Bidirectional Influences of Trauma in a Multipathway Model of Attention Deficit Hyperactivity Disorder

The long-standing scientific and popular recognition of attention deficit hyperactivity disorder (ADHD) as a diagnosis of pervasive neurodevelopmental impairment attests to its clinical utility and legitimacy as a neuropsychological construct. However, its symptomatological overlap with proposed diagnoses that capture the pervasive behavioral and attentional sequelae of early developmental trauma as well as certain symptoms of post-traumatic stress disorder (PTSD) give rise to etiological and diagnostic complications when considering the heterogeneous presentation of ADHD across the lifespan. The current study addresses this gap in knowledge by exposing systemic fluctuations in the neuropsychological profiles of individuals based on their exposure to trauma and trauma-related symptomology. In service of this task, the current study used a de-identified archival dataset from a neuropsychological testing facility in Austin, Texas. Only profiles of individuals 16 and older being assessed for attentional dysfunction were included. The first analysis aimed to develop a significantly predictive best fit regression model to differentiate the Conners’ Continuous Performance Test 2nd Edition (CPT-II) profiles of trauma-exposed from non-exposed individuals. The second analysis sought to discover replicable patterns linking specific trauma symptom clusters and features with significant CPT-II scores identified in the first analysis. Women did not evince significant correlations differentiating traumatized from non-traumatized subjects, but males exhibited a significant three factor model. Trauma-exposure in the male sample was negatively correlated with omission errors and confidence index scores, and positively correlated with hit-rate standard error, a measure of response inconstancy. Response inconstancy was further predicted by peri-traumatic dissociation and re-experiencing. Confidence index scores, the rating of a profile’s consistency with ADHD, were negatively associated with post-traumatic stress, and positively associated with re-experiencing. It was surmised that the analysis was influenced by discrete groups of testers seeking assessment for differing reasons. However, the discovery of a significant positive correlation between trauma-exposure and response inconstancy and the association of this measure with higher rates of peri-traumatic dissociation and re-experiencing provides evidence of attentional disturbance associated with traumatization. The association of confidence index scores with re-experiencing suggests a vulnerability factor of ADHD subjects for traumatization. Overall, a bidirectional relationship linking trauma and attentional-dysfunction was supported