ADHD Isn’t A Trauma Response

Newer approaches to ADHD shed light on its origins, challenges, and gifts.

In his popular book Scattered Minds, Canadian physician Gabor Maté argues that ADHD develops as a way of coping with childhood trauma and the emotional stresses that children experience in their early life. In his most recent book, The Myth of Normal, he argues that the source of this emotional distress and proliferation of diagnoses lies primarily with our “toxic society.” He dismisses “the prevalent myth that genetic traits account for human behavior” and only acknowledges general “sensitivity genes” that make a person more likely to be affected by trauma without influencing what type of reaction they have to it.

These ideas are everywhere in our culture. I can’t seem to go a single day without a popular social media thread arguing that ADHD is not in your genes and that childhood trauma is the hidden root of all suffering. I am also inundated with Instagram ads telling me that “ADHD is not laziness, it’s a trauma response.”

Well actually, it's neither! These falsehoods are so popular, yet so wrong. I believe it’s time for a more accurate narrative surrounding ADHD, one that recognizes the complex etiology of this diagnosis, the potential strengths and weaknesses of ADHD, and the potential for hope and change among people who suffer with this diagnosis.

What is ADHD?

The latest science suggests that the best way to think of ADHD is a combination of different extreme personality traits that are related to each other but exist on a continuum among all of us. This includes poor organization and attentional control and high impulsivity and risk-taking.

What's more, various symptoms of ADHD share comorbidity with other psychiatric diagnoses. For instance, some features of ADHD having to do with low perseverance, poor schoolwork, and impulsivity align more with the externalizing dimension of psychopathology, while attention-related problems such as poor concentration and “zoning out” are tied more to the neurodevelopmental and internalizing dimensions of psychopathology.

Considering the heterogenous nature of psychological disorders, a growing number of psychologists and psychiatrists are moving toward a continuum and symptom-focused approach to understanding ADHD as well as other traditional psychiatric classifications. This “paradigm shift” is finally acknowledging the many problems with the Diagnostic and Statistical Manual of Mental Disorders(DSM), including the creation of arbitrary boundaries between “psychopathology and normality,” the unclear boundaries between disorders, and the lumping together of various symptoms that have inherent heterogeneity. This new approach—called the Hierarchical Taxonomy of Psychopathology (HiTOP) approach— doesn’t assume that everyone currently diagnosed with ADHD has the same underlying problem or require the same clinical intervention.

This approach also doesn’t assume that ADHD is necessarily a disorder or an illness. While ADHD is often referred to as a “disorder”— literally the last “D” in ADHD stands for disorder— no trait is inherently a disorder unless it’s making a person unable to function in life. If a person learns to manage their traits in a way that helps them lead a productive and meaningful life, they should no longer be considered to have any disorder. For too long, the dominant paradigm in psychiatry has been to define psychopathology in terms of statistical deviance in brain function. This newer approach instead argues that deviations from the norm in neural functioning may serve as a risk factor for psychopathology but are not in themselves necessary nor sufficient to identify psychopathology.

Importantly, this approach recognizes that people can get an ADHD diagnosis for different reasons, and for showing a different set of symptoms. ADHD is often just the diagnostic label that is put on people for exhibiting behavior in school and in life that others deem “problematic.” This is especially true for children. An estimated 7 million (11.4%) of U.S. children aged 3-17 years of age have been diagnosed with ADHD, whereas the overall prevalence of adult ADHD is 4.4%. That’s not to say that many of the behavior’s among children aren’t truly challenging within a certain context—having ADHD-related traits can absolutely be debilitating and make it hard to function— but far too many children receive the ADHD diagnosis when they don’t actually fit the ADHD criteria and when they may actually have a comorbid disorder such as autism or generalized anxiety. Also, the fact that ADHD is, by definition (according to the DSM) a disorder that must start in childhood also contributes to this diagnostic pattern.

Also, since children’s brains are still developing (especially their prefrontal cortex), many children who are diagnosed with ADHD may no longer fit the criteria later in their life once their brains are more fully developed and they have more opportunities and freedom to channel their ADHD-related behaviors into their job, their creativity, and their meaningful life.

The Genetics of ADHD

All personality traits— including the constellation of extreme personality traits that make up the ADHD diagnosis— develop as the result of nature via nurture. Yes the environment matters. For instance, if you’re in an environment where you’re constantly being told that your traits are a disorder, or where your extreme traits bring you problems (e.g., having trouble concentrating in school), surely that can affect your self-esteem and mental health. But the nature part also really matters: Our genes influence what we pay attention to, the environments we seek out, what specifically we are motivated to engage with in our environment, and how we react to stressors and other events.

There is evidence that ADHD is among the most heritable psychiatric diagnoses— twin and family studies have estimated that the heritability of ADHD is between 72 and 88 percent across the lifespan. Often you will hear Dr. Maté say that no gene for ADHD has ever been found. But he’s wrong! Twenty-seven specific genetic variants have been identified for ADHD. What’s more, the specific genes that confer risk for ADHD are not the same genes that confer risk for many other disorders, so they can’t just be general sensitivity genes.

While it is true that each gene taken individually has only small effects on ADHD, multiple genes taken together relate to ADHD-symptomology. As the number of people studied has increased, so too have the effect sizes, and more specific genetic variants will be identified as the studies grow larger. ADHD’s etiology is complex, as many of the genes that put a person at risk for physical health ailments—such as iron deficiency, obesity, type 2 diabetes, neck or shoulder pain, and substance use— also put them at risk for an ADHD diagnosis. For instance, there is emerging research that iron deficiency may contribute to ADHD symptomatology by influencing dopaminergic functioning, suggesting that those with a high ADHD predisposition and low iron levels could benefit from iron supplementation. Importantly, there are genetic protective factors for ADHD as well, such as genetic variants associated with the likelihood of participating in socially supportive and interactive activities.

