When children come to a child psychiatrist for the first time, very often it is right after some major trauma or change that has happened in the child's life. Sometimes what has happened to the child is something that most adults would agree is a tragedy like the death of a parent or the child's home being destroyed by a fire. Sometimes what a child perceives as an extremely stressful event may not be thought of as a major source of anxiety by adults, like moving into a new home, beginning middle school, or an older sibling going off to college. The child may start acting out and start exhibiting troubling behaviors at school or at home. When they see the psychiatrists, they may have many of the symptoms of attention deficit disorder; however these symptoms may be due to a major change in the child's life resulting in an anxiety or mood disorder. In this entry I'll discuss some of the features of one anxiety disorder, acute stress disorder (ASD) and how they may be distinguished from ADHD.
First of all, for ASD to exist there has to be a traumatic event. Now as I said, this may be some obvious event like family members being injured by a home destroyed by a hurricane, however in the mind of a child, it can be something as seemingly innocuous as a mother crossing a street and appearing to almost be hit by a car. This event is one that involves threats of serious injury, death, or physical integrity to the child or to others.
The child who experiences ASD also must have some symptoms of dissociation. Symptoms of dissociation include a reduced awareness of the child's surroundings, feeling numb or detached, and dissociative amnesia. The last symptom can be quite striking. A boy who was injured escaping a collapsing building may have no recollection of how he got from the home to the hospital.
Children who develop ASD also experience significant avoidance of cues that arouse recollection of the initial trauma. They may avoid conversation of the incident, avoid walking close to the areas where the event occurred, and may refuse to talk to people who were also in the event.
Children with ASD also exhibit increased arousal or anxiety. These symptoms are very difficult to differentiate from mood disorders and ADHD. Children with out of control anxiety can have a very tough time with concentration and have a difficult time sitting still, both hallmark signs of ADHD. These children can also be quite irritable, have an exaggerated startle response, and have a great deal of trouble sleeping.
Symptoms of ASD occur for at least two days, but can last as long as four weeks after the traumatic event. This is an important point, because if the child is experiencing symptoms of inattention due to ADHD, they will exist whether symptoms of ASD are present or not. If ADHD is the cause of the behavioral problems with the child, usually one or more of the 18 symptoms that has been associated with the illness will be present before and after the traumatic event, and it's still worthwhile to treat these symptoms whether the child develops an anxiety disorder or not.
The traumatized child won't ordinarily know why he or she is acting out, why it's difficult to concentrate, why it's tough to keep still. This is why a careful evaluation by a trained professional is so important. If you think that your child may have ADHD or ASD, please consult a physician and find out if treatment would be helpful.