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  • Writer's pictureDr. Amy Mednick

ADHD and Trauma

Updated: Mar 30, 2022

Sometimes early trauma can cause difficulties in focus and executive functioning. The explanation that follows below is theoretical only.

Let’s look at an example.

Your boss asks you to write a proposal by the end of the day, so you do it. The pathway in your brain looks something like this:

(A) Task requested --> Task initiated --> timeline set (day end) --> subtasks identified and prioritized --> subtasks completed --> task complete --> task reviewed for adherence to initial guidelines --> (B) Task turned in.

If you have ADHD the pathway might look very different, because those things don’t follow naturally, and the right brain circuits for the right task don’t get activated (more on that here later). You may not even get to point B by the end of the day. You may have lived your life with intense shame and anxiety around that shortcoming, which in reality is no fault of your own.

What if you have been traumatized as a child? What if, for example, your primary caregiver was hurtful to you at a young age while your brain pathways were developing? Phillip Bromberg suggests that when incompatible feelings about a person are required to be held in the brain at the same time (e.g., “I love my mom” and “I’m terrified of my mom”), and both cannot be held onto without splitting the person in two, one is “unhooked” from cognitive processing and is no longer available to the consciousness, except in emergencies when it can be suddenly activated (times of stress). This is an adaptive function called dissociation that is very helpful to children in trouble and very harmful to adults trying to function in the real world.

Perhaps in that case the pathway now looks like this:

A) Task requested --> urgency of boss interpreted as threat --> “threat module” subconsciously activated --> survival mode initiated for fear of death --> higher executive functioning shut down to prioritize ability to run at a moment’s notice and continue to monitor --> ​

B) Panic attack.

Thus with all the competing demands that every interaction with the world requires of the victim of unprocessed trauma—cognitive appraisal, emotion regulation, threat monitoring, survival, etc etc, getting from point A to point B can look like this as compared to others:

Sometimes a stimulant can help make the jump when the two points are close together:

Regardless, trauma therapy and often an SSRI are required to untangle the string eventually, as the stimulant in this case is only a band-aid. However, band-aids have an important role too and sometimes they can be helpful and even necessary to keep functioning, and do the therapy work, to reach recovery.

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