In today’s episode, we have a listener question dealing with the root cause of ADHD and whether or not ADHD comes from trauma or it's something we're born with.
I’m sure a lot of people have had similar thoughts on what the root cause of ADHD and sometimes it’s hard to find accurate information because so much of it can conflict.
In today’s episode, we’re going to be looking into the issue of whether or not ADHD is an issue of genetics or if it is one of trauma - but I also want to be upfront about this and be clear that this isn’t really a both side issue, all of our best research supports the idea that ADHD is a genetic condition.
Just as a note before we get started, I do talk a good deal about trauma in this episode, so if that’s not your thing, feel free to skip this episode.
To talk about this issue we’ve got to talk about Dr. Gabor Maté, who is the biggest proponent of the idea that ADHD is caused by trauma.
Dr. Mate is a physician who practices in Canada and is somewhat of a celebrity in the medical field - as we know of medical celebrities that’s not always a good thing or because they are a leader in their field.
In Dr. Mate’s case he has published five books, with his book Scattered Mind being specifically about ADHD. I personally have not read any of Dr. Mates books but I have heard him in a number of interviews. I do know some people who have felt incredibly validated by his writing on ADHD and others that had no resonance with his theories.
He has achieved his celebrity status by appearing on a number of talk shows (fact check) and also on some large podcasts such as The Joe Rogan Experience and The Tim Ferriss show. So he has been able to promote his ideas to millions of people.
Dr. Maté was born in Hungary in 1944, and shortly thereafter, his family began fleeing Europe as World War 2 broke out. It is from these experiences that Dr. Maté has developed his special interest in trauma and how trauma affects us in the long term.
He has since then built up his theory that ADHD is based on trauma instead of being genetic - that rather than viewing ADHD as a pathology that can be diagnosed, it should instead be viewed as a coping mechanism for that trauma.
Dr. Russel Barkley refers to Dr. Mate’s theory on ADHD being caused by trauma more than wrong because of this preponderance of evidence on ADHD being genetic. If you aren’t familiar with Dr. Barkley he was one of the most influential researchers on ADHD, and although he has since retired he is still making ADHD content on YouTube - in fact that line about Dr. Mate being more than wrong comes from one of his videos on this exact topic (I’ll link in the show notes).
So let’s talk a bit about why even with this preponderance of evidence Dr. Mate still insists that ADHD is caused by trauma.
Now I can’t speak to why he dismisses what we already know about ADHD - perhaps it’s because he isn’t an ADHD researcher himself.
Now, admittedly, there is a point that we don’t have a particular gene that we can point to that shows that ADHD is a genetic condition. But despite that we can still have plenty of evidence of that ADHD is hereditary - one of the biggest predictors of ADHD is having a parent or sibling with ADHD.
Now in some interviews with Dr. Mate I have seen him argue that this rate of parents with ADHD having children with ADHD is due to generational trauma and parent stress, but for me that’s a hard pill to swallow. For one thing it seems like if that were the case we’d see way more cases of ADHD than we do. But we also have evidence from studies of twins raised in separate households that show that the home environment isn’t a predicting factor in ADHD.
Dr. Mate agrees that ADHD is a developmental condition; however, where he differs is that he believes that it is trauma that is stunting that development, whereas the established ADHD research field views this as a genetic condition.
And this isn’t entirely wrong on Dr. Mate’s part - trauma will stunt our cognitive development. In fact we see a huge overlap in symptoms of ADHD and trauma.
For example, you’ll see:
Difficulty concentrating
Distractibility
Poor self-esteem
Disorganization
Inattention
Difficulty with sleeping, working, schooling etc
Restlessness
in both conditions. With ADHD, you can also see hyperactivity, impulsivity, and forgetfulness as additional symptoms, and with trauma, you could also expect dissociation, nightmares, flashbacks, and angry outbursts.
But with those overlapping symptoms, it’s quite clear that ADHD and trauma have a very similar response pattern.
Now, I do want to step away from this topic for a second to talk about what trauma is, because it is a very encompassing word and it’s a complex subject.
Trauma is our emotional response to a distressing or traumatic event that can have long-lasting effects on our well-being, be it mental, physical, or emotional. Now it’s important to note that just because we go through a traumatic event doesn’t necessarily mean that we are going to be experiencing trauma. In the US, it is estimated that about 70% of adults have experienced at least one traumatic event in their lives, but only about 20% of those adults meet the criteria for post-traumatic stress disorder (PTSD).
