Therapy can help reduce anxiety from the burnout of school, work, life, and relationships.
Attention Deficit Disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are among the most diagnosed mental health challenges in Canada. Previously thought to be genetic conditions, these disorders historically have been treated with pharmaceuticals.
New research, however, has the medical and psychiatric communities rethinking these diagnoses. As we study trauma and traumatic stress, we find that the feelings, behaviours, and experiences of people who experienced childhood trauma are remarkably similar to what we previously diagnosed as symptoms of ADD/ADHD.
These include difficulty concentrating and learning, distractibility, disorganization, the appearance of not listening, difficulty sleeping, restlessness, and hyperactivity.
The (basic) Science of ACES and ADHD symptoms
Adverse childhood experiences have been shown to alter the architecture of children’s brains. Ongoing childhood trauma leads to toxic stress, the result of repeated and prolonged fear response in the body’s nervous system.
When we are subject to an adverse circumstance, an automated chain of events occurs in our bodies; adrenaline is released, triggering a fight or flight response, while Cortisol is released, mobilizing our stores of energy, and boosting our immune system.
Our brain is a fantastic device, working to always protect us, and in these moments our entire body rearranges itself to face the threat (whether it is real or perceived). Energy is redirected to our heart, lungs, and extremities so that every available resource can be accessed to fight or run; our breath shallows and speeds up, our heart rate accelerates, our muscles tense, and our senses become acutely aware of the threat. Processes deemed unnecessary, such as critical thinking, are shut down.
The importance of the presence of a caring, attuned adult during these moments cannot be understated; children rely on their caregivers for emotional and physiological regulation, and the presence of a caring adult allows the child to calm down and deactivate their fear response once the threat, or the perception of threat, has gone.
Nervous system regulation is a learned response, but it requires an attentive teacher. If an attuned caregiver is not available in times of activation, or if the adult is the cause of the trauma, the child never learns to self-regulate. Adrenaline and Cortisol levels remain high and lasting, ongoing toxic stress can be the result.
Because of the changes to brain chemistry and architecture created by complex trauma and toxic stress, brain development is adversely impacted. Excess neural connections are created in the areas of the brain responsible for anxiety, fear, and impulsivity, while fewer neurons connect in the regions responsible for critical thinking, planning, reason, and impulse control.
The resulting ‘maladaptive behaviours’ appear as anxiety, depression or other mood disorders, or ADD/ADHD. If stress hormones remain high, neurons in the prefrontal cortex can even be killed off, and since this part of the brain is associated with memory, learning, emotional regulation, and attention, it makes sense that ADD/ADHD ‘symptoms’ could be coping strategies for childhood trauma.
Adverse Childhood Experiences
So, what kind of childhood events can lead to these reactions? Adverse Childhood Experiences (ACES) have been studied extensively over the past few decades; these are events that occur prior to the age of 18 and include:
Psychological, physical, or sexual abuse.
Physical or emotional neglect.
Dysfunctional behaviour by the adults in the household such as substance abuse. mental illness, domestic violence, incarceration, or divorce.
With so many of these situations rampant in society today, it is no wonder that, knowing what we now know about the brain’s reaction to stress, that ADD/ADHD medications, antidepressants, and anti-anxiety medication prescriptions are at an all-time high.
And the news gets worse; studies have shown that the more Adverse Childhood Experiences one has, the more likely they are to engage in high-risk behaviours like smoking, alcohol and substance use, and criminal behaviour, leading to higher rates of divorce, economic hardship, mental illness, violence, and incarceration in adulthood. Childhood stress breeds adult stress.
And it doesn’t stop there; individuals who experienced multiple adverse experiences in childhood have been shown to be, in adulthood, at significantly higher risk of heart disease and stroke (2x more likely) and chronic bronchitis or emphysema (4x more likely) as well as a host of other chronic conditions including migraines, Irritable Bowel Syndrome (IBS), Colic and other gastrointestinal issues, Chronic Fatigue, Fibromyalgia, Asthma, allergies, inflammation, environmental sensitivities, and even Scoliosis in addition to mental health challenges including Dissociation and Dissociative Disorders (DID), depression, ADD/ADHD, anxiety, panic attacks, Obsessive Compulsive Disorder (OCD), phobias, paranoia, and self-harm.
Small 't' Traumas.
The Adverse Childhood Experiences studies have focused primarily on ‘Big T’ traumas; the horrific instances of abuse and neglect that make news headlines. Does that mean that if you weren’t slapped around, locked up, or sexually assaulted as a kid that this article does not apply to you? No! More and more we have people coming to psychotherapy who insist that their childhoods ‘weren’t that bad’ but exhibit the same behaviours as those whose childhoods were horrific.
Let’s explore. Close your eyes and imagine yourself as a fetus; you’re curled up, floating around in warm fluid for months. You are fully connected to your mother who meets all your needs; she supplies you with nutrition, she eliminates your waste, she shifts when you are uncomfortable and makes room for you to grow. She sings to you and strokes you when you are agitated. You are plugged in to her nervous system, entirely regulated by her. The rhythmic beat of her heart and movement of her lungs are familiar and comforting.
