Have you ever wondered why someone might struggle to concentrate, feel constantly restless, become overwhelmed very easily, or find it difficult to switch off?
Perhaps they are forgetful, emotionally reactive, easily distracted, constantly scanning their surroundings, or struggling with sleep.
At first glance, these difficulties might look like ADHD.
But what if there is something else happening underneath?
For some people, the answer is post-traumatic stress disorder (PTSD). And for others, it may be both ADHD and PTSD.
ADHD and PTSD are two very different conditions, but they can overlap in surprisingly complicated ways. In fact, research suggests that people with ADHD are more likely to experience PTSD, and people with PTSD are also more likely to meet criteria for ADHD. A recent systematic review of adults found that the two conditions frequently occur together and that their combination can be associated with greater psychological and functional difficulties.
So how do we tell them apart?
And what happens when they coexist?
First, what is ADHD?
Attention-deficit/
Although ADHD is often associated with children who are unable to sit still or concentrate at school, that picture is far too narrow.
ADHD can affect attention, impulse control, activity levels, organisation, working memory, motivation and emotional regulation.
An adult with ADHD might say:
"I know exactly what I need to do, but I just can't seem to start."
Or:
"I walked into the room and completely forgot why I was there."
"I have ten things going through my head at once."
"I can concentrate for hours on something I'm interested in, but I can't focus for ten minutes on something boring."
"My emotions feel much bigger than they seem to be for everyone else."
ADHD isn't simply about a lack of attention.
For many people, it is about regulating attention.
The brain may struggle to decide what deserves attention, when attention should shift, and how long it should remain focused on something.
And this is important when we start talking about trauma.
Now, what is PTSD?
Post-traumatic stress disorder can develop after experiencing or witnessing a traumatic or frightening event.
Trauma doesn't affect everyone in the same way, and not everyone who experiences trauma develops PTSD.
When PTSD develops, however, the nervous system can remain stuck in a state of perceived danger even after the threat has passed.
Someone may experience:
- intrusive memories
- nightmares
- flashbacks
- avoidance
- emotional numbness
- hypervigilance
- exaggerated startle responses
- irritability or anger
- sleep difficulties
- concentration problems
- feelings of guilt or shame
- persistent feelings of fear or danger.
The person may intellectually understand that they are safe.
But their nervous system may not have received the message yet.
It's almost as though the body is saying:
"Something terrible happened before, so I need to make sure it never happens again."
That can create a state of constant alertness.
And this is where things become interesting.
When ADHD and PTSD look similar
One of the biggest challenges is that ADHD and PTSD can produce some remarkably similar symptoms.
Both can involve:
Difficulty concentrating
A person with ADHD may struggle to maintain attention because their attention is easily diverted.
A person with PTSD may struggle to concentrate because their mind is preoccupied with danger, memories, intrusive thoughts or emotional distress.
The outward behaviour can look almost identical.
But the underlying mechanism may be completely different.
Restlessness
Someone with ADHD may experience a persistent need for movement, stimulation or activity.
Someone with PTSD may feel physically restless because their nervous system is activated and preparing for danger.
In other words:
ADHD may say, "I need stimulation."
PTSD may say, "I need to stay ready."
And sometimes both messages can be operating at the same time.
Emotional dysregulation
Emotional regulation can also be difficult in both conditions.
A person with ADHD may experience emotions intensely and move rapidly from one emotional state to another.
They might become frustrated quickly, feel overwhelmed by criticism, or experience rejection very intensely.
With PTSD, emotional reactions may be triggered by reminders of trauma, perceived threats, interpersonal situations or memories associated with the traumatic experience.
Again, the behaviour may look similar.
The why is different.
And understanding the why matters.
Hypervigilance versus distractibility
Here's another important distinction.
Imagine someone sitting in a café.
They keep looking around the room.
They're listening to every conversation.
They notice when someone walks behind them.
They become distracted by noises.
They can't relax.
Is that ADHD?
Possibly.
But it could also be hypervigilance associated with PTSD.
A person experiencing hypervigilance isn't necessarily distracted because their attention system is simply "wandering."
Their brain may actually be doing the opposite.
It may be paying attention to everything because it is searching for danger.
That distinction can be incredibly important in assessment.
ADHD can exist before the trauma
One of the most important questions to ask is:
"When did these difficulties begin?"
ADHD is a neurodevelopmental condition, meaning that symptoms begin during childhood, even though they may not always be recognised or diagnosed until adulthood.
A person may have developed coping strategies that masked their difficulties for years.
