When it comes to ADHD and Post-Traumatic Stress Disorder (PTSD), the lines can easily blur. It can be very difficult to get an accurate diagnosis of one or both. On top of this, ADHD increases the risk of experiencing trauma and developing subsequent PTSD, and trauma can both worsen existing ADHD symptoms or even trigger it in those who are predisposed.[1]
ADHD and PTSD have a lot of overlap and often co-occur, which complicates things further. Characteristics like difficulty focusing, impulsivity, emotional dysregulation, and struggles with working memory can be indicators of both conditions and are typically related to executive dysfunction. It’s not unusual for people to wonder is it ADHD or PTSD that’s causing their struggles.
Executive function refers to the set of cognitive processes that help us manage our thoughts, actions, and emotions. They allow us to plan, organize, focus, and adapt as needed. While both ADHD and PTSD have the potential to disrupt these critical skills, understanding the distinct origins and manifestations of these struggles and how they differ is important for getting the right diagnosis and starting effective treatment.
We’re going to explore how the executive functioning struggles of PTSD and ADHD in adults are similar and how they differ so you can have a clearer understanding of what’s going on and access the most appropriate and effective support. Let’s dive in.
What is Executive Function/Dysfunction?
Executive function is the process that allows people to effectively manage themselves and their resources to achieve a goal. It affects many aspects of our daily lives, from our jobs to household chores and personal care. People who have difficulty accomplishing goals due to struggles with emotional management, cognitive rigidity, impulsiveness, short-term memory, procrastination, and/or disorganization are said to have executive dysfunction.
Executive functioning skills primarily governed by the prefrontal cortex, located in the front part of the brain. While other brain regions store learned information, the prefrontal cortex integrates and applies this knowledge. It determines which information is relevant to a given task, its optimal timing and manner of use, and any associated emotional context. You can think of it like a conductor who’s leading an orchestra, making sure everyone works in harmony to achieve beautiful outcomes.
When someone is experiencing executive dysfunction, they may struggle to follow directions, misplace personal items, miss deadlines, or behave impulsively. Due to their executive functioning challenges, this person will likely also experience poor performance at work or school, which often leads to low self—confidence.
How Do I know if I Have ADHD? What Does ADHD Executive Dysfunction in Adults Look Like?
Executive dysfunction isn’t exclusive to ADHD, but it is a hallmark symptom of the condition and can be a major source of difficulty for those trying to manage day-to-day life. It manifests in different ways. Many ADHD adults (or, as we like to say, adult ADHD-ers) develop coping strategies that can mask underlying difficulties. For this reason, no two people’s executive dysfunction presents the same.
So what does ADHD look like in adults? Some common struggles include starting projects or getting organized, even with important tasks. Procrastination and feeling overwhelmed by the thought of beginning something can be frequent obstacles for adults with ADHD. This can lead to missed deadlines or trying to do too much in one go, quickly leading to burnout. It can also look like difficulties switching gears between tasks, such as getting fixated on one activity and having trouble adapting to unexpected changes in routine or plans.
It is also common to struggle to remember multiple pieces of information simultaneously. This can make following multi-step instructions, applying knowledge to new situations, or keeping track of details within a task more challenging. Time blindness and poor time management overall, such as chronic lateness or under- or overestimating the time it takes to complete tasks, are common. This can lead to frequent heightened stress and difficulties socially and at work.
All of this, combined with difficulties with impulse control and emotional regulation, means that living with ADHD executive dysfunction can be exhausting at best and extremely detrimental to quality of life if unmanaged.
What Does PTSD Executive Dysfunction in Adults Look Like?
PTSD often results from exposure to intensely stressful or even life-threatening events. When a person’s sense of safety is shattered, the brain’s stress response system can become overactive, even when a threat is no longer present. This profoundly impacts the brain’s structure and function, particularly in areas responsible for emotional regulation, memory, and attention. Because of this, in many ways, it can resemble ADHD.
Prolonged or repeated exposure to stressors can lead to dysregulation of the stress response (i.e., sympathetic nervous system). This causes the body to remain in a heightened state of alert (e.g., fight, flight, freeze, fawn), characterized by the excessive production of adrenaline and cortisol. These hormones contribute to a state of nervous system hyperarousal.
Common symptoms that can arise in conjunction with PTSD executive dysfunction include hypervigilance, which means the brain is constantly scanning for potential threats, leading to heightened anxiety, difficulty concentrating, and dissociation. Dissociation is a sense of disconnection from one’s body, thoughts, emotions, or environment, often used as a coping mechanism. Flashbacks, nightmares, and distressing, involuntary thoughts related to the traumatic event can also disrupt focus and mental clarity and lead to executive dysfunction.
Is PTSD the Same as ADHD?: Overlapping Executive Function Difficulties Between PTSD and ADHD
Distinguishing between ADHD and trauma-related executive dysfunction in adults can be a significant hurdle for accurate diagnosis. This is because of a natural overlap in symptoms, which potentially leads to the misidentification of PTSD as ADHD or even a misreading of symptoms entirely.