One day, you are born. In an ideal world you are healthy and immediately placed in the arms of the only familiar person in an unfamiliar world. After 9 months of getting to know each other, you recognize her sounds, smells, and happiness while she senses your distress and soothes you. This person is fully attuned to you, anticipates your needs, and accompanies you lovingly as you journey through childhood. A loving mother teaches us, over time, how to regulate our emotions, how to explore the world safely, how to build and be in relationships, and how to grow into healthy, happy adults. In Attachment Theory, this is known as a secure or organized attachment.
What if something else happens, though? Suppose that you were separated from your mother at birth, perhaps due to voluntary relinquishment, maybe you were apprehended by child protection workers and placed in a foster or adoptive home. Perhaps you or your mother experience a medical emergency that forces you to be separated for a time. Maybe your mother doesn’t want to be a mother or struggles with mental health challenges or addictions that interfere with her ability to be present and attuned to you.
There is a multitude of social determinants that can lead to misattunement between mother and child.
Suppose you get hungry; with no one to anticipate and satisfy your hunger, it grows. You have no way of meeting your own needs as an infant, so you communicate those needs to your environment. If you are not in proximity to a caring adult who can interpret your cry, recognize what you need, and feed you, the hunger grows to discomfort. You escalate your pleas to the environment.
Meanwhile, your primitive brain that has just begun to develop has no way to cognitively process your situation; instead, it simply recognizes that if you don’t receive nourishment soon, you could die. Instinctively, a fear response kicks in, and you enter fight/flight mode; you turn red, your arms and legs stiffen, and you begin to kick and flail; your temperature rises, your crying intensifies, your heart races and your lungs hyperventilate. If you do not receive food along with emotional soothing soon, the fear and pain can become unbearable.
The Child's Perspective
It is safer for a child to believe that they are unlovable than to believe that their parents do not love them. Think about it; as an infant if you realize that your parents are not capable of caring for you, you are admitting that you will die. But if, instead, you view yourself as unlovable and your parents as caring you at least give yourself the opportunity to survive by improving your own ‘lovability’.
So, the infant whose needs are not being met copes with this unbearable situation by dissociating from their needs (I shouldn’t be hungry so I will just ignore it) and internalizing self-hatred (I am bad. It is bad to have needs. I am unlovable).
This is an oversimplification, but it illustrates how early childhood trauma (also known as complex or developmental trauma) effects the very identity of the child even before that identity has begun forming.
The very foundation of the child’s identity rests on self-hatred and shame, and every single subsequent event cements this identity. Is it any wonder that this child, as they move through adolescence and adulthood, have difficulty developing and maintaining meaningful relationships, advocating for their needs to be met, feel the need to self-medicate, and have difficulty focusing on the world outside of them?
The world is a perpetually dangerous place to them, they are perpetually in fight/flight activation mode with elevated adrenaline and Cortisol levels and limited prefrontal cortex functionality. They have reduced ability to self-regulate, control impulsivity, or learn new things, and their senses are overwhelmed with signs of perceived danger.
Throughout this person’s life they are likely to seek help from medical professionals who do not ask for or understand the full family history, and they are likely to receive a diagnosis and pharmaceutical treatment for any number of common ailments including ADD/ADHD, depression, or anxiety.
The good news is this; THERE IS ABSOLUTELY NOTHING WRONG WITH YOU! If you are having any of the challenges mentioned throughout this article and think they may be related to childhood trauma (which you may or may not even be able to remember), know this; as a child, your environment failed you.
Your incredible brain and nervous systems developed strategies to cope with this failure. These strategies SAVED YOUR LIFE! Unfortunately, because you did not have access to a caring adult who could teach you new or different strategies, you are still relying on those old ones even though they don’t serve you anymore.
The even better news is, you can build new strategies while honouring the ones that got you this far. There are psychotherapeutic modalities specifically designed to help you rebuild your life, reframe your shame-based identity, create meaningful relationships, and build a wonderful life. Perhaps the most effective of these modalities is the NeuroAffective Relational Model (NARM), which is specifically designed to resolve complex developmental trauma.
This therapy “is a cutting-edge model for addressing attachment, relational and developmental trauma, by working with the attachment patterns that cause life-long psychobiological symptoms and interpersonal difficulties. These early, unconscious patterns of disconnection deeply affect our identity, emotions, physiology, behaviour and relationships. Learning how to work simultaneously with these diverse elements is a radical shift that has profound clinical implications for healing complex trauma.” (https://narmtraining.com/what-is-narm/.
If you are experiencing symptoms associated with ADD/ADHD, anxiety, or depression, or if you are having difficulty maintaining personal or professional relationships, a NARM therapist might be able to help you. Medication can mask and alleviate the symptoms, but psychotherapy may address the root cause and support you to build the life you deserve.
