This is a Global Player Original Podcast. Hello and welcome to Your Wrong About ADHD. I'm Katie Breathwick. And I'm Sam Pritis.
We are looking at a topic that has come up a lot during the course of making these series all about the different challenges of ADHD. Today we're talking about trauma and there are two positions on that, aren't there Sam? Yes, I suppose broadly there are. There is an official position.
We still don't understand everything about ADHD but if you go on the NHS website it will say that genetics play a part in causing ADHD and there are other things at play to do with our sort of neurological makeup. But there is another sort of thought that actually trauma itself can either trigger ADHD or ADHD can be developed as a coping mechanism after childhood trauma. It's something that fascinates me because there are so many questions still about ADHD and clearly trauma plays a part in the lives of most people with ADHD. It's sort of fascinating to see what comes first.
Yes, that's a really interesting point actually. I will get on to the question of whether or not it is caused by trauma in a minute which between you and me actually I find really irritating that idea but you're right. It also causes trauma itself. ADHD can be an incredibly, it is an incredibly traumatic thing to experience isn't it?
In lots of different ways, I'm like goodness me dare I say it, when we know and believe it to be inherited well that's certainly my position anyway, isn't it interesting to think about what that was like to be the child of somebody who perhaps had ADHD. Now I'm talking from personal experience here. I look back on my mum's life and I feel incredibly sorry for her because she was undiden as well her life. She died at 89 and we talked about the fact that perhaps she had ADHD but she never talked to a doctor about it or sought help or treatment and she was erratic.
She lost her temper a lot. She could be violent. She could be very, very difficult and you know there's trauma isn't there? That's one way of looking at ADHD's relationship with trauma.
I think also it's a question of what we understand trauma to be. I think if we had a conversation in the past where I didn't want to use the word trauma because I felt a bit silly trying to equate what I've experienced with my ADHD to a traumatic experience because I think you think these people who've been on the front line or people who've got PTSD but actually trauma doesn't have to be that extreme. People who have traumatic experiences for sorts of reasons and I've described my journey with ADHD of not being diagnosed, trying to cope with everything that was going on inside of me, coping with people's responses to me through my entire childhood which led me ultimately to having a breakdown in getting lots of therapy. I mean that is a traumatic experience and it was something I sought help for.
You actually got to the point where things became untenable. I mean that's how traumatic it got for you before you were forced to go and seek help. I mean that's your relationship with trauma and ADHD. And the number of people who get in touch with us and say that they are struggling to manage or they're waiting to be diagnosed, they're pretty sure they've got ADHD and it's crippling.
That is a traumatic experience and I think sometimes I know I certainly think I can't call what happens to me, trauma but if you talk to therapist I mean that is by definition what trauma is. Absolutely and it goes back to what Leanne Maskel said about name it, to tame it. It's a phrase I've used quite a lot since we spoke to her. Sometimes you talk about awareness, it's the same thing isn't it?
Sometimes you have to break it open, shine a light on it, look at it, talk about it and process it before you can start to deal with it and a traumatic experience remains traumatic unless you are brave enough to really really kind of pull up the magnifying glass and look closely at it. And if we dig into something we've talked about a lot of emotional dysregulation so you've gone through school trying to keep a lid on yourself because you don't get any more in trouble you've gone into the workplace trying to keep a lid on yourself you're emotionally dysregulated actually that traumatic experience makes your ADHD worse because we know conversations we've had you're dealing with your ADHD but you're also dealing with the guilt and the shame and the frustration and all the things that go alongside it. And that hidden panic that panic that you're always trying to mask and cover up because you don't want anyone to know that you're feeling that way. What about this idea that some people have that and it is a story that's out there that trauma itself can cause ADHD, it's not genetic.
