ADHD, autism or complex trauma? [pdf](cambridge.org) |
ADHD, autism or complex trauma? [pdf](cambridge.org) |
> those most affected by executive dysfunction require therapy to be more directive, specific and accountable; that is, processing of past trauma and relational approaches are not sufficient. What often does not seem like trauma therapy at all can lead to great strides forward if it allows individuals to obtain a greater sense of structure and mastery in day-to-day life tasks
I've spent so much time in therapy doing the whole "let's go through your childhood and your past" and it was just not effective in tackling what I really needed. It's remarkable how many licensed therapists just didn't know how to deal with this. I'm sure it's really helpful for some people, but outside of increasing some basic awareness about how my family of origin resulted in present-day behaviors, I definitely reached diminishing returns on that route.
As skeptical as I am of AI as an interventional tool for "reaching our most effective selves", I can't help but feel that if it can be wired up to do the appropriate "micro-interventions" that reflect OP's insight ("directive, specific and accountable ... to obtain a grater sense of structure"), we might see 'ADHD' become a thing of the past (at least for the people that share my phenotype of it). It's my hope at least...
I wasn't sexually abused, I wasn't neglected, I wasn't wanting of love. I was however often scolded to a point where I felt horrible about myself. Scolded to a point where I didn't even feel like I could exist without disrupting the world. At times yes, physically scolded but nothing so extreme as to leave a mark.
To be fair to my parents I was a very high energy and "difficult" child. Big emotions. I was always the problem.
Obviously compared to some upbringings this was a walk in the park. But it really did have an impact on me and who I grew up to be. In some ways it was likely a good impact. I learned that my energy had no place in the world. I learned that my emotions would likely cause more problems than they would solve. I learned to shut up, and sit down, and follow the rules, even when every ounce of my inner being wanted to do the opposite.
I've had a myriad of mental health issues throughout my adult life, ranging from low severity to medium, and on some rare occasions high. Genetics? Upbringing? Modern life? All of the above?
A car accident is a car accident. Sometimes they are fatal, sometimes the paint gets scratched. People sometimes get long term health effects from a fender-bender.
You were meant to learn to recognize and name that energy and emotionality, and then learn to sit with it and develop adaptive coping strategies as needed, not maladaptive ones like negative self-concept and emotional repression.
It can take quite a long time to realize all of this and unlearn the patterns, and unfortunately, first line therapies like CBT are possibly detrimental for these issues.
Edit: also, you need not be fair to your parents. They are meant to adapt to parenting you, even if you were legitimately overactive or overemotional. Instead, you adapted to them.
The classic example is a child who drew a picture shortly after 9/11. The picture included people floating down the building on (I believe) balloons or umbrellas. Obviously unphysical; but the child imagining ways (however fantastical) that could have helped was a factor in reducing that child's trauma.
On a therapist can tell you whether you personally have trauma, but the lessons you took away from your experiences certainly sound like it to me.
I'm kinda confused. Is that the good impact you think that had in you? Why?
I learned to regulate my emotions, one way or another. Did it possibly (likely?) also have a long lasting negative effect on aspects of my mood, motivation, focus, etc.? I think there's a good chance.
I have found in my own life that the practice of emotional regulation has made me a pretty good diplomat in difficult situations. Sitting down, shutting up, and following the rules when I want to yell at people is the essence of de-escalation.
Really, that's it. Read the PDF.
The article even acknowledges that psychiatrist answer is wrong, and that all of the above are on a spectrum and nobody is ADHD-free or 100%-autist. This is not a problem because the answer is not meant to be correct, but only to be helpful and to "alleviate shame to enable people to achieve their fullest potential".
So there isn't even an answer.
Which, judging by your post, I'm guessing you will find a deeply unsatisfying way to look at the world, as you sound like someone with a positivist view (facts are correct and everything is true or false, you either have ADHD or not, and even on a spectrum there's a number. But there isn't)
> Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that".
This is definitely a factor for me when I tried to get diagnosed (which failed lol), because my parents whom caused my trauma would obviously refuse to blame themselves for my emotionally stunted development
In my case they had interviews with two exes (who are two of my best friends), my sister and my parents.
Government doesn't like that "too many" people want to get support, so looks like they reach for academics.
