The Confusion Between ADHD and Trauma: Misdiagnosis in Childhood Mental Health
- Micaela Myers
- 2 days ago
- 7 min read
Updated: 1 day ago
From the time Amanda’s* daughter Meg* (names changed for privacy) was 1, she was incredibly difficult to parent.
“I distinctly remember a moment where, at age 2.5, I took her to the gym with me,” Amanda recalls. “It was my cherished time as a stay-at-home mom back then to get a break from the kids. I dropped her off at the gym childcare and was exercising on one of the treadmills when I saw one of the young teachers carrying Meg, kicking, screaming and pulling the poor 20-something woman's hair. She looked like a wild animal. I wasn’t surprised though. It was behavior I was used to at home but it was embarrassing when her outbursts impacted other people. I looked the other way and cried right there on that treadmill, knowing I'd need to go get her but wasn't ready. I still needed a break. I was mentally exhausted.”
Meg easily became overwhelmed, emotional and upset and, when she did, it escalated quickly. “I still have a thumb that isn't quite the same years later from when she aggressively tried to get my attention when she was little and full of frustration. She pulled my thumb all the way back to my hand,” Amanda says.
At home, Meg would have long and hectic temper tantrums. When she started preschool, Amanda got calls from school frequently. In kindergarten, Meg’s behavior got her suspended. She struggled to keep friends. At home, she’d lie often. Play therapy didn’t help much.
At age 7, Amanda took Meg for a full psychological evaluation, and she was diagnosed with severe ADHD, which was causing her a lot of anxiety, the doctor said.
Up to this point, Meg’s story could be about a child with developmental trauma disorder, also referred to as reactive attachment disorder (RAD). Many kids with RAD have also been diagnosed with ADHD. But here’s where the story diverges. Once Meg went on medication for ADHD, things drastically improved. Today Amanda describes her as a typical 14-year-old girl.
“My daughter is so much calmer and content now,” Amanda says. “She's done a lot of work to better understand herself and her diagnosis, along with the help of a therapist who knows she has ADHD. Her medication has played a huge role in supporting her so that she can slow down, think more clearly and react to things more calmly. She's thriving socially, has healthy relationships and is doing much better in school.”
ADHD medication and the right therapy has helped Meg because she truly has ADHD. However, for children with developmental trauma disorder, ADHD medications and therapy rarely work. These interventions can make things worse for children with developmental trauma, in fact. We break this down further in When Reactive Attachment Disorder Looks Like Something Else — and the Medication Consequences and Why Traditional Therapy Doesn't Usually Work (and Can Even Make Things Worse) for Kids with Reactive Attachment Disorder.
Understanding the Symptoms of ADHD and Trauma Impacts
According to the ADDitude website, symptoms of ADHD, depending on the subtype, can include self-focused behavior, emotional turmoil, impulsivity, trouble paying attention, trouble sleeping, avoiding long mental tasks, trouble staying on task, being disorganized and forgetful, not paying attention to details, being unable to follow directions, blurting things out or interrupting, talking too much, fidgeting/squirming/tapping, being unable to stay seated and the inability to play quietly.
ADHD stands for attention deficit hyperactivity disorder and three subtypes exist: inattentive, hyperactive/impulsive and combined. Those with the inattentive type, commonly referred to as ADD without the “H,” have trouble focusing, organizing and staying on task. Those with the hyperactive/impulsive type may be predominantly hyperactive and impulsive, while the combined type struggles with a mix of inattentiveness and hyperactivity.
Meanwhile, symptoms of developmental trauma in children can include having a low tolerance for frustration, having trouble focusing, having difficulty sleeping, having trouble in school, relationship problems, risk-taking behavior and more. Given the impact of trauma on behavior, it’s easy to see why many of our kids are misdiagnosed with ADHD when the real issue is developmental trauma disorder.
Why ADHD and Trauma Impacts Get Confused So Often
Licensed clinical social worker Forrest Lien spent 40 years working with children and families impacted by developmental trauma disorder and is well-versed in ADHD misdiagnosis.
“Every single child that came into the clinic I once ran for children with RAD were labeled ADHD, but they were having all kinds of problems in the home,” Lien explains. “Professionals know the symptoms of ADHD, and they prescribe medicine and label them ADHD because developmental trauma also dysregulates the central nervous system and mimics ADHD symptoms. Kids with developmental trauma have a lot of anxiety, and so they have difficulty focusing. They're distracted very easily. They have impulsive behaviors. They can be hyperactive. And so, when you look at those symptoms that are driven by trauma, they also look like ADHD.”
ADHD medication and therapy has helped Meg because she truly has ADHD. However, for children with developmental trauma disorder, ADHD medications and therapy rarely work. These interventions can make things worse for children with developmental trauma, in fact.