So like I said I find this really irritating when I was first diagnosed I had a couple of friends suggest to me that this was this was nurture, ADHD was nurture and they were people who know a lot about therapy and things like that and the human mind so I was interested in it as an idea if disappointed because I felt that I felt that that wasn't me it didn't make me it was something that had landed on me therefore who was I if I wasn't this I suppose that was the difficulty I had with it but that as we know is as you said earlier that's not the World Health Organization doesn't believe that they believe it is inherited you know the NHS believes it's inherited there's a genetic component but that is not to say that some trauma might not trigger ADHD that might not be some predisposition to ADHD that is triggered by trauma so that's an interesting question I am I'm done with the idea that it's it's caused by trauma but maybe there is a relationship with it sort of having some basis in maybe maybe more extreme age I don't know I was a ADHD sort of dormant inside you in the drama wakes it up or maybe maybe I said earlier I find it fascinating I do find it fascinating because I think about my experience being younger and that emotional dysregulation you know masking shutting yourself off actually those are all things which are patterns that develop from from trauma as well so the way that they go alongside each other and how they interact ADHD and trauma is really interesting I think I think if I look at the pattern of people I know with it I think it's a genetic component I mean that makes sense I think more I look at people's families other people I know who got ADHD you can see a pattern you can see a sort of genetic link but it'd be interesting to see you know can you have ADHD and not have trauma for example that's another question actually could you have ADHD just sell through life I mean my experience is absolutely not maybe you can how do those two things interact I think we need to ask an expert don't you I think we really do because that's not what we are we'll be speaking to Dr Max Day D pediatrician and co-founder of ADHD UK in a moment Max thank you so much for coming back to join us again it's a great pleasure it's really great to talk to you particularly because we've got lots of questions we want to ask you this subject is a bit of a minefield and we you know I'm fascinated by it but I've got lots and lots of questions I suppose maybe the place to start is this idea that some suggest that childhood trauma or stress-run events can cause ADHD is there any evidence to support them I can see where people get the idea from I suppose I would say that I don't want to be dismissive of the idea by any means or the idea that Chantor trauma is extremely important as a public health problem and a mental health problem generally however the evidence is kind of circumstantial I suppose you could say so we know that people who subsequently get a diagnosis of ADHD are more likely to have what is called adverse childhood experiences and are more likely to have had a difficult time in childhood also to exhibit more symptoms that are associated with trauma I wanted to get to what trauma is in a minute but that's all true so that leads people to the idea that there's a causative link between more likely to have had traumatic events more likely to have some symptoms which are associated with people who've been traumatized and therefore they draw a causative link between those two but I would argue that that's not a valid inference it's not necessarily causative there's lots of reasons why people who have ADHD now I'm not even more difficult childhood we know that ADHD is associated or severity of ADHD at least is associated with socioeconomic class which is in turn associated with childhood traumatic events we know that young children who subsequently end up with ADHD diagnoses are subject to maltreatment i.e. are hit more and who are rejected more because they are difficult and their parents often also have ADHD and other medical health difficulties so there's a whole range of difficult reasons which have nothing to do with a causative link as to why there might be that connection the second thing about the current symptoms is the current you know the trauma specialist who kind of pushed trauma as a answer to mental health symptoms they basically pretty much any mental health symptom any developmental symptom can be ascribed to trauma so they would cause the net so worried that anything could be trauma then which sort of means that nothing has to be trauma that makes sense so dig into trauma for us then that was yes it does that was fascinating so dig into trauma for us like you said you wanted to what do we mean by trauma so I think I think different people mean different things but I having kind of thought to read thought and read and talked a lot about this the most convincing and compelling definition that I have is a traumatic event is one where your psychological defenses are overwhelmed so knowing what events you've had in your life to not tell you to what extent you have been traumatized because it's about where you were at at the time how protected did you feel internally how protected were you by other people so there's lots of implications of that one really important implication is that almost everyone has had that experience at some point in their life so trauma is kind of a human universal in a way very