Now, some clarification there - what’s the difference between trauma and PTSD? While the terms are often used interchangeably, they aren’t quite the same thing. We can think of trauma as the emotional or psychological response to a distressing event, while PTSD is then the diagnosable mental health condition that may develop following trauma. With PTSD being a longer-term condition characterized by specific symptoms that persist over time and significantly impact daily life.
Not everyone who experiences trauma will develop PTSD, but PTSD is a common response to traumatic experiences.
Additionally, we have Complex PTSD (C-PTSD) that typically arises from prolonged or repeated trauma such as abuse, neglect, abandonment or domestic violence.
For some it is easier to break down traumas into “big T” and “little t”.
“Big T” traumas would usually be associated with PTSD and include combat and sexual assault.
“Little t” traumas could involve big life changes, emotional abuse, bullying, or even the death of a pet or a loved one. I think this differentiation is often used to try and separate out traumas that we kind of expect to experience in life and those that we don’t.
And I want to emphasize here that trauma is trauma, it doesn’t matter if it’s “big T” or “little t” it can still have a big effect on your life. We all process thing differently and so some people will go through traumatic event and be fine while others will have lasting cognitive or physical effects.
Okay, but let’s jump back on our topic of if ADHD is caused by trauma and I think a relevant question that many people might be forming here is, well do I have ADHD or am I dealing with some kind of trauma?
And this is a fair question to ask because so many people with ADHD have some sort of trauma in their background - I’ve seen some estimates of up to 80% of those of us with ADHD have some kind of trauma. Now again it is important we remember that definition of trauma that we were talking about earlier and that we also have an estimated 70% of US adults having experienced some kind of trauma.
It’s also important to note again that we have a difference between experiencing a traumatic event and then our cognitive, emotional or physical response to that trauma.
But with those numbers of course we might have the question of what we’re dealing with. An important consideration here is our history with ADHD and we see this with the diagnostic criteria. Because we know that ADHD is genetic it’s important that when going through the diagnostic process that we see these ADHD symptoms in childhood. And then also for those who have experienced trauma, to look at if those symptoms existed before that trauma.
And of course it is entirely possible to have both and as we saw with the numbers earlier it’s in fact more than likely.
Now what I think can be missed is how trauma can exacerbate ADHD symptoms to the point that they become a problem. What I’m toying with in my brain here is how you might have a subclinical ADHD diagnosis pushed over the edge into actual ADHD with the addition of trauma to the mix.
And just to be clear here, I don’t have a study to back this up. These are just some thoughts that I’ve been playing with as I’ve been thinking about these issues and, specifically, something that has been itching at me when people talk about how ADHD started becoming such a thing during the pandemic.
My thoughts are that we had the pandemic which was a global trauma event. I know we’re just pretending like it was a little blip in our lives and now everything is back to normal, but we also kind of know it’s not. We are also seeing that there have been some far-reaching effects of having gone through this trauma event.
All that to say that I do believe the collective trauma we went through because of the pandemic did cause a rise in the number of ADHD diagnoses.
Again, this isn’t something that I have an actual study for to back up my ideas on, but we do have evidence that trauma can exacerbate ADHD, we all went through a global traumatic event and we saw an increase in the number of people diagnosed with ADHD. It seems like a logical series of events to me, but, of course, I also could definitely be missing a piece of the picture.
So while we have ton of evidence that ADHD is a genetic condition, trauma is likely playing a role in most people’s ADHD symptoms. And while I do appreciate Dr. Mate’s approach to treating trauma, he is definitely wrong about the causes of ADHD and I’d have to recommend taking his talking points with more than a grain of salt - I mean I saw one interview with him claiming that there is no evidence that ADHD medication is effective, that is demonstrably wrong.
This Episode's Top Tips
Just in case I didn’t make this clear enough in the episode, ADHD is a genetic condition, and while trauma may play a role in the severity of ADHD, it is not a cause of ADHD.
The mix-up between the conditions comes from the overlap in symptoms between ADHD and trauma, such as difficulty concentrating, disorganization, and inattention, which can complicate diagnosis and management.
Trauma can exacerbate ADHD symptoms, potentially pushing subclinical ADHD diagnoses into clinical ADHD territory. We also have to acknowledge the validity of individual experiences and perspectives regarding ADHD and trauma, recognizing that different factors may contribute to symptom manifestation and severity.
If you want to better understand what’s happening with you, it is best to consult with an ADHD specialist or mental health professional who can conduct a comprehensive assessment to untangle the complexities of ADHD and trauma, aiding in accurate diagnosis and tailored treatment plans.