ADHD and PTSD - What is the Difference?

People with ADHD are often confused with those with PTSD. YES, it is possible to have both, however it is more than likely that a person will have one or the other. So many may ask what are the similarities and what are the differences.

In ADHD, many have:

Inattention, Distraction, Restlessness, Impatience, Impulsivity, Anger, Sleeping Problems, Poor Memory, Poor Concentration, Anxiety, Depression, Low Self Esteem, Addiction Problems, Shame.

In PTSD many have:

Inattention , Distraction, Restlessness, Impatience, Impulsivity, Anger, Sleeping Problems, Poor Memory, Poor Concentration, Anxiety, Depression, Low Self Esteem, Addiction Problems, Shame

I am sure you have noticed that the symptoms appear to be the same, so it is easy to confuse the two. However, the differences lie in the etiology or how the symptoms appeared.

PTSD is usually secondary to a traumatic incident, something that we rarely see or are not accustomed to experiencing. ADD/HD’s etiology, although we don’t know for sure, may be in the genes and/or environment. As many specialists in ADHD will tell you, there are differences in at least three (3) areas: anatomical, chemical and functional. Additionally, most neuropsychologists will tell you that the brain of a person with ADD/HD is different from that of someone with PTSD. In a National Institute of Health study, children with ADHD had been found to have brains that are smaller by about 3 percent (1), although it is important to point out that intelligence is not affected by brain size. The researchers also reported that brain development was the same in children with or without ADHD.

The study also found that certain areas of the brain were smaller in children with more severe ADHD symptoms, such as the frontal lobes, are involved in:

• impulse control
• inhibition
• motor activity
• concentration

Researchers also looked at the differences in white and grey matter in children with and without ADHD. White matter consists of axons, or nerve fibers. Grey matter is the outer layer of the brain. Researchers found that people with ADHD may have different neural pathways in areas of the brain involved in:

• impulsive behavior
• attention
• inhibition
• motor activity (1)

These different pathways might partly explain why people with ADHD often have behavioral issues and learning difficulties.

With PTSD, we are looking at different anatomical areas.

Throughout the brain several chemical and biological imbalances can present after trauma. Their effects are especially exacerbated by three major brain function deregulations:

• Overstimulated amygdala: An almond-shaped mass located deep in the brain, the amygdala is responsible for survival-related threat identification, plus tagging memories with emotion. After trauma, the amygdala can get caught up in a highly alert and activated loop during which it looks for and perceives threat everywhere.
• Underactive hippocampus: An increase in the stress hormone glucocorticoid kills cells in the hippocampus, which renders it less effective in making synaptic connections necessary for memory consolidation. This interruption keeps both the body and mind stimulated in reactive mode as neither element receives the message that the threat has transformed into the past tense.
• Ineffective variability: The constant elevation of stress hormones interferes with the body’s ability to regulate itself. The sympathetic nervous system remains highly activated leading to fatigue of the body and many of its systems, most notably the adrenal.(4)

How we can look at it in plain English is:

With PTSD, the person has three major problems:

1.     Re-experiencing the Trauma

2.     Avoidance, and

3.     Hypervigilance

From a diagnostic perspective:

The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury to themselves or someone else.

In so doing, the victim’s response may be, fear, helplessness or horror. (5)

These events cause:

Sleeplessness, irritability or outbursts of anger, difficulty concentrating, hypervigilance, overstated startle response.

In short, the responses that someone with PTSD can also be found in those with ADHD. We determine the difference by investigating a thorough history, some specific assessments and asking the right questions.

 References:

1.     Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. [email protected]

2.     ADHD and Brain Structure and Function https://www.healthline.com/health/adhd/the-brains-structure-and-function 3/18/2016

3.     Sinfield, Jacqueline. “Home.” Untapped Brilliance, 2016, untappedbrilliance.com/ptsd-vs-adhd/.

4.     Rosenthal, M. (2018). The Science Behind PTSD Symptoms: How Trauma Changes The Brain. Psych Central. Retrieved on March 7, 2019, from https://psychcentral.com/blog/the-science-behind-ptsd-symptoms-how-trauma-changes-the-brain/

5.     Risch, E., & Hakman, M. (2019). Differentiating PTSD and ADHD. Retrieved from https://www.oumedicine.com/docs/ad-pediatrics-workfiles/ptsd-adhd_presentation_0902091.pdf?sfvrsn=2