difficult to find someone who that has never happened but also the second thing is if you have somebody's life story you are not able from that life story to predict to one degree and how often they have been traumatized you don't know because you don't know what the context of whatever event is so the loss of a parent can be traumatizing or if you are protected and held through that process it isn't necessarily so simply the habit that people sometimes have and I'm afraid I see it in pediatrics as well I'm simply counting the number of traumatic potentially traumatic events in the person's past and saying that that somehow predicts their mental health or their chances of having ADHD that is not valid that's not something that I would ever kind of support because you don't know what the subjective experience of those events were and how resilient that person might have been in that moment because people respond in different ways don't they? Is there a question mark over whether trauma exacerbates ADHD is there a chance that maybe we are predisposed as ADHD is to respond worse to a particular situation or for a traumatic situation to trigger ADHD to a more extreme version of itself that might not have been the case had that traumatic event not happened I think that's absolutely right and I think that's important if you go back to something that just said that trauma is almost a human universal and the symptoms of trauma are I would say hypothesize that that's just strictly true but most people accept that the symptoms of trauma are triggered by memory or association with a previous traumatic event that's not controversial but it's hard to prove absolutely let's say that that's the case so if you have ADHD you are likely to have had more traumatic events in your past level you'd be triggered more likely to be triggered when and we all know that ADHD symptoms are highly sensitive to your emotional state so when you are in a triggered state and are using that word not in a kind of you know woke way but a trigger a psychologically accurate way of being triggered by something that has happened that has happened to you that triggers a traumatic response which may not be a memory it may just be a visceral response of course your ADHD is going to be harder to deal with the other thing of course is that emotional responses in ADHD are first of all internally subjectively amplified so they are stronger in themselves and they are acted on with more external behaviors as we know we're more impulsive we're more kind of prone to act out our emotions so you have more trauma more triggers because life is harder now for people with ADHD so they're triggered more less emotional control and less behavioral control so all of that adds up to trauma being more important for people with ADHD I would say as an element of their well-being but that's not the same as the two being the same thing or one causing the other. It's interesting also what you said earlier about having a parent with ADHD because obviously if we are going to finally say once and for all that this is an inherited condition the likelihood is that one or both of your parents will have had it and and someone I was talking earlier and I talked about my relationship with my mother which was loving in many ways but there were times there were pockets of our experience that were awful and I feel you know dispassionately quite sorry for my mum because I know that she was never diagnosed and I'm pretty sure this was a woman who had ADHD and she never knew and you know so a lot of people listening to this yes will have ADHD but they will have experienced what it's also like to have a parent with ADHD and that is a traumatic experience too isn't it?
It can be anyway. It can be yes it is a stress it is a adversity I want to you know think you need to be careful about using traumatic experience unless you're talking about someone's and someone talking about their own subjective experience they can say what's traumatic you cannot I cannot say what's traumatic you can't and you can call for me so that's one thing the other thing to say is just to say a lot of parents that I see of kids some have obviously had diagnosed with ADHD but some will have just traits bits and bobs or some bits and bobs of other neurodevelopmental associated conditions so lots of parents of kids with ADHD with some autistic traits but not necessarily diagnosable or some you know just just some general bits from the neurodevelopmental soup rather than a specific diagnosis but you know that all said growing up with the parent the parenting experience of kids with ADHD is often stressful and difficult and that can tip over into crisis if there's particularly if there's external stresses such as you know I mean in my population in South London there's gang involvement domestic violence all those sorts of things it's very common and those are things that can tip that stressful situation into a crisis situation which for the individual may be traumatic which then may then have an impact on their later social emotional responses that was all true there's no denying any of that even though we have clear and firm evidence it's not even that we're concluding that it's inherited the genetic influence on ADHD is extremely strong there's no question about that I talk about your own experience and I've shared my own on this podcast and I shared again I was undiagnosed until I was 37 and that caused me all sorts of mental