Same crap they did with cannabis and others when it was impacting certain interests.
Couple that with just plain generational trauma - physical punishment that ND people are more sensitive to, the high prevalence of CSA, and a world that doesn’t even try to make any accommodations and you find it more rare to find neurodivergent people who are untraumatized.
One result mentioned here but worth highlighting is the capacity to dissociate and the existence of dissociative disorders. Many people in this cohort also find they have the ability to structurally dissociate as a coping mechanism of last resort - an outsized percentage of people diagnosed with OSDD, DID, and DDNOS are neurodivergent, and among social groups of neurodivergent people often dissociative people will tend to attract - it’s nearly to the point that “capacity to dissociate” could itself be a neurotype. Anyway it’s a fascinating line of study, and if I didn’t have folks w dissociative disorders in my life I might doubt their existence.
Any apparent disorder in a person or persons has to be decomposed into the innate parts that existed prior to birth and the environmental experiences that happened afterwards as a prerequisite for any kind of theorising to give useful results instead of noise. They call this the diathesis-stress model and it's easily overlooked.
What does this mean? Do you mean the congenital aspects of a disorder?
For example, restricting the range of discourse to the purely congenital excludes things like fetal alcohol syndrome, the ages of both parent's gametes and pre-natal exposure to endocrine disruptors. However, in everyday usage, the diathesis refers primarily to those of the symptoms in the physiology, psychology and behavior of the subject that aren't attributable to life experiences (good and bad) rather than the microbiology specifics that act as carriers for any specific cause.
What's important above all else for the psychiatric practice is effective decomposition of any disease into parts that are amenable to study and treatment, rather than comparison to the hypothetical of what kind of "peak" may be achievable for a specific genotype if everything else went well.
This may be useful:
Those who are to be born in to an abusive environment may be more prone to continuing the traits of abuse than those who come from reasonable families.
- People with ADHD and Autism have higher probabilities of childhood trauma and abuse. They might seek a diagnose in adulthood and that can bring them relief and be helpful.
- People with non-ADHD/autism related childhood trauma are more likely to perceive themselves as being neuro divergent. They might have executive disfunctions, and try to find an ADHD diagnosis (that could probably get, as it matches their symptoms) but as of today seems like there isn't evidence that ADHD stimulant medication helps with non-ADHD executive disfunctions.
- Hence, is important for professionals to verify the history of the patient and make sure they had ADHD symptoms when they were children (that would confirm ADHD), and if not, maybe try to find different psychotherapeutic treatments that would be more helpful to their complex PTSD.
My read of the article is balancing the fact that there's a lot of overlap between CPTSD/ADHD/ASD in the symptoms (emotional dysregulation, hyperarousal, etc) and in hereditary factors (undiagnosed parents causing trauma more often on average). Also that traumatic childhood experiences are more likely to stick around as CPTSD in adulthood if there's also neurodivergence.
The author says there can be incredible relief to be correctly diagnosed with ADHD/ASD, so obviously she says it's helpful.
But she also warns that wrong treatment can often happen (eg. Giving stimulants to perpetual fight or flight PTSD brains), or inneffective therapy.
Especially when the trauma involes a caretaker. Parents are like a child's image of god, and for one to turn against the child is devastating.
Although diagnosis relies on observations made while patients are awake, the prevalence of sleep disturbances in individuals with ADHD is reported to be in the range 25–55 % (Corkum et al. 1998; Hodgkins et al. 2013; Owens 2005; Sung et al. 2008). In a recent Australian study, 62 % of children with ADHD had moderate or severe sleep problems and 22 % took sleep medications during the 1-week observation period (Efron et al. 2014). Indeed, high nocturnal activity and disordered sleep were defining characteristics of ‘hyperkinetic reaction in childhood’ or ‘attention deficit disorder’ in earlier versions of the DSM (American Psychiatric Association 1980; Barkley 1990; Sadeh et al. 2006; Spruyt and Gozal 2011).
My hot take is that *a ton* of ADHD cases is primarily lack of restorative sleep due to sleep disordered breathing, that is suffocating in sleep. Brain does not enjoy suffocating so people tend to wake up. Every couple minutes. Whole night. Without actually being aware that they do. They feel tired and brain fogged, lose concentration easily, have poor impulse control and so on. Even "mildly" disordered breathing in sleep causes frequent microarousals that fragment sleep and basically obliterate its restorative quality.
