I recently received an email from a pediatrician asking about how to distinguish symptoms from trauma vs. ADHD, and whether to use medication for ADHD. They were wondering if this is something I run into frequently, and if I have thoughts or guidance that I regularly provide to pediatricians? After 20 years in practice, I have a lot to say about this. Here was my answer in a nutshell.

When a child can’t sit still, follow directions, or pay attention, ADHD may seem like the obvious explanation. We often run quickly to give stimulants first. But for a traumatized child, whose nervous system has been shaped by fear, unpredictability, or loss, those same symptoms may be the echoes of survival, not signs of a neurodevelopmental disorder.

I’ve met countless children referred for ADHD evaluations who are, in truth, living in a constant state of alarm. The difference between a hyperactive child and a hypervigilant one is subtle, but the treatment path can be radically different.

Marcus came to therapy after multiple disruptions in his early life due to neglect and domestic violence. By the time he entered third grade, he had experienced several stressful transitions in

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