ADHD & Polyvagal Theory: Making sense of the link between ADHD and trauma

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Christina Crowe, Registered Psychotherapist, Clinical Supervisor

Dear TikTok viewer, What a wonderful question you asked last week, “What do you think about Polyvagal theory?” Given that particular social media channel is mostly about Attention Deficit Hyperactivity Disorder (ADHD), I wonder if what you might have been asking was, “What did I think about how some of the polyvagal thought leaders talk about ADHD?”

​A fantastic topic to dig into. 

In brief, Polyvagal Theory, characterized by Dr. Stephen Porges, describes three main things:  

  1. the process in which our neural circuits read cues of danger in our environment (neuroception),
  2. the hierarchical nature of our autonomic nervous system responses, and
  3. the biological imperative of co-regulation.

I use polyvagal theory every single day. I wrote a blog post about how I (and you) can use music to stimulate our vagus nerve.  I’m drawn to polyvagal theory for the very simple reason that it applies to all human beings.  

I also a love good complication and nuance.

There is a difference between a theory itself, and then the opinions of experts on things that there just isn’t a solid theory for yet.

​This kind of grey area is where discussions about the experience of trauma and ADHD start to become intertwined, and about as clear as mud.

A good starting point is figuring out what came first.​

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) categorizes ADHD as a ‘neurodevelopmental’ disorder because for the most part, we understand we are born with it*. Intergenerational trauma aside, we are not born with post traumatic stress disorder (PTSD) (however, in some cases, trauma can start as early as in utero or infancy, but that is one data point that by itself would not fulfill an ADHD diagnosis). 

Some trauma clinicians say one never fully recovers from PTSD. My experience has taught be that isn’t really true, (nor should be stated generally). It’s important for us to exercise mental boundaries – the place where scientific facts end and opinions (even well intentioned ones) begin. 

We know from the body of existing research there is a bi-directional relationship between developmental trauma and ADHD. (Bi-directional meaning we don’t definitely know which comes first, the chicken or the egg? Also useful here is the Golden Rule of Psychology Undergrad life: ‘correlation does not equal causation’).

  1. ​There might be no true way to fully tease apart whether anyone’s particular ADHD brain is solely the result of:
  2. ​Standard genetics, like your height (about an 80% chance), or
  3. The unmanaged ADHD in your childhood was the pre-existing condition for the trauma that came later, closely related to,
  4. Our young ADHD brains grew up surrounded by other untreated, unmanaged ADHD brain’s, each dealing (sometimes pretty maladaptively) with their own developmental trauma, therefore couldn’t respond to our needs? or
  5. Developmental trauma along the way has caused ADHD-like symptoms that we just call ADHD, or
  6. Simply, all of the above.

If you grew up with parents (who buy no measure of how much they love you) absolutely could not pay the minimal amount of attention required to meet ‘good enough parenting’ (and didn’t know or have access to medical care to investigate they might have a condition like undiagnosed ADHD) then our attachment relationship to our parents might be less secure than we’d like (a little more insecure or disorganized).

​Then yes, you might have the double whammy of ADHD and ‘trauma’ (see important note**).

​But it might not have anything to do with how much we were loved. This could be a really important nuance. So while as adults, we’re still very much suffering the long term and deep effects of childhood emotional neglect (CEN), a really important piece of missing data could be that our parents did not intend to neglect us. 

In fact (if they have undiagnosed ADHD) they had no idea that the way they paid attention to us was a problem at all.

And they might still not.

Another example of the complicated relationship between ADHD and developmental trauma, is that ADHD can often walk hand-in-hand with perfectionism. It seems like a strange combination, until we break it down. 

Perfectionism can be understood as a function of shame, and having been shamed as a child (and certainly polyvagal theory classifies it this way).  The development of perfectionism in an ADHD brain is that people growing up with ADHD are statistically more likely to have been shamed for their behaviours, despite the fact that these are brain-driven behaviours originating outside of their immediate control.

As a result, we know people with ADHD brains as more likely to be ‘on guard’ (involuntarily, and at all times) against any possible sign of not measuring up (and have a nervous system with a similar involuntary counterattack ready to go, at all times). 

If you had an inattentive parent, the unfortunate lesson you might’ve learned along the way, is that you only have yourself to rely on. The conclusion you might draw is that your parents didn’t want to be there for you, didn’t care enough to be there, or worse yet, that perhaps you weren’t worth it.

​As adults, we remain islands unto ourselves, acting ‘strong’, not wanting to rely on people for fear of feeling the shame and isolation of being ignored again, what we don’t develop well is the skill of strong self-advocacy, or asking very clearly for what we want or need. 