Another issue is that clinicians tend to be more familiar with ADHD, and they mistakenly believe conditions like reactive attachment disorder are rare. While RAD may be rare in the general population, studies have shown nearly 40% of children in foster care meet the criteria. We covered this in Reactive Attachment Disorder: The "Rare" Culprit That Stifles Traumatized Kids and Their Parents.
“A lot of mental health professionals are not looking at the cause,” Lien says. “Symptoms are pretty much all they know, and they know more about ADHD than they know about RAD or mood disorders in children.”
Clinicians need to assess the child’s background and the child’s behaviors in the home and toward their parents to determine if it’s ADHD or the impact of trauma. Kids with developmental trauma disorder feel unsafe unless they’re in control and often push away their caregivers too. “Kids with ADHD are not vindictive,” Lien says of one of the key differences. “They're not trying to control the environment on their terms. They’re not trying to be devious. Control is not their main focus like it is for many kids with developmental trauma. A child with ADHD that's bonded won't have these big rage reactions when someone directs them.”
If the child has trauma mimicking ADHD, stimulants will either make them worse or only help briefly. This was the case with our son, who was diagnosed with ADHD before eventually receiving a reactive attachment disorder diagnosis. We tried two different stimulants, and both made him much, much worse. On these medications, he began eating strange things like paper and threatened to kill my husband for the one and only time.
“If they don’t have ADHD, and you give them stimulants, they can look psychotic like that,” Lien explains. “Then you know that they’re not ADHD because if they are, the medicine usually works pretty well.”
“Kids with ADHD are not vindictive,” Lien says of one of the key differences. “They're not trying to control the environment on their terms. They’re not trying to be devious. Control is not their main focus like it is for many kids with developmental trauma. A child with ADHD that's bonded won't have these big rage reactions when someone directs them.”
Lien works with RAD Advocates hoping to raise awareness of developmental trauma so that fellow clinicians can better recognize it and support families. Lien and RAD Advocates are working together on an educational series for clinicians to be released the summer of 2025. Lien will also be the keynote speaker at NavRAD26, the RAD Advocates' biennial plan-building and connection-making guided experience for those parenting kids with developmental trauma.
“My biggest frustration is that mental health professionals just scratch their heads and look at you funny when you're talking about developmental trauma,” he laments. “They just don't have the experience to help families figure this out.” This lack of expertise is something we’ve addressed in our article about why families can’t find good help for reactive attachment disorder.
Living With ADHD Versus Trauma-Based Symptoms
Amanda has a good friend who is parenting a child with reactive attachment disorder/developmental trauma disorder, and they often share their struggles of feeling misunderstood by teachers, friends, and family who think if they “just” parented better, their children would behave. They also share their experiences of household chaos and difficult behaviors.
Despite all of the similar feelings and experiences the friends have shared, Amanda also understands the stark differences between ADHD and reactive attachment disorder. “No matter how hard it was to parent Meg before her diagnosis, I also know that RAD and ADHD are nothing alike,” Amanda says. “The biggest difference between the two disorders across the spectrum, I believe, lies in the manipulation, lack of remorse and extreme behaviors with RAD. Meg was never manipulative and felt remorse when she hurt people, whether emotionally or sometimes physically by accident in the midst of emotional overwhelm.”
Another difference is that Meg’s behaviors were not saved for behind closed doors or just with her parents, as attachment-driven trauma behaviors often are. In addition, Meg’s behaviors never reached the level that many parents see with kids suffering from severe developmental trauma, such as urinating and defecating in places other than the toilet after potty training, death threats, running away, etc.
While behaviors like lying and stealing are common in developmental trauma and ADHD, the reasons for them are different. Kids with ADHD lie and steal out of impulsivity, or they lie to get out of trouble, while lying and stealing from kids with developmental trauma stems from manipulative and survival-based behaviors that have no rhyme or reason to the parent. Read more about that in our post How Lying and Stealing from a Child with Reactive Attachment Disorder is Different from Another Kid.
“We have so much to learn about mental health overall,” Amanda says. “Just like RAD, there is so much that people don’t understand about ADHD. I will never claim to know what it’s like to parent a child with RAD. I will never know the fear and PTSD that RAD parents experience. But I empathize with parents of children with RAD and remember how it felt to be shamed and blamed as a parent. Overall, people need to stop pointing fingers at parents and start supporting them with far more empathy when their children struggle with matters that impact them mentally. Just because people can’t see a disability or disorder does not mean it’s the fault of the parents.”
Not sure whether your child’s behaviors stem from ADHD or trauma?
You’re not alone — and you don’t have to figure it out on your own. Connect with RAD Advocates to find real answers from those who’ve walked this path.
✔️ Article content verified by RAD Advocates Approved Professional Forrest Lien, LCSW