They may have performed well academically but struggled enormously with organisation.
They may have relied on intense last-minute pressure to complete tasks.
They may have been described as "lazy," "careless," "daydreamy," "too sensitive," or "not reaching their potential."
Then something traumatic happens.
Suddenly, their existing difficulties become much more noticeable.
The trauma hasn't necessarily caused the ADHD.
Instead, it may have overwhelmed the coping strategies that previously kept the ADHD manageable.
Trauma can also make ADHD symptoms appear worse
Imagine someone who already struggles with attention.
Now add:
- poor sleep
- nightmares
- anxiety
- intrusive memories
- hypervigilance
- emotional distress
- avoidance
- constant physiological arousal.
Of course their concentration may deteriorate.
Their executive functioning may feel worse.
Their memory may become less reliable.
They may struggle even more with planning and organisation.
This is one reason clinicians need to be careful about assuming that every concentration problem automatically means ADHD.
And sometimes it really is both
This is perhaps the most important message.
We don't always have to choose between ADHD or PTSD.
Sometimes the answer is:
ADHD and PTSD.
Research has consistently identified an association between the two conditions. A systematic review and meta-analysis found evidence of a bidirectional relationship, with people with ADHD showing increased risk of PTSD and people with PTSD showing increased likelihood of ADHD.
A more recent systematic review of adult studies similarly found substantial overlap between the conditions and reported that people with both may experience greater psychosocial impairment and more severe PTSD symptoms.
This doesn't mean that ADHD inevitably causes PTSD, or that PTSD inevitably causes ADHD.
Rather, their relationship appears to be complex and multifaceted.
Why might ADHD and PTSD be connected?
Researchers are still investigating this question.
One possibility is that people with ADHD may experience greater exposure to certain risks across their lives.
Impulsivity, difficulties with planning, emotional regulation difficulties, interpersonal problems and problems recognising or responding to risk can sometimes increase vulnerability to adverse experiences.
At the same time, repeated exposure to stressful or traumatic environments can have profound effects on attention, emotional regulation and arousal.
There may also be shared biological and familial factors.
Research has identified overlapping features involving arousal regulation, for example.
But it is important not to reduce this relationship to a simple cause-and-effect story.
Trauma is not simply another explanation for ADHD, and ADHD is not simply a cause of trauma.
Each person needs to be understood within their own developmental and psychological history.
The importance of developmental history
When assessing possible ADHD in someone who also has PTSD, one of the most useful questions is:
"What was this person like before the trauma?"
This doesn't mean that we dismiss their current symptoms.
Instead, we are trying to understand their timeline.
For example:
Before trauma:
- Were they chronically forgetful?
- Did they struggle with organisation?
- Were they easily distracted?
- Did they have difficulties completing tasks?
- Were they impulsive?
- Did teachers describe them as inattentive or restless?
- Did these difficulties occur across different environments?
After trauma:
- Did concentration suddenly deteriorate?
- Did nightmares begin?
- Did they become hypervigilant?
- Did they start avoiding particular situations?
- Did they develop intrusive memories?
- Did their sleep change?
- Did they become more emotionally reactive?
This timeline can provide valuable clinical information.
A person can be misunderstood for years
There is another human side to this conversation.
Imagine someone who has spent their entire life being told:
"You're not trying hard enough."
"Why can't you just concentrate?"
"You're so disorganised."
"You're too emotional."
"You overreact to everything."
Then they experience trauma.
Now they're told:
"You're anxious."
"You're on edge."
"You need to calm down."
"Why can't you just move on?"
They may eventually begin to believe that something is fundamentally wrong with them.
But sometimes the more helpful question isn't:
"What's wrong with you?"
It's:
"What has your brain and nervous system learned to do in order to survive?"
That shift can be incredibly compassionate.
ADHD, PTSD and the nervous system
It can be helpful to think about both conditions through the concept of regulation.
The nervous system is constantly receiving information about what is happening inside and outside the body.
For someone with PTSD, the nervous system may become particularly sensitive to cues associated with danger.
For someone with ADHD, regulation of attention, impulses, motivation and arousal can be challenging.
When both are present, the person may experience an exhausting combination:
"My brain won't focus, and my body won't relax."
They may feel simultaneously:
- overwhelmed and under-stimulated
- exhausted and restless
- distracted and hyperfocused
- emotionally numb and emotionally flooded
- desperate for stimulation but unable to tolerate too much stimulation.
This can be incredibly confusing for the person experiencing it.
Treatment: where do we begin?