Polyvagal theory can help us understand why our nervous systems found relief in perfectionism as a survival strategy, and this same physiological process holds the clues to the way out of that response. Applying interventions grounded in polyvagal theory doesn’t make the ADHD go away, but it can help make distressing emotional dysregulation symptoms much more manageable. By enabling a much more mindful response to what our nervous system is doing to keep us safe, we can intentionally access more regulation.

Navigating facts and opinions

I recently heard a well-known polyvagal leader, whom I quite like, say on a podcast they thought ADHD inattentiveness (zone-outs) were due to trauma – to constantly feeling threatened.  To argue the position that ADHD symptoms like inattentiveness are singularly caused by feeling threatened, would be to ignore all of the research in the world that demonstrates the myriad origins of ADHD that can be found in structural, functional and neurotransmitter dysfunction in our brains (1,2). 

It ignores the research that has demonstrated how ADHD brains show an inability to sustain attention due to these brain differences, which are not due to a sense of feeling threatened in the moment (3). The inability to sustain attention – to zone out involuntarily – can look like a trauma dissociation to the untrained eye. And sometimes it can be both.

But it isn’t always trauma. 

Another very influential leader also discusses a trauma origin, and I think there is a nuance this person intends that gets often missed by the casual listener, which is that epigenetics and intergenerational trauma likely play a role in any and all things that can go amis for us developmentally (their point I believe), including ADHD. But despite having access to every single therapeutic option in the world really, this person still talks about having and managing ADHD today. 

Does trauma exacerbate ADHD symptoms?

Of course it can.

Can you have ADHD symptoms and not have trauma? Of course you can.

Are we all doomed?

Of course not. 

Maybe it’s more reasonable to say trauma can maintain or worsen ADHD in its troubling manifestations, but that does not mean it causes it.

Trauma can be healed.

​You can have PTSD, and then not have PTSD.

​I quite like the way relationship expert John Gottman teaches that despite all the work and loving relationships, we can have “enduring vulnerabilities”. We can work on a lot of things, and heal a lot of stuff, and still have one or two lingering things that are just raw spots for us. Does this mean you have lifelong PTSD? Absolutely not!

​It means you’re a human. 

And when you have an enduring vulnerability lighting up your nervous system from time to time, if what you have also created in your adult life is the ability to connect and cope in a generally healthy way and take care of yourself with people you trust, then the symptoms are likely not things that whatever approach criteria to say you have a ‘mental illness’.

Your diagnosis is the human condition. 

In therapy, we’re not trying to cure you of your humanity. 

We’re trying to let your humanity shine through without shame. The aim isn’t to never be sad again. It means that being sad is not going to derail your life or fill you with shame and destroy your relationships. It’s healthy to feel and express sadness when sad things happen. 

Consider somebody with ADHD, whose mind was darting around, and who couldn’t settle, and then happened to see something, that because of their creativity and ability to think laterally, allowed them to see an opportunity they wouldn’t have been able to see had they been a more linear thinker. 

Perhaps that was the turning point that made all the difference in the trajectory of their life, and positively influenced where they are today. This happened despite their score of 10 on the ACE scale, and despite having spotty parents with undiagnosed/untreated ADHD. 

Perhaps in that way, ADHD created the conditions that also saved them.

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References

* Historically, the DSM used to categorize other things humans are born with as mental illnesses, that are considered absurd today, and perhaps this will happen with ADHD in the future as well.

** Experiencing trauma does not mean you will have PTSD, or are ‘traumatized’. Many people (>60%) who experience trauma will not develop PTSD. But having undiagnosed/unmanaged ADHD significantly increases those chances.

1. Tomasi D, Volkow ND. Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cereb Cortex 2014; 24: 935-944.

2. Naaijen J, Bralten J, Poelmans G, et al. Glutamatergic and GABAergic gene sets in attention-deficit/hyperactivity disorder: association to overlapping traits in ADHD and autism. Transl Psychiatry 2017; 7: e999.

3. Mitko, Alex et al. “Individual differences in sustained attention are associated with cortical thickness.” Human brain mapping vol. 40,11 (2019): 3243-3253. doi:10.1002/hbm.24594

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Picture of ​Christina Crowe, H.BSc. MACP, RP

​Christina Crowe, H.BSc. MACP, RP

Registered Psychotherapist, Validated Clinical Supervisor, ADHD Therapist & Coach Podcast Host The Christina Crowe Podcast Christina is a Canadian Registered Psychotherapist, a member of CADDRA's Advocacy Committee and relentless mental health advocate. Christina believes great mental health information should be available to everyone, loves creating content that makes invisible things VISIBLE and finding new ways to bring healing experiences to as many people as possible.

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