Uh huh. Explain the completely opposite reaction to Amphetamines and basically being impossible to become addicted to them. Explain the altered brain structure.
Everyone has a 'hot take,' it's amazing that they all lead to it not being a thing.
Now let me help you, the sleep disturbances are the hyperactivity of the brain not letting you go to sleep until you hit complete exhaustion and the dysregulation of the circadian rhythm.
The increased awareness genuinely helps to many others. I suspect there's widespread denial do be untangled, too.
Unless you get quite lucky, it can be extremely difficult to hold down long-term employment, build stable relationships, or get anything done, and in some places it's very difficult to get treatment.
It makes life more difficult than it needs to be unless it doesn't.
UK, EU, America has different societal values. I never had an issue with ADHD growing up in Asia. Nobody friggin cares. It's only western people making a huge deal outta nothing.
I consider my ADHD as a weapon because I can take it down a notch with medicine when I need to focus, but for other things like gaming, I can use my aDHD for better perf.
Shit's nothing.
I kind of think, any scrapbook/sheet you may compile yourself would have a much bigger impact. The effort you put in give it importance for the children as well, this is how humans work :)
Must be challenging, and I'm rooting for you.
Assuming ADHD is to some extent a chemical thing (I.e. brain didn’t properly develop impulse control or attention span or whatever), we now live in a world that enables those exact things.
If you lived in a world where the principal media were written articles/books and long-form TV shows/movies, your brain was still trained to focus.
Most media is now basically an ADHD simulator, with constant context switching, intense stimuli etc. which only reinforces whatever ADHD traits one may have.
I would guess it’s somewhat similar to the interaction between smoking and asthma.
My kid has some form of behavioral disorder but it doesn't really check all the boxes of any known condition. He doesn't have attention problems. He's very active, but not unmanageable. I don't think he's autistic, though he's socially awkward. He's very defiant with adults, so OCD does match (though that doesn't help much). Definitely very low self-esteem and all that. Mostly he's aggressive, low patience, disobedient AF, requires a ton of attention.
A particularly telling thing is that when we take long drives we often listen to children stories. He can listen for them for hours no problem. But when a story stops and until another one starts, he gets really nervous, makes a bunch of noise, annoys his brother, like he can't be canalised if he's not focused.
But what strikes me is that he seems to have a bunch of other conditions that doctors dismiss as benign. He has low teeth mineralization, often small skin bumps around his joints. He has a geographic tongue. He had digestive track pain when he was smaller. He had discoloration on his cheeks. He is quite skinny while he eats normally.
ChatGPT told us he could have coeliac, but we blood tested for coeliac and it came back negative. We tried a gluten free diet for a bit anyway, and that didn't seem to change anything at all.
We're like very puzzled. It's pretty clear that a psy test will find something behavioral, but no one is going to look at any kind of mineral deficiency, or anyhting like that.
Posting this here, Idk why, I'm kind of clueless about what to do at this stage.
I’m not sure what people will even need the fucking adderral for now anyway now that the computer programs like a drugged out maniac now for us anyway.
You don’t have adhd. It was always insane to expect humans to program like a fucking machine. You’d have to take a drug to do shit like that and that’s the sad truth of the software industry.
The children are so broken that their parents and entire community give them status and money for actually doing this (taking drugs to make money in the world).
Your dealer (the pharmaceutical industry) will never make you feel bad about this (enter media planted articles), thus, here you go, feel good about doing the wrong thing because … uh, you are a victim.
God sees through ALL bullshit, especially the ones we tell ourselves.
Most parents are corrupted with the academic pursuit such that they seek better and better results and are now drugging their children (rather, that is a well known thing, so much so that the fucking children grow up and give it to their children with the same mental corruption of academic excellence - it’s godless shit).
God is god dude. Nothing is god, not your parents, not their “doing what is best” excuse, nothing. They are playing god. No one is getting away with this bullshit in the end, because it’s a lie, and God knows and cares.
