
As the table below shows, similar surface-level presentations may stem from very different root causes. This is why a trauma-informed assessment is essential—one that considers the child’s full life context, not just the behaviours being observed.
How Trauma and ADHD Might Appear on the Surface
| Symptom / Trait | ADHD | Trauma |
|---|---|---|
| Inattention / distractibility | Persistent across settings; may be due to underarousal or impulsivity | May be linked to hypervigilance or dissociation |
| Hyperactivity / restlessness | Often motor-driven and observable from a young age | May be a stress response or anxiety-driven movement |
| Impulsivity | Difficulty delaying gratification; poor inhibition control | Linked to survival instincts or disorganised attachment |
| Emotional dysregulation | Quick mood shifts; difficulty managing frustration | Heightened emotional reactivity due to unsafe or unpredictable experiences |
| Sleep disturbances | Common due to dysregulation or overstimulation | Often caused by nightmares, anxiety, or feeling unsafe |
| Difficulty following instructions | Linked to attention or processing difficulties | May stem from mistrust, fear, or the need for control |
| Social difficulties | Trouble with turn-taking, excessive talking, interrupting | May withdraw, show clinginess, or misread social cues due to trauma |
| Poor academic performance | Often related to executive functioning challenges | May reflect disrupted memory, stress, or difficulty concentrating |
| Low self-esteem | Can develop from repeated failure or criticism | Often rooted in shame or adverse relational experiences |
| Behavioural outbursts | May result from frustration or under-stimulation | Can be triggered by trauma reminders or a need to feel in control |
If clinicians focus only on behaviours without considering the child’s trauma history, the risk of misdiagnosis increases. Without recognising the impact of trauma, symptoms attributed to ADHD may in fact be expressions of unresolved traumatic experiences.
Misdiagnosis isn’t just unhelpful—it can be harmful. Many children are prescribed medication for ADHD without a full understanding of what underlies their struggles. For example, a child may meet criteria for ADHD while also showing signs of post-traumatic stress disorder (PTSD), which can exacerbate symptoms and complicate treatment outcomes.
Childhood Trauma Symptoms
Trauma doesn’t always leave visible scars. Many children and young people do not talk about what they’ve experienced—particularly if the trauma is ongoing or involves someone they care about. Parents and caregivers may also withhold information, either out of fear of judgement or because they don’t realise how significantly a situation may have affected the child (for example, a child not being in the same room during a domestic violence incident may still be deeply impacted).
In busy classrooms and overstretched services, children who struggle to focus or sit still may quickly be referred for an ADHD assessment. If the assessment is not trauma-informed, the broader context of the child’s life may be overlooked entirely.
While ADHD is a neurodevelopmental condition present from birth, trauma can arise from a wide range of experiences, including:
- Abuse or neglect
- Witnessing (seeing or hearing) domestic violence
- Loss or separation from a caregiver
- Living in unstable or unsafe environments
- Medical trauma
Children affected by trauma often develop survival-based behaviours—strategies to feel safe or stay in control in unpredictable environments. These behaviours can easily be mistaken for symptoms of ADHD, especially when practitioners are not trained in trauma-informed approaches (Bath, 2008).
ADHD Misdiagnosis
Accurate assessment of ADHD requires a holistic, trauma-informed approach. Without this, children who have experienced trauma may be mistakenly diagnosed with ADHD—a well-intentioned error that can have lasting consequences (Siegel, 2012).
Currently, many clinicians lack clear, evidence-based guidelines for distinguishing between ADHD and trauma-related responses. As recent research highlights, there is an urgent need for assessment frameworks that prioritise curiosity, contextual understanding, and comprehensive evaluation—rather than relying on brief checklists or surface-level observations.
Tools such as the Hospitalized Child and Adolescent Trauma and Psychopathology Questionnaire can help professionals identify trauma-related symptoms and experiences. When used alongside standard ADHD assessments, these tools support more accurate, nuanced diagnoses that reflect the full complexity of a child’s history and behaviour.
