In her 15 years working in the mental health field, the New York social worker Asha Tarry only recently found herself screening children for Post-Traumatic Stress Disorder. “PTSD came about post-Vietnam war,” says Tarry. “It was always considered an adult diagnosis and if you look in the last DSM [Diagnostic and Statistical Manual of Mental Disorders], that doesn’t fall under a childhood disorder.” And yet, Tarry said, she has started seeing cases of children suffering from PTSD after trauma they experience at a young age — and it is often misdiagnosed as another disorder, Attention Deficit/Hyperactivity Disorder.
This month Tarry began consulting for an agency in Brooklyn that screens children for PTSD. The problem of misdiagnosis of PTSD is particularly acute among black boys, Tarry said. Indeed, over half – 55 percent, according to the U.S. Bureau of Justice – of black children aged 12 to 14 have been a victim of violent crime. In comparison, a third of whites and Hispanic children of the same age group have been victimized. Despite violence decreasing in the U.S. over nearly two decades, black youth are more than twice as likely than their white and Hispanic counterparts to experience serious violence against them. And black children also have higher rates of maltreatment at home than their white and Hispanic counterparts.
One in four African American* children — over 25 percent, according to the National Alliance on Mental Health — who have been exposed to violence have symptoms of PTSD. But those symptoms are often mistaken for ADHD, partly due to the lack of cultural training among mental health professionals. In a 2010 study, it was estimated that nearly 1 million of the 4.5 million American children are misdiagnosed with ADHD. T
he New York behavior analyst Arwa Pathari has spent several years working to properly diagnose the mental health issues of both children and adults, and in particular inner city youth.
“ADHD has become a common diagnosis amongst the current generation,” says Pathari. But she said, a common misconception even among professionals is that a difficult childhood can cause ADHD. In fact, she said, “low socioeconomic statuses and exposure to trauma don’t lead to ADHD. If exposed to trauma, kids can act out and that can likely be a symptom of PTSD.”
What’s the difference? A significant one, it turns out. PTSD is an anxiety disorder that appears after a traumatic event. Symptoms include flashbacks, depression, avoidance, and hyperarousal. Contrary to traditional belief, PTSD can present itself to anyone who experiences trauma, at any age.
ADHD, meanwhile, is a disorder that presents itself during childhood brain growth. The cause of ADHD is thought to be genetic or due to prenatal exposure to harmful substances. Symptoms of ADHD include hyperactivity, inattention, and impulsivity.
The hyperarousal of PTSD can be mistaken for the hyperactivity of ADHD, according to The National Institute for Trauma and Loss in Children. It is also possible to be diagnosed with both, making treatment much more challenging for mental health professionals and patients alike.
Both PTSD and ADHD are diagnosed through observation by a mental health professional; there are no physical tests to determine the presence of either disorder.
Both PTSD and ADHD are treatable, but the treatments are different. A cure does not exist for ADHD and professionals continue to debate whether or not PTSD is curable. For now, therapy and separate medications exist to treat symptoms of both disorders. “Depending on the symptoms, PTSD can often be managed through psychotherapy. For ADHD, medication is often needed. But if a child is being misdiagnosed and overmedicated for ADHD, which is a common problem, that can be an issue for the child.”
*The study specified African American, and not black