Thank you. There is no adhd , there is simply a drug that people resorted to when the sinful academic shitheads created a fucking impossibly ridiculously unnecessarily competitive and elitist institution that they force people to worship - Education.
This happens because most parents are godless. They don’t actually know what God wants from them and thus follow what this world tells them to follow, and this world is evil. This evil world tell them to enslave their children and feed them drugs for “education”, this is insanity.
It’s godless.
There you go. Seems like the academics are either pressured to gaslight people managing ADHD and autism or jump on bandwagon hoping a department notices and perhaps provide funding or other jolly.
They should get fucked with this harmful "research".
I never understood this sentiment. It's just who I am and always have been. And I learned to deal with the circumstances. I don't understand why it makes people feel better to have a diagnosis they can blame.
Perhaps it's a generational thing? I know as a manager it's pretty common for reports to cite them having ADHD as why they can't do this or that. Meanwhile I mentally roll my eyes thinking, "no shit, me too, but I manage to get this done"
Yeah that's exactly what I'm saying, but more specifically I wanted to relieve myself of blame through a label my parents could more easily empathize with
I think ADHD is something you are born with, but there are many other things that can cause similar difficulties, including trauma. And as the linked article mentions, neurodivergent children are more likely to have parents who suffer from similar difficulties, which may increase their chance of suffering some sort of childhood trauma.
I'm saying this to offer an honest counterpoint to your anecdote. I don't think you meant to imply that ADHD is entirely due to trauma, but in fairness to parents it's probably worth entertaining the idea that some kids are just born that way.
I have an ADHD diagnosis. The only particularly traumatic thing in my childhood was my parents getting divorced when I was a teenager because my mother had an affair. I already had some symptoms of it before that happened. Prior to that, my parents might not have been the best parents you could possibly have, but they didn’t do anything that would merit the label “severe childhood trauma”
You need a trusted therapist to guide you into exposing what the subconscious mind is holding onto from infancy. It is subtle, deep, difficult, rewarding work. But I do think people discount trauma because it sounds scarier than "someone snapped at me in frustration as an infant for expressing some emotion and I learned to disconnect from myself."
Every person with headache I met had painkillers.
Therefore their pain is caused by painkillers.
Daft.
Part of pubescence is incrementally transferring your reliance on your parents to reliance on your peers. Which is why teenagers test boundaries constantly. They have to divorce from their parents incrementally, and on their own timeline, not the parents’. Your brain has reward systems to encourage that, but can also be hijacked by substances, which is why we pay special attention to substance abuse in children. But there are many reasons for children to fail to socialize, some of them environmental, and a biological drive to fill that with something (including The Internet and “engagement” in particular) if it can’t be filled with social safety. And once it has begun it can be a feedback loop of intentionally choosing one over the other.
There are some models of addiction medicine that say that people with hope and connection have a much easier time giving up physical addictions than people who don’t. There isn’t enough stick in the consequences of addiction to get you out of the cycle. You need carrot to transition, and the bigger the carrots the easier the journey.
I totally agree with this. And I think this is the part that's easy to miss in the narrative around how trauma and ADHD connect. Wherever ADHD traits originate, someone's desire to change matters.
If you love your job, but inability to concentrate is hampering performance, you're much more likely to WANT to change than if your job is merely a nuisance required for economic sustenance.
For me, I need something more deeply stimulating and long-form. A good weekend outing for me is a 14 hour hike with a sketchy scramble. I don't get any value out of constant context switching, constant bright flashing lights like rythym games or any of that, and I'm way more comfortable than most literally just sitting quietly and thinking.
I think the big divergence between how I respond to my environment and how normal people respond to their environment is that normal people tend to be problematically attracted to artificial gamified stimulated experiences, like academics, slot machine style social media, scary movies, sports, stuff like that. My biggest difficulty is that I just don't really care about arbitrary competition, benign social threats, existential danger etc.. I'd much rather be in a position where I'm actually in real danger if I mess up, or if I write some program incorrectly and risk leaking sensitive data. That's where my brain works at its best.
Right now I'm hesitating to go back to school because I have no idea if I—as a man in his mid-thirties—will be able to trick my brain into being stressed appropriately when exams come around, at least enough to show up and complete them.