health issues and it caused me you know I've talked to therapists about it and I was slightly reticent to use the word trauma but it was traumatic being undiagnosed and coping with the severe emotional dysregulation and mental health issues and behavioral issues and one of the questions I had for you was whether you know on top of your ADHD that perhaps don't know about you are then coping with all these other things that are caused by trauma does that make diagnosing ADHD and treating ADHD actually more difficult because it's sort of hidden by the other things that need to be unpicked first yes I think undoubtedly it can I think I mean I don't want to step outside of my professional expertise because I only diagnose children but I think my experience for you know let's say for example older adolescents where I will still have a role is that there's often an overlay of low self-esteem and stress and anxiety I think it's really important and I don't want to say it is up to you to say whether something is trauma or not that's absolutely right but I think you know as well as thinking about trauma which is a event when you are overwhelmed also just stress we can talk about stress we can talk about low self-esteem we can talk about you know our reactions to rejection I think you know people talk about rejection sensitivity a lot I think that might be sort of relatively low level traumatic rejections that are then being reactivated by the memories of which are being reactivated by perceived rejection down the line so I think I think it's helpful to think about what is actually trauma and what is just me feeling rubbish about myself because of what's happened which is a different thing to trauma actually specifically so I think that's why I find it much easier to and I'm much more comfortable you know diagnosing the breezy and bright and bouncy primary school kids that I see than the um certainly an angry adolescence that kind of get spied out let's not talk about the adults let's not get out but I have huge sympathy for people who are trying to unpick this in adulthood but but I think you know if you're thinking about adulthood you know what is my is this symptom that I am suffering due to my trauma or is it ADHD I think thinking about is it triggered by particular things if it's triggered by particular things then it might be a trauma reaction if it's something that's with you all the time then that's much more likely to be neurodevelopmental because ADHD is with you all the time so I think that is a useful from an individual level that is a useful way to think about it it's not I'm not it's not a test but isn't a useful way to think about your own symptoms if you are considering a diagnosis or if you're thinking about how to address things therapeutically talking about that adult experience of ADHD it's I'm not talking about this a lot to the trauma caused by ADHD on a day to day basis you know that awareness that we are running late and feeling that we're going to get criticized for it you know tripping downstairs because we're running down the stairs rather than we've lost our keys we are there's a lot of trauma that is caused by this condition as well as it they you know the emotional dysregulation is that trauma or is that stress I think you see I mean I would put that stress which and then that's not to I mean that's not to that's not to I'm supposed in a way we're using trauma because this is you know it makes it sound proper like it's really damaging well stress is just something that we just expect because we live you know because society expects us to be stressed because stress is good for us in some sort of weird way but actually I think it's more helpful to make a distinction between everyday stresses which are not to be dismissed and traumatic experiences which have a long-term impact down the line of your responses to similar or analogous situations yeah I think that's quite helpful distinction because you know for example I could say that you know sometimes I procrastinate my friend to make myself and then I get a bit fed up about that and that's gonna be stressful whereas actually the work I've had to do with a therapist about my school life I would say is probably trauma rather than stress and actually you know picking a distinction between those things is quite helpful in terms of trying to do it. It allows you to sort of sweep away the sort of smaller microaggressions as well doesn't it and realize that it's when those things are really beginning to affect you can we talk about treatment you know if as Sam describes you've got these experiences in your childhood that keep making you respond in certain ways and they bring up the visceral response that you described what is the best way I mean we've talked about medication all these different ways that we can mitigate some of the challenges of ADHD when it comes to trauma what is the best way to kind of face it and look at it and get on with it. This is a really difficult question because so historically trauma has not been treated within a sort of medical paradigm so there's not the kind of nice guidance for trauma if you have specific trauma-based diagnostic label so you know some PTSD or something like that you know I'm not a PTSD expert but there are lots of treatments available for PTSD symptoms so there's CBT there's psychotherapy there's EMDR which is the eye movement desensitization which is really remarkably effective but if you're that's quite