Can PTSD look like ADHD? Both PTSD and ADHD executive dysfunction can manifest in similar ways but with different root causes. Here’s where they can overlap:
1) Organization & Planning Difficulties
For someone with ADHD, difficulties with organizing and planning can stem from executive dysfunction. This is most commonly associated with ADHDers. In trauma survivors, these same struggles can arise from the overwhelming nature of managing ongoing stress, anxiety, and intrusive thoughts, along with the mental energy spent trying to avoid reminders of the trauma. This can lead to exhaustion and burnout, making managing day-to-day life difficult.
2) Irritability and Anxiety
Both ADHD and PTSD in adults can trigger feelings of frustration, impatience, and heightened worry. ADHDers can struggle with emotional regulation due to executive function challenges. Trauma survivors also experience emotional volatility as their nervous system remains in a heightened state– leading to strong reactions that may seem out of proportion to the trigger.
3) Difficulties with Focus and Attention
While the underlying reasons differ, both individuals with ADHD and those experiencing trauma-related challenges may struggle to sustain focus, appear easily distracted, or have trouble following instructions. This can be frustrating for many reasons, like missing important information or facing difficulties in work, school, and even relationships.
4) Poor Impulse Control
Impulsivity with ADHD can look like interrupting others, making hasty decisions without thinking through consequences, or engaging in risky behaviors. It has a lot to do with structural brain differences and neurochemical imbalances. Trauma survivors, on the other hand, may also act impulsively, but this is typically due to a heightened sense of threat, a need to feel in control, or as a way to numb intense emotions through risky actions. It can be difficult to tell the difference as an observer, so understanding the root of impulsivity is important.
5) Struggles with Working Memory
Working memory deficits in ADHD are a neurological trait. However, PTSD can also severely impact memory, particularly if it involves dissociation or fragmented recall of the event. This adds a layer of complexity when understanding the origin of such difficulties.
The source of these challenges can be subtle. For instance, someone with PTSD may have difficulty following instructions because they are preoccupied with intrusive memories or focused with managing hyperarousal, mimicking the distractibility often seen in ADHD. Similarly, the hypervigilance associated with PTSD can appear outwardly as inattention and be mistaken for ADHD.
This overlap in symptoms between ADHD and trauma-related executive dysfunction highlights the importance of a thorough evaluation by an understanding professional. By working with an expert who can carefully consider your history, symptom profile, and response to various interventions, you can get an accurate diagnosis and receive the most effective treatment.
How are ADHD and PTSD Different?
Despite the overlap, several key distinctions can help get an accurate diagnosis. For example, how long the symptoms have been present can help. ADHD is a neurotype, typically with signs and symptoms present throughout someone’s life. Whereas trauma-related challenges often have a clearer point of origin and are tied to specific events. Unless the trauma occurred in early childhood, executive functioning struggles are less likely to manifest at a young age.
ADHD symptoms tend to be pervasive across multiple settings. Executive dysfunction from PTSD may be more situational, worsening in environments that trigger reminders of past events or provoke a sense of vulnerability. PTSD presentations often include a broader set of symptoms like intrusive memories, hypervigilance, emotional numbing, or social withdrawal, which can impact executive function or look like executive dysfunction but actually help differentiate between the two conditions.
Does ADHD make PTSD worse? Managing Comorbid ADHD and PTSD
As mentioned, it’s not uncommon for ADHD and PTSD to co-occur, which, like other co-occurrences such as AuDHD, can lead to misdiagnosis since one condition can easily mask the other. Studies have found that 10% of people with ADHD also had PTSD, compared to 1.6% of the general population[2].
There are many reasons why someone may have comorbid PTSD and ADHD. Living with ADHD can increase the likelihood of experiencing trauma, especially in childhood[3]. And childhood trauma can even act as a trigger for ADHD[4]. This, combined with a sensitive nervous system often found in those with ADHD, can make traumatic experiences disproportionately impactful, raising the likelihood of developing PTSD. The experience of trauma can also potentially trigger ADHD in those predisposed to ADHD or worsen already present ADHD symptoms. Accurate diagnosis and an integrated treatment approach are very important when both struggles are present.
Distinguishing between adult ADHD and PTSD executive dysfunction requires careful consideration of your history, symptom profile, and response to previous treatments. With accurate diagnosis and a compassionate, tailored approach, people with ADHD, PTSD, or both can overcome these struggles, regain a sense of control, and achieve their full potential.
Struggling with Executive Dysfunction? Work with a Specialist who Understands Adult ADHD and PTSD to get the Right Support
The unique and complex intersection of ADHD and PTSD requires specialized understanding and support to address the different needs of each person. If you’re struggling with executive dysfunction and aren’t sure how to manage it, getting the right kind of support can be life-changing.
If you are interested in seeing a therapist in Los Angeles or California who specializes in neurodivergent-affirming care at our practice, you can send us a message or book a free 20 minute consultation call with Dr. Barajas or Dr. Goldman.
Wondering if perhaps your ADHD has been overlooked or you’ve been misdiagnosed? Working with a skilled assessor, such as Dr. Lee, can help.
