By: Chellsea Sparks M.A., LPC-Associate
Attention-Deficit Hyperactivity Disorder (ADHD) and Post Traumatic Stress (PTS) will sometimes co-occur. We seek to understand how each impacts the brain and organize treatment in a way that honors an individual’s whole experience.
Attention-Deficit Hyperactivity Disorder is a neurodevelopmental disorder that includes clusters of symptoms that fall under inattention and hyperactivity/impulsivity. Inattention symptoms include trouble concentrating, struggling to stay organized, task avoidance, feeling easily bored, losing items that are necessary to function, easily distracted, forgetful, and poor time management skills. Hyperactivity or impulsivity symptoms include inability to sit still (both internally and externally), inability to engage in relaxation or rest, talking excessively, difficulty waiting, interrupting others, and impulsive or reckless behaviors (substance abuse, financial, etc.).
Individuals who experience ADHD lack the necessary dopamine to support the front portion of the brain (prefrontal cortex), which has to do with executive functioning. Executive functioning involves processing and cognitive functioning.
Trauma is anything that overwhelms the nervous system and causes us to be “stuck” in a state of hyper or hypo-arousal. Symptoms may include nightmares, depression, anxiety, concentration issues, appetite problems, flashbacks, avoidance, negative beliefs about self/others/the world, trouble regulating self or trouble regulating emotions, reckless or impulsive behaviors, feeling distant from others, and sleep issues. Trauma related disorders could include Post Traumatic Stress Disorder, Adjustment Disorder, and Acute Stress Disorder. Experiencing a traumatic event doesn’t automatically lead to PTSD or another related trauma disorder. PTSD happens when the brain gets “stuck” after the traumatic event. Getting stuck after a traumatic event is often influenced by the environment and the support received after the traumatic event has occurred. Trauma, similar to ADHD, impacts the prefrontal cortex of the brain. In disorders like PTSD there is an overproduction of cortisol (which happens in the amygdala of the brain) which can inhibit proper function of the pre-frontal cortex, hence the being stuck.
Heckman (2023) reports that “co-occurring ADHD and trauma are more common than previously thought. People with ADHD are often bullied, feel that they don’t fit in, struggle academically and socially in school, and are admonished by adults for behaviors over which they have little control. The body’s chronic stress response is commonly referred to as the ‘fight or flight’ response. Another name for it is ‘sympathetic arousal’, because it is an activation of the sympathetic nervous system. Sympathetic arousal is the body’s involuntary response to danger and causes adrenaline and cortisol to rush through the body, heart rate to increase, muscles to become tense. If this response happens repeatedly— as it does for individuals with ADHD navigating daily disappointments, admonishments, and blows to their self-esteem— the body learns to treat everything it encounters as a dangerous threat. Over time, it creates fixed action patterns in the body’s tissues, such as habitual muscle tension (clenching jaw or raised shoulders), digestive distress, and neurons that fire the same way repeatedly (defensive behavior patterns). All of these are signs of dysregulation. The nervous system has learned to respond to past events as if they are happening in the present. Think of the nervous system as our body’s version of a building’s electrical wiring. The brain is the fuse box. The nerves are the wires that extend throughout the body. Our wires contain billions of neurons that communicate via neurotransmitters much like electricity — jumping from one neuron to the next. In people with ADHD and trauma, the neurological functioning becomes altered and dysregulated, causing the wiring to fire differently. This begs the question, what is the cause of impaired neurological functioning? ADHD and trauma are so interrelated, we may never be able to tease them apart. So how do we move forward? We treat both.”
Lanza (2025) further explains that neurodivergent people or people with ADHD may experience trauma in connection with the disorder. For example, an individual who grows with undiagnosed ADHD or with ADHD that was supported, may carry shame or embarrassment, experience isolation or bullying, and experience unhealthy corrective actions by caregivers or others. Research shows that ADHD individuals are more likely to experience other types of traumas that are not directly linked to being neurodivergent. Unless both the ADHD and the trauma are treated, the likelihood of successful symptom resolution decreases.
The symptoms of ADHD will be intensified if trauma remains untreated and vice versa. The big question that I get all the time is how do I process trauma when I have ADHD. I think about this in the concept of layers. One of the layers is learning skills to improve executive functioning (organization, problem-solving, decreasing avoidance, and impulse control). The second layer is possible medication management to decrease ADHD and trauma symptoms. The third layer is therapy that is geared towards an overall integrative approach. The focus is on treating the whole person and encouraging the reconnection and balance between the brain and body.