POTENTIAL CONSEQUENCES OF MISDIAGNOSIS
If a child affected by trauma is incorrectly diagnosed with ADHD, several outcomes may follow:
- Inappropriate medication, which may suppress surface behaviours without addressing the underlying emotional pain
- Unresolved trauma, continuing to affect the child’s mental health, relationships, and daily functioning
- Feelings of shame or confusion, especially if the child is misunderstood or labelled as “naughty” or “difficult”
- Behaviour-focused interventions, which prioritise compliance over connection and may miss crucial opportunities for healing
Ultimately, misdiagnosis doesn’t just delay the right kind of support—it can deepen a child’s distress and make recovery more difficult.
The Importance of Trauma-Informed Care
Professionals working with children and young people must consider trauma as part of the assessment process. Understanding the role of trauma is essential when evaluating behaviours that may resemble ADHD. A trauma-informed lens invites practitioners to look beyond surface behaviours and explore the child’s history, relationships, and environment.
Rather than asking, “What’s wrong with this child?”, trauma-informed practice encourages the more compassionate question: “What has happened to this child?”
This shift is more than just a change in wording, it transforms the entire approach to support. Trauma-informed assessments prioritise emotional safety, trust, and relational understanding, recognising that what appears to be disruptive behaviour may in fact be a survival response.
KEY ELEMENTS OF A TRAUMA-INFORMED APPROACH:
- Holistic assessment – Taking into account family history, early experiences, attachment patterns, and current life circumstances alongside symptom checklists
- Collaborative working – Involving caregivers, educators, and health professionals to build a complete picture of the child’s needs
- Use of appropriate screening tools – Including trauma history in routine assessments to avoid missing critical factors
- Avoiding assumptions – Resisting the urge to label behaviour without first understanding possible underlying causes, such as fear, neglect, or loss
- Prioritising relationships – Creating stable, supportive environments where children feel safe enough to express and process their emotions
A trauma-informed lens doesn’t mean ruling out ADHD, it means ensuring any diagnosis is accurate, thoughtful, and rooted in the child’s lived experience.
What Can You Do?
Whether you're a parent, teacher, SENCO, or healthcare provider, there are meaningful steps you can take to ensure children receive the right support—especially when trauma and ADHD symptoms may overlap.
PAUSE AND REFLECT
Before jumping to conclusions, take a moment to consider the broader context. Ask yourself:
- Has the child experienced any losses, stressors, or disruptions?
- Could their behaviour be a response to unmet emotional needs or past trauma?
A moment of reflection can shift the approach from correction to compassion.
SEEK HOLISTIC ASSESSMENTS
Advocate for assessments that go beyond surface behaviours and explore:
- Developmental history
- Family and caregiving environment
- Adverse childhood experiences (ACEs)
- Attachment and relational patterns
When ADHD is assessed without exploring potential trauma, vital information can be missed (Felitti, 1998).
BUILD CONSISTENT, TRUSTING RELATIONSHIPS
Children who have experienced trauma need adults they can rely on. Predictable routines, calm communication, and emotional availability help them feel safe and supported, often reducing behaviours that might otherwise be labelled as “ADHD-like.”
USE TRAUMA-INFORMED STRATEGIES IN DAILY PRACTICE
- Avoid punitive responses to behaviour
- Provide sensory tools or movement breaks
- Use visual supports and structured routines
- Validate emotions and teach self-regulation at the child’s pace
These strategies benefit all children—regardless of diagnosis.
ADVOCATE FOR TRAINING AND AWARENESS
Where possible, encourage trauma-informed training in schools, clinics, and parent programmes. Shared understanding across systems creates more consistent and effective support.
STAYING CURIOUS AND CONNECTED
Families and professionals aren’t expected to have all the answers. But by staying curious, compassionate, and collaborative, they can make a lasting difference in the life of a child who is struggling.
Conclusion
The overlap between trauma and ADHD symptoms highlights just how important it is to approach each child with curiosity, care, and a comprehensive understanding of their life story. When trauma goes unrecognised, children may be misdiagnosed and miss out on the support they truly need.
By embracing trauma-informed, holistic assessments and promoting collaborative, relationship-based approaches, professionals and families can work together to ensure children receive the right help at the right time.
Continued research and the development of clear clinical guidelines will be essential in supporting practitioners to navigate these complex cases—always with the child's wellbeing at the centre.
*If you're working with children who display ADHD-like symptoms, take a trauma-informed pause. Your understanding could make all the difference.