a specific sort of trauma reaction and I think one of the things that's undoubtedly true is that again to go back to the idea that everyone has a degree of trauma or almost everyone has a degree of trauma in their life which plays into the narrative of their symptoms and their experience a small proportion of people will have full-blown PTSD or classic PTSD now they have a very clear treatment pathway for everyone else there isn't a clear treatment pathway because the people who have been concerned with that kind of trauma and people call it developmental trauma and that's all valid there's some really useful and interesting stuff in that area mainly from psychotherapy and psychotherapy simply hasn't had the tradition of evidence-based practice for lots of good reasons that medicine has and so it's very difficult if you are presented with someone who has developmental trauma to give if you that's the only thing you know about them it's very difficult to give a recommendation of what they should do however I think if you feel like developmental trauma is an important part of your picture and you are the NHS may not be able to help you because it's very much a medical model and there's no evidence-based treatment for it but if you are able to explore other options then you know I think it's the only thing and again don't want to stray outside of my professional expertise but therapy is helpful for a huge number of people it is helpful for a huge number of people and the thing that makes a therapist most effective is the quality of the relationship with a therapist so I would say to people just I'm stepping outside of a professional role as somebody who's experienced therapy who is married to a therapist and those sorts of things the key thing is the relationship so it doesn't matter what kind of therapist you decide to go with you've got to have a good relationship with that person that is the most important thing so that's the only piece of advice I think is sensible to give to people that's really interesting and people talk before about maybe making sure that they have an ADHD a sense of what ADHD is as well when you're in the room with that person so that they are kind of respectful of that when they are talking to you about your issues and your problems yes I think that's right and I think to go back to something we said before we start recording so not to go back to talk about something which sometimes happens there is sometimes a very unhelpful dynamic of this isn't ADHD this is trauma and I think it is if you're a person who you feel you know you identify as ADHD whether you have a diagnosis or not it's not helpful to go to somebody where you're constantly going to be pushing against this oh no your ADHD doesn't exist it's just it's just traumatic stuff from your childhood that's not a helpful dynamic it's someone who will embrace your identity or your diagnosis but also work around your trauma as a coexisting phenomenon which is where I think it's most helpful I don't think we should be thinking should we think about medicine or therapy I think we should think about both of those things as valid tools for helping people I completely agree completely agree not that I've yet been brave enough to go down the therapy route but I'm saying I can look at it you know I can talk about my journey which was that I was diagnosed I essentially had what was a you know nervous breakdown and I had you know I've told I had traces BPD and then I did DBT therapy which was brilliant and having done that almost returned myself to sort of base level I've you know you mentioned it I've now actually started on a process of the MDR which is about dealing with some of the sort of you know trauma stresses of the past that perhaps are not dealt with and I think you know I couldn't take medication but I have found different ways to manage ADHD but I think one of the important things for me was before I had started to look at the emotional regulation and the mental health issues I wasn't in a place where I could then start to manage my ADHD so what you're saying about doing those two things alongside each other makes sense because actually trying to manage your ADHD when you've got unresolved trauma is next impossible is it I don't think it's next to impossible it depends on the degree of the trauma and I don't think resolved is not as you know resolved is not an all-inutting thing it's a process isn't it but I would agree that it is vastly easier to manage your own emotions and manage your ADHD when you understand yourself and you understand at least you've made one too start making progress towards understanding your trauma understanding your own responses that is a really important step on the way so I wouldn't I would agree with you but not I was sort of as I often do I think you've probably noticed as sort of caveat lots of things but that's why you know that's that's meant for you that's being talked to yeah I you know I've heard I've heard it said especially by the older generation that we look at things too much we we talk about things too much we we you know least said soon as mended it's that thing isn't it of oh you know stiff up just get on with it knuckle down and it's a really old-fashioned view and one that is disappearing but it is still around and what would you say to those people I would say that if you look at sort of the emotional health of previous generations not great the number of kind of very damaged people