ADHD vs. PTSD: Is It ADHD, Trauma, or Both?
One question I am asked frequently is,“How do I know if this is ADHD or PTSD?” I thought my dissertation would never come in handy, but good thing the topic was ADHD and with growing interest in ADHD and PTSD, the research I did nearly 20 years ago has really helped me. People often come in describing difficulty concentrating, forgetfulness, procrastination, restlessness, trouble sleeping, feeling overwhelmed, or a mind that never seems to shut off. These symptoms are commonly associated with adult ADHD, but they can also occur with PTSD and other trauma-related difficulties. In fact, the overlap between ADHD and PTSD symptoms can sometimes make it difficult to tell what is actually driving the problem.
The important thing to understand is that having trouble concentrating does not automatically mean you have ADHD. Two people can both say, “I can’t focus,” while describing very different experiences. Someone with ADHD may tell me that they have struggled with attention for as long as they can remember. They might have been the child who stared out the window, forgot homework, lost things, procrastinated until the last minute, interrupted people, or constantly heard some version of, “You’re so smart, but you need to apply yourself.” Someone with PTSD may describe a very different pattern. Perhaps they were able to concentrate reasonably well in the past, but their attention changed after experiencing trauma. Now part of their attention may be occupied by intrusive memories, anxiety, monitoring their surroundings, or anticipating that something bad could happen. Both people may look distracted, but ADHD and trauma can interfere with attention for very different reasons. [novopsych.com]
ADHD is a neurodevelopmental condition, which means that when evaluating an adult for ADHD, I am interested in more than what is happening right now. I want to understand what that person was like growing up. ADHD affects the regulation of attention and can also involve difficulties with impulsivity, organization, task completion, restlessness, and other aspects of executive functioning. This is why ADHD is not simply a matter of being unable to pay attention. A person with ADHD may have tremendous difficulty starting a boring task while being able to focus intensely on something they find interesting. The difficulty is often less about whether the person can pay attention and more about their ability to consistently regulate attention and executive functioning.
PTSD develops in a different context. PTSD occurs following trauma and involves symptoms related to re-experiencing, avoidance, changes in thoughts and emotions, and increased arousal or reactivity. Someone with PTSD may experience intrusive memories, nightmares, hypervigilance, irritability, sleep problems, or a sense that they always need to remain alert. When part of your attention is continually focused on whether you are safe, it can be incredibly difficult to focus on an email, remember an appointment, complete paperwork, or stay engaged in a conversation. From the outside, this may resemble adult ADHD, but what is happening internally may be quite different.
One of the most important things I look at when trying to distinguish ADHD vs. PTSD is the timeline. When did these difficulties begin? What were you like as a child? Were you losing things, forgetting assignments, daydreaming, procrastinating, struggling with organization, or acting impulsively long before significant trauma occurred? Or was there a noticeable change in your concentration, memory, sleep, emotional regulation, or ability to function following a traumatic experience? Understanding the developmental history can be incredibly helpful because ADHD begins during development, whereas PTSD is connected to traumatic exposure.
I also want to understand what is happening when someone loses focus. Imagine someone with ADHD who starts cleaning the kitchen, notices the mail, remembers a bill needs to be paid, picks up their phone, sees a text message, responds to the message, notices another notification, and suddenly realizes that 30 minutes have passed and the kitchen is still half-cleaned. Now imagine someone whose concentration disappears because a sound, facial expression, argument, location, smell, or other reminder activates memories or a sense of danger. Both people may say, “I get distracted easily,” but understanding why that distraction occurs gives us much more useful information.
The same is true with procrastination and avoidance. Someone with ADHD may put off paperwork because the task feels boring, overwhelming, difficult to organize, or mentally exhausting to initiate. Someone with PTSD might avoid a situation because it brings up painful memories, emotions, or a sense of threat. On the surface, both people may appear to be avoiding something. What is happening underneath that behavior, however, may be very different.
Restlessness is another area where ADHD and PTSD overlap. An adult with ADHD might describe constantly needing stimulation, fidgeting, talking excessively, feeling internally restless, or having difficulty sitting through a long meeting. Someone with PTSD may also feel restless, but their experience may be connected to hyperarousal or hypervigilance. They may feel keyed up, tense, easily startled, or unable to fully relax because their nervous system is responding as though it needs to remain prepared for danger. These experiences can look remarkably similar, which is why simply checking “restlessness” on a symptom checklist does not necessarily tell us what is causing it.
There is also another possibility that is sometimes overlooked: you can have both ADHD and PTSD. The question does not always have to be “ADHD or PTSD?” Someone may have longstanding ADHD symptoms that began during childhood and later experience trauma that contributes additional problems with sleep, concentration, intrusive memories, avoidance, hypervigilance, or emotional regulation. ADHD and PTSD can occur together, so trying to force every symptom into a single diagnosis can sometimes oversimplify what a person is actually experiencing.
This is one reason a thoughtful adult ADHD assessment or PTSD assessment involves more than completing a checklist. When I am trying to understand whether someone’s difficulties are related to ADHD, PTSD, trauma, or a combination of factors, I want to understand the whole picture. I am interested in developmental history, childhood and school functioning, trauma history, executive functioning, attention, impulsivity, sleep, emotional regulation, avoidance, intrusive experiences, hypervigilance, and how the symptoms affect everyday life.
Instead of simply asking, “Do you have trouble concentrating?” I am interested in questions such as: When did the concentration problems begin? What were you like as a child? Were symptoms present before the trauma? What changed afterward? Are there particular situations that make the symptoms worse? Are there intrusive memories, nightmares, avoidance, or hypervigilance? And perhaps most importantly, does one diagnosis adequately explain the entire picture, or could both ADHD and PTSD be contributing?
If you have been wondering, “Do I have ADHD or PTSD?”, you are asking an important question. ADHD and PTSD can both affect attention, memory, sleep, emotional regulation, and everyday functioning, but similar symptoms do not necessarily mean the same underlying process. The goal of a comprehensive psychological evaluation for ADHD or PTSD is not simply to count symptoms or assign a label. It is to understand when the symptoms started, what is driving them, how they affect your life, and whether ADHD, trauma, PTSD, or more than one condition provides the best explanation.
Sometimes the answer is ADHD. Sometimes the answer is PTSD or another trauma-related condition. And sometimes, the answer really is both.