(No child is deserving of being mistreated but that's a whole other bag of worms)
But some regions/cultures are lagging (but catching up fast) as per my experience living in 5 states across 3 countries spanning two very different continents.
The only way it does make sense is if you think the consequences should be different because some doctor give it a name. But then you say nobody should have been treated that way regardless of the diagnoses. If the diagnoses doesn't matter why does it matter?
As someone who definitely has dealt with all this for my entire life I've found it much easier to just focus on behavior and consequences and alternatives. Trying to place it all in a moral/medical framework is a black hole. If your actions hurt others or otherwise have negative results you have to address that.
I'm sure it's very fun for everyone abusing adderall to get a doctor to believe their story (after all, they barely understand these conditions themselves), but it's a difficult life to have these conditions. Lot of what I hear described by the people self diagnosed or have a more "modern" (I'll just put it this way) diagnosis just sound like garden variety trauma due to less than tactful parents.
Learning that you were not, in fact, a horrible and wicked child that your parents had to endure is life changing.
ADHD is often an executive function disorder. As a manager, have you offered them an accommodation?
Lots of “I” statements from you and not a whole lot of understanding.
Yes, and that wasn't my point. Except for one case who was definitely abusing the situation, I never once revealed that my inner monologue was pointing out that I have the same issues they do but I don't use it as an excuse for not getting my work done.
This worries me.
Also, what's so noble about hiding own struggles?
And also, why shouldn't I be relieved when I understand a big factor in my struggles?
This is a very confusing comment.
Would a valid example of this be the ADHD tag on twitch streamer channels?
I should add, even when I was in grade school it was discussed for me to get evaluated. But that was far enough back that it was just "hyperactivity" & before people started talking in terms of ADD, ADHD, and subtypes, and I didn't match the criteria back then. So it wasn't like it was a big surprise decades later when revised criteria started matching my phenotype
I’m sure you don’t need validation from random internet strangers, but as one with a similar enough childhood, I wanted to share that it’s a thoroughly shit club to be in.
So, your life is sprinkled with unhelpful people that mean well but think you're just not listening to them.
And you yourself think, your too dumb or lazy or whatever to get things done consistently.
The you find out it's ADHD and you learn different methods to get things done. Which is nice.
But it's also very sad if that happens years after childhood. Because you realise, you might had a more successful life if you knew earlier
YMMV, maybe other individuals need confirmation/closure on the topic in their lives to help them move onto the next chapter? Knowledge is power.
(Post-comment reflection: this is needed in a lot of other aspects in life, why not here as well?)
to make an analogy to physical health:
someone has chronic gastrointestinal pain, but they just live with it and have never talked to a doctor about it.
they watch a video from someone talking about having chronic GI pain and getting diagnosed with ulcerative colitis.
they go to a doctor and say "I think I have ulcerative colitis"
the doctor runs tests, and they come back negative.
I get that it's tempting to say "oh this person was misled by a video on social media"
but, the pain they were feeling was real. even if they jumped to an incorrect conclusion about its cause.
and after those negative tests, they can work with their doctor to find out "ok, what else might be causing my symptoms?"
When I search for 'bidirectional causality' I get a lot of scientific results. Are those all wrong?
Maybe it's not just a label as your are painting it, but rather a complex situation over ones entire life with many layers, which cannot be easily understood in a short time (and much less in a manager-employee conversation).
I suppose that this is a clear case for the commonly used acronym here on Hackernews: YMMV (your mileage may vary (or the other that I forgot)).
Maybe you forgot that despite us being all human, part of the same species, living on the same planet: no individuals will have the exact same life, same thought process, same ability to deal, cope or handle adversity or environmental factors.
It feels wrong to read you saying that you are comparing yourself to others in such a manner...
I sincerely suggest that you try to be understanding of your reports instead of being mildly inconvenienced by their problems and labeling them negatively as you have suggested here.
People leave jobs because of bad management. Be better.
And also pay attention to how I said I kept those thoughts to myself. I recognize that the younger generations seem to feel it's all quite alright, and I handle it appropriately in the contemporary style.
Plus, isn’t this comment thread under a post regarding a link between ADHD and complex trauma? Complex trauma is… complex. I doubt that you share the same circumstances that resulted in the diagnosis that you and your reports both share.
