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Thursday, October 30, 2014

Is it CPTSD or ADHD?

After almost three years of treatment, it seems almost absurd to revisit my diagnoses and re-examine my symptomology.  However, my recent self-education in how ADHD can impact adults has been an eye-opening experience, and I have to ensure my recovery takes this into account.  
Determining the differences in symptoms between Complex PTSD (CPTSD) and ADHD, both of which I have been diagnosed as having, is actually extremely challenging.  Even clinicians find disentangling the two to be quite difficult, and this is especially true when there’s child abuse involved in the diagnostic equation... and a traumatic childhood is certainly involved in my differential diagnosis of CPSTD vs ADHD.
I'm going to start from square one to ensure I haven’t been misdiagnosed with CPTSD, ADHD, or possibly both.  To begin with I don’t need a research study to definitively conclude I experienced repeated traumas over the course of my entire life until age 20..  
My previous night terrors, hyper-vigilance, and panic/anxiety problems are clearly linked to that abuse because they became serious problems as I approached fatherhood and began examining how I was parented.  This is not an unexpected development during midlife introspection regarding a childhood such as mine. 
To finally put this question to rest, I bear the actual physical scars and disfigurements from those experiences. It’s clear that I suffered serious repeated childhood traumas and have experienced substantial complications from Complex PTSD as a result later in life.
Chronic and persistent childhood traumas result in long-lasting changes to the brain including difficulty with attention, struggles with creating lasting and close relationships, impatience and restlessness, addictive behaviors, harmful risk-taking, tendency towards distraction, inability to prioritize, and emotional regulation problems.  Sounds a lot like the challenges we often associate with ADHD doesn’t it?
This presents serious frustration for me for obvious reasons, not the least of which is that I’m unsure whether my recovery plan properly accounts for this overlap.  Again, I want to emphasize that I am in no way questioning the capabilities or performance of my psychologist and/or psychiatrist, both of whom I hold in the highest regard... otherwise I wouldn't continue to see them.  Anyway, I noted how CPTSD is so symptomatically similar to ADHD, so I have to question whether I even have ADHD.  
This question is infinitely more complicated because the causes of ADHD have not been conclusively identified by well-designed scientific research studies.  There is a criteria test included in the DSM-5, the diagnostic manual used by mental health clinicians, that I “passed” indicating I have ADHD.  
Furthermore, I was diagnosed at age 4 but never treated in any fashion at my father’s behest.  My present and past diagnostic results seem to clearly indicate the presence of ADHD, but my problem is meeting that criteria could just as easily be due to how my CPTSD presents. 
For example, my father enjoys telling a story from one of my misadventures when I was three years old that, in his mind, was an early demonstration of my intelligence and abilities.  It actually is a demonstration of how early I endured traumatic experiences no child should ever experience, much less one that young.  I was raised by my father during the day as he worked nights while my mother worked days until I went to kindergarten. 
Somehow I was neglected long enough to go into the garage, pull out a toolbox to remove a flathead screwdriver, open a can of paint, and proceeded to paint various parts of our home: the wrought iron fence, the exterior brick work, the shag carpet in the living room (yes, this was the late 70’s!), and generally made a magnificent mess over the course of an extended period of time. 
He ends the story by saying how he beat me “good enough” to make sure I never did something like that again.  While I’m not privy to any other similar stories of beatings, neglect, and maltreatment, I feel it’s safe to say this wasn’t a singular event.  It’s very likely that this was a microcosm of my formative years overall.
So, the behavioral issues with which I was plagued as a young child resulting in an ADHD diagnosis at age 4 could have been directly related to this type of abuse.  There’s another aspect of ADHD which could help me make this determination, though: the hereditary factor.
While not definitively conclusive, there is strong evidence that ADHD is genetically-based according to the American Journal of Medical Genetics.  I won’t go into fine details here, but my father and mother both have behavioral tendencies indicative of ADHD given everything I’ve seen and know about them.  
Maybe the reasons for their behaviors are just as convoluted by past experiences as mine appear to be.  I'm a fairly statistically-oriented individual, though, and this confluence of coincidences is highly improbable.  It's quite likely I have been genetically "endowed" with ADHD, but that's not sufficiently conclusive for me.
After my most recent diagnostic ADHD indication I was prescribed Adderall.  I have intermittently taken it for various periods of time over the past 18 months to essentially experiment the efficacy of the medication.  Fortunately (or unfortunately), the medicine seems to ameliorate many of my daily challenges: it allows me to stay on top of my scheduled routine; I maintain consistent effort on tasks for longer than 15 minutes; and it grants me the ability to be productive in general. 
While it’s true that amphetamines allow virtually anyone to be more productive, I don’t mean productive in the work-for-9-hours-straight-without-blinking type of productivity.   It’s so difficult for me to stay on task, sustain any modicum of attentiveness (unless it’s something I absolutely love to do), or even get started on virtually anything productive while not taking the medication regularly and appropriately.  I don't receive an unnecessary performance-enhancing effect as someone without ADHD typically does.
As a result of the early and recent diagnostic tests, the probable genetic aspect, and the symptomatic improvement Adderall provides,  it seems reasonable to conclude that I do have ADHD.  Awesome.
It appears I am “lucky” enough to in fact have both CPTSD and ADHD, so now it’s time to deal with addressing the symptoms of each.  That will have to wait until I do some more work with my clinicians and adjust my recovery plan.  
Until then, I hope this helps you or your loved one if faced with similar challenges and divining their provenance.  I'm NOT clinically trained and simply present my experiences to encourage you to hopefully work closely and cooperatively with your clinician(s) in determining whether the challenges you experience are from ADHD, CPTSD, or like me a combination of both.  It takes time, a lot of patience, significant research, some deductive experimentation, and a lot of work.  We're worth all of that work and more, though!
"It takes courage to grow up and become who you really are." - EE Cummings

4 comments:

  1. while googling ADHD AND CPTSD i came across your article. i would like to hear your current ideas, as i, too have self diagnosed myself with both. i am studying early childhood adverse experiences and results ..100% agreeing with Dr. Gabor Mate and others, and am interested in your latest ideas. my name is Susie Beifuss and email is susiebeifuss@gmail.com thanks, Susie

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  2. I have been diagnosed through the Amen clinic with ADHD and CPTSD. My treatment has included stimulants to address ADHD symptoms and improve executive functioning. Treating CPTSD has meant working with a trauma therapist and using tool like EMDR and Brainspotting to control emotional flashbacks.

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  3. I will add that by receiving treatment for CPTSD my ADHD symptoms have become significantly easier to manage.

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  4. Lucky to have found the INK FOR ALL tool. So impressed with the advanced Accessibility Features, my favorite is the offline mode http://bit.ly/2DWi1K9

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