Effective therapy often includes ADHD specific CBT (that is skill focused) and integrating EMDR or somatic related techniques. Treating trauma may include processing through the body or emotionally rather than cognitively. For example, the therapist might focus on physical sensation in addition to the story of the trauma. The research shows promise in treating both ADHD and trauma together through an integrated approach with both EMDR and skills to address ADHD.
According to EMDRIA (2024) Eye Movement Desensitization and Reprocessing (EMDR) “is an eight-phase psychotherapy approach that helps people recover from trauma without having to talk at length about the traumatic experience(s). It is an effective therapy with a lot of research support. An EMDR therapist will help you to tell important aspects of your story and will be mindful of how your culture and personal context impact you. They will build a working relationship with you, and help you develop tools for coping with how you are feeling currently. The therapist will help you identify your internal and external resources and the experiences causing distress (traumas) and their relationship with current symptoms. The therapist will assess your readiness for addressing your trauma and move at a pace that works for you.”
EMDR therapy is an intentional, 8 phase approach. EMDR therapy must be adapted for ADHD or neurodivergent individuals. Treatment must value the whole person, presume competence, and lead with curiosity and exploration (Lanza 2025).
EMDR processing relies on bilateral stimulation (BLS). A therapist utilizing EMDR to treat both ADHD and trauma will often have different forms of bilateral stimulation (BLS) available to clients. Lanza (2025) reports that “a way to create an (neurodivergent) or ND-affirming environment in the therapy session is by having a menu of BLS options for the client to practice and choose from that stimulate the right to left motion. Having the client practice these then allows for an ND-affirming approach versus an abstract ask to the client of which BLS modality they would prefer. Many ND individuals need to see or try something rather than respond to an abstract ask when it comes to decision-making. Then, clients should be provided the opportunity to practice these options before going into a target to find what may work best.”
BLS can be done in a variety of ways. This includes:
- Eye movements– by following a hand, light bar, ball on a screen or wand.
- Touch or Tactile– tapping with hands or finger, buzzing from vibrations, or butterfly hug.
- Auditory– Music that utilizes bilateral stimulation (left to right).
- Physical Movement– walking, pacing, swaying, tapping feet (left to right).
The main purpose of the BLS discovery is to reduce as many distractions, struggles, or obstructions as possible before a client processes traumatic material. We want clients to feel empowered and in control of how EMDR is going to work for them. Things can feel out of control with ADHD and trauma, and we respect the need for autonomy and control. The permission to do BLS as the client feels best is not only validating but also healing to individuals who haven’t had choice before.
Some things that I have found helpful when doing EMDR processing with ADHD individuals are to allow movement and creativity to lead in session. This can look like
- Changing language and including visual cues
- Allowing movement in therapy
- Sounds machines
- Moving quicker with BLS and tailoring to fit the individual
- Following the lead of the client
We owe it to our clients as therapists to continue to be aware of new research and provide a safe environment for our clients to heal. ADHD’s influence on emotional control, behavior, and stress management can increase the probability of encountering trauma. The persistent and chronic challenges of surviving with ADHD, linked with the potential for increased vulnerability to bullying, abuse, or miscommunication, can make individuals with ADHD more susceptible to developing PTSD or trauma disorders. Addressing both ADHD and trauma jointly in therapy can be essential for healing and improving overall well-being. Please always remember to stay curious, compassionate, humble, and that you are a capable human being.
References:
DSM-5-TR Handbook of Differential Diagnosis. (2024). American Psychiatric Association Publishing.
Kerry J. Heckman, L. (2023, October 11). ADHD and trauma: Untangling causes, symptoms & treatments. ADDitude. https://www.additudemag.com/adhd-trauma-somatic-therapy/
EMDR Therapy & PTSD. EMDR International Association. (2024, December 19). https://www.emdria.org/about-emdr-therapy/emdr-ptsd/
Lanza, T. (2025, February 25). EMDR therapy and Neurodiversity GWT Magazine® issue. EMDR International Association. https://www.emdria.org/blog/emdr-therapy-and-neurodiversity-gwt-magazine-issue/
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