that kind of come out of these kind of cultures the one thing I would concede is that there is a danger that trauma narratives can lead to a cul-de-sac so what I mean by that is I'm traumatized there's nothing that can be done it's that's that's it now I'm a traumatized person or maybe there is some kind of therapeutic thing that could kind of heal me but it's so far off and it's so unattainable it's going to take so long that it just it just will never happen so I think we need to adopt trauma narratives and I I find the fact that trauma is almost a human universal to actually be a hopeful thing because it's all around us and we all we all get on most of the time okay mainly fine even so the idea that trauma is some unbearable weight that will always weigh us down and can never be kind of mitigated is incorrect and I sometimes feel like there is a bit of trauma industry out there that encourages that trauma is everything trauma is always going to be with us because that feeds the industry so there is a sort of trauma which you can sometimes see trauma narrative sometimes the on social media which I think is unhelpful but the kind of things conversations we're having here about the importance of understanding yourself the importance of resolving trauma there's nothing there's nothing unhealthy there's nothing unhelpful about that I would say you know I've totally agreed with you and that's why I think it was so great that you jumped in when I mentioned when I said unresolved trauma because you're right the idea of reaching a resolution one of the things that I have learned that has been so helpful as I come to terms with my ADHD is that yes I need to unpack some of the things that happen to me in the past when I was undiagnosed but it isn't about necessarily getting them all resolved and happily packaging them away part of the journey is learning resilience it is so rather than sort of as you said going into a trauma cul-de-sac or whatever things are awful and I can you know I can look back at some point you need to be able to say but I can manage that or I can cope with that or I can live day to day with the knowledge of that and that resilience I think is the key part yeah and resilience can't be imposed externally you can't teach someone to be resilient you can't make them be resilient I think you know generations of experience of the kind of grit and you know the sort of attempts to instill grit in people by you know brutalizing them as schools and so forth has taught us that doesn't work it can only come from being supported from within to develop your own resilience and that's what people miss about resilience is that it's not it can only come from the person themselves Dr Max Davies it's been a pleasure to talk to you today thank you so much for joining us on the podcast no worries because I'm fascinating and I'd say quite challenging as well with you lots there that whole distinction between trauma and stress hmm that was very interesting I also really liked what he said about parenting push back on me and the blame game on parenting quite right to you but I also do think that it's necessary to do what we are doing here isn't it which is to acknowledge and take responsibility for our behaviours as adults with ADHD who have children who might well have ADHD so that we don't pass on those behaviours to the next generation and the next generation after that you know it's on us to make sure we are dealing with this and making changes I suppose yeah totally and you mentioned that distinction between stress and trauma you know a big part of understanding your ADHD and you know I talked about going through therapy and that being really useful is learning resilience it's learning to identify what's stressful and finding strategies to manage that and identifying if there is trauma in your life and it may not be packaging it away neatly and putting it away and saying that's dealt with forever but it is about processing it and then building resilience so that you know you don't go through a sort of trauma cul-de-sac I think is the phrase that Max used you end up saying oh where is me this big thing happened and I'm stuck here it's about processing something and finding a way to move forward in life and that is the really key next step of therapy yeah absolutely and I do think you know it's also worth remembering something that he talked about that you know we see here very comfortable with money to spend on therapy and all those things and with jobs that pay and comfortable middle-class lives and he made reference to something that it is important to remember that when you don't have those things when you're struggling to put food on the table when you're struggling to find work ADHD is much harder to handle and we mustn't forget that ADHD is hard for everyone but it's harder for some people more than others which is why it's so important to raise awareness about it and try and get some change so that treatment and support is made available to everyone with ADHD that's everything from us for today on Wednesday we are going to be talking to entrepreneur Sonia Barlow she got in touch with us on social media to say how much she wanted to tell her story I can hear on Wednesday in our bonus episode of your ron by ADHD and don't forget you can listen and subscribe to your ron about ADHD on the Global Player or wherever you get your podcast thanks for listening and see you next time this is a global player original podcast