Whatever the complex etiology of ADHD, it’s becoming abundantly clear that early childhood parenting style has very little effect on the development of ADHD-related personality traits. If anything, Dr. Mate may have the causality exactly backwards. It is often assumed that children develop ADHD symptoms because of their adverse childhood experiences, but the research actually suggests that ADHD-related traits predict subsequent adverse childhood experiences (with the inattention-related behaviors conferring the most risk). In many cases, a bidirectional relationship exists. As one team of researchers put it, “bidirectional relationships between ADHD and ACEs may ensnare children in developmental pathways predictive of poor outcomes.”

If you want to blame your parents for your ADHD diagnosis, blame them for giving you their genes and then forcing you to stay in an environment for about 18 years where both you and your parents with ADHD-related personality traits have to continually interact with each other! Parental ADHD is the single biggest predictor of a child’s ADHD diagnosis. If a parent has an ADHD diagnosis, the child is 8 times more likely to receive an ADHD diagnosis as well. These findings can help identify early manifestations of ADHD in young children at risk.

This highlights something that I believe Dr. Mate is right about: Chaotic and stressful early family environments can exacerbate ADHD-related traits. ADHD-related traits existing in unsupportive environments or without resources and help can certainly be a traumatic experience. But this is not the same thing as saying that ADHD-related traits are primarily the result of trauma in childhood. Just because trauma can cause lasting problems in our lives does not mean that ADHD (or any mental health problem) is caused by childhood trauma. For those with a different genetic proclivity, trauma may affect them differently. You tend to break in ways that you’re genetically prone to break.

While childhood trauma does changes our brain and can have long-lasting biological effects, it it’s also true that anything that affects us persistently can change our brain and biology. That includes a variety of techniques to “rewire our brain” and help us learn, grow, and find healing.

Overcoming an ADHD Victim Mindset

There is hope. Heritability does not mean immutability (a common misconception). Heritability doesn’t even mean hereditary (another common misconception)! I agree with Dr. Maté about the potential for healing and hope among adults diagnosed with ADHD. Dr. Mate argues that people with ADHD can heal by becoming more authentic, self-accepting, connected to themselves, agentic, and compassionate. They can heal by creating healthier boundaries, avoiding self-blame, and overcoming self-limiting beliefs. I am totally on-board with all of this, and think the research does suggest that significant agency, mindfulness, change, and growth are possible among people diagnosed with ADHD.

However, not only is his ADHD victim mindset narrative about trauma false— there is no evidence whatsoever that all ADHD is caused by trauma— but I don't believe it's likely to empower someone to pursue healing and self-acceptance. For one, Dr. Maté ’s narrative marks the parent of a child diagnosed with ADHD as a bad parent. This can be incredibly damaging to the psyche of so many well-meaning, loving parents who are perplexed why their child exhibits ADHD-related traits. The victim mindset narrative surrounding ADHD also marks the child (or adult) with an ADHD diagnosis as a person with a history of family trauma— even though many people diagnosed with ADHD have no history of family trauma!

This narrative also plays too much into the idea that ADHD is necessarily an illness—when it’s not. Treating a person with ADHD-related traits as though they have an illness is pretty stigmatizing in my view. This is a problem not only with Dr. Maté ’s narrative, but also a big problem I see in the scientific literature. Yes, ADHD is reliably associated with a range of adverse social, behavioral, and emotional outcomes in life, including low educational attainment, depression, substance abuse, criminality, and poor physical health. But there are also a lot of benefits in our society to people who do not conform, who are risk-takers, who do not “play nice”, and who have a rich imagination.

For some people diagnosed with ADHD, their divergent thinking and difficulties with rule-following actually allow them to think outside the box more creatively. In my article “The Creative Gifts of ADHD” that I wrote for Scientific Americanover a decade ago, I summarized emerging research suggesting that while people with an ADHD diagnosis may have trouble focusing on external goals and tasks, their overactive “Imagination Brain Network” can enable them to come up with creative ideas and a more imaginative vision for the future. Also, many people diagnosed with ADHD report the ability to “hyperfocus” on things they actually intrinsically care about, being able to get into the flow state for very long periods of time. It’s absolutely possible to be highly intelligent and also score high on ADHD-related traits. In fact, I would argue that this combination puts you at “risk” for being a more creative person!

All personality traits have trade-offs, and ADHD-related traits are no different. ADHD is not a superpower (but can be in some contexts), nor is it a disorder (although it can be in some contexts). In my view, the complex and nuanced truth is far more empowering and likely to actually lead to the self-acceptance and avoidance of self-blame that Dr. Maté argues is important for people with an ADHD diagnosis.

I respect Dr. Maté ’s work humanizing ADHD and addiction and I know he has provided healing to so many people struggling with their mental health. Also, I agree with him that it's really important to look at the support systems and resources that exist in a person’s environment. But I think we must not neglect that nature also matters. Instead of adopting a victim mindset and trying to find “blame” for ADHD-related traits, let’s see the traits for what they are— a constellation of extreme personality traits that offer both challenges and opportunities.

I believe the truth about ADHD offers more hope for human agency than either environmental determinism or genetic determinism. Who would want to be completely at the mercy either of society or of our genetics? Thankfully, we aren’t completely subject to either.

To all those with an ADHD diagnosis, may you live long and thrive, not trying to find “blame” for who you are, but taking responsibility for your psychological makeup and steering the course of your life in the way you truly want with self-acceptance, self-compassion, and creativity.