I was sitting here and remembering a couple of my clients early in my career, young children diagnosed with ADHD by the psychiatrist. They had all the classic symptoms, restlessness, inattention, one child was bouncing off the walls and climbing under chairs, would not sit still or pay attention. I called him over, he was 6 years old and I had him come sit on my lap and to my amazement, he was completely still. He was able to participate throughout the rest of group without any problems. This child had witnessed severe abuse and been a victim of abuse.
I had another child, she was 3 years old with the same symptoms as the previous client and diagnosed ADHD by the psychiatrist. When I asked her what was wrong when she wouldn't sit down and was crawling all over the chairs, she said pictures were going through her head and she wanted it to stop. Yes a 3 year old said that!! Can you imagine? This child's history was that when she was a baby around 1 year old she witnessed her entire family being murdered. Although she couldn't verbalize what the pictures were, they were obviously disturbing enough for her to act out.
I had another client diagnosed with ADHD, acting out history and classic ADHD symptoms. He could not sit still at all, and nothing helped this except medication. I think that is the difference between him and the other two diagnosed with ADHD. The medication did not help the other two. So they kept changing the dosage of medication.
I realized the difference between ADHD and PTSD in children can be difficult to diagnose and takes some important history taking. Usually we are required to make a provisional diagnosis the first time we see a client, many times that leads to a PTSD child being diagnosed as ADHD. It is our job as counselors to really taking the time to explore the diagnosis and give the appropriate treatment. In the cases above, I was not the children's counselor, I was in the role of a mental health worker therefore I had no say in the diagnosis; however I did stress the behavior changes to the counselors and psychiatrist.
It is my hope that counselor's reading this will differentiate between ADHD and PTSD in children. It is crucial they get on the right medication, if it is needed.
Kimberly Beck is a counselor and a doctoral candidate with a special interest in Self-injury. Other interests are PTSD, trauma, and Borderline personality disorder