There isn't one universal treatment plan for everyone with ADHD and PTSD.
Treatment needs to be individualised, taking into account symptom severity, developmental history, trauma history, current functioning, safety, comorbid conditions and the person's own goals.
For PTSD, evidence-based trauma-focused psychological therapies include approaches such as trauma-focused CBT, cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy and prolonged exposure. NICE recommends individual trauma-focused CBT for adults with PTSD or clinically important PTSD symptoms presenting more than one month after the traumatic event.
For ADHD, treatment may involve psychological strategies, environmental adjustments, psychoeducation and, where clinically appropriate, medication.
When both conditions are present, clinicians may need to think carefully about which symptoms are maintaining the person's difficulties and what needs to be stabilised first.
Don't rush trauma processing
This is particularly important clinically.
Someone with PTSD may desperately want to "get rid of the memories."
But effective trauma therapy isn't simply about asking someone to repeatedly describe the worst thing that ever happened to them.
Good trauma treatment includes preparation.
This can involve developing:
- emotional regulation skills
- grounding strategies
- awareness of triggers
- coping strategies
- safety planning
- stabilisation
- strategies for managing physiological arousal.
NICE guidance specifically recommends psychoeducation, strategies for managing arousal and flashbacks, safety planning and the development and processing of trauma memories within trauma-focused treatment.
For someone with ADHD, therapy may also need to be adapted to their attentional and executive-functioning needs.
For example, shorter tasks, written reminders, repetition, visual structure and practical exercises may be more helpful than lengthy verbal explanations.
Therapy doesn't have to be "one size fits all"
Imagine telling someone with ADHD:
"Your homework is to remember to complete this long worksheet every day."
And then becoming frustrated when they don't do it.
Perhaps the problem isn't lack of motivation.
Perhaps the task doesn't fit the person's executive-functioning profile.
Similarly, telling someone with PTSD:
"You need to stop avoiding your memories."
isn't enough.
We need to understand what their avoidance is doing for them.
What are they afraid will happen if they remember?
What does the memory mean to them?
What sensations appear in their body?
What do they believe about themselves since the trauma?
Good therapy looks beyond the symptom and asks:
"What function does this behaviour serve?"
The importance of self-compassion
People living with ADHD and PTSD often carry enormous amounts of shame.
They may think:
"Why can't I be normal?"
"Why can't I get my life together?"
"Why am I still affected by this?"
"Everyone else seems to cope. Why can't I?"
But healing isn't about becoming someone who never struggles.
It is about developing a better understanding of yourself and learning strategies that work with your brain and nervous system rather than constantly fighting against them.
ADHD does not mean someone is lazy.
PTSD does not mean someone is weak.
And having both certainly does not mean someone is broken.
When ADHD and PTSD meet, compassion matters
ADHD and PTSD can create a complicated web of symptoms.
Difficulty concentrating may be ADHD.
Or PTSD.
Or both.
Restlessness may be ADHD.
Or hyperarousal.
Emotional dysregulation may be associated with ADHD.
Or trauma.
Sleep problems may intensify both.
And once the conditions interact, each can potentially make the other's symptoms more difficult to manage.
This is why careful assessment matters.
Rather than asking:
"Which diagnosis explains everything?"
we can ask:
"What is happening for this person, when did it begin, what maintains it, and what would help them feel safer and more capable?"
That approach allows us to see the whole person rather than reducing them to a diagnosis.
And perhaps that is one of the most important things therapy can offer:
Not simply an explanation for why someone struggles, but a compassionate understanding of who they are beyond their symptoms.
Final thoughts
Living with ADHD can already make everyday life feel harder than it appears from the outside.
Living with PTSD can make the world feel unsafe even when danger is no longer present.
Living with both can feel like having a brain that struggles to slow down while a nervous system struggles to stand down.
But understanding the connection can be the beginning of change.
With appropriate assessment, evidence-based treatment, practical strategies and compassionate support, people can learn to understand their brains, regulate their nervous systems and rebuild a sense of safety and confidence.
A diagnosis should never become a label that limits someone.
At its best, it becomes a map—a way of understanding the journey so that we can finally work out where to go next.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing.
Magdi, H. M., Abousoliman, A. D., Megahed Ibrahim, A., Gamal Elsehrawy, M., EL-Gazar, H. E., & Zoromba, M. A. (2025). Attention-deficit/
NICE. (2018, updated guidance). Post-traumatic stress disorder (NG116): Recommendations. National Institute for Health and Care Excellence.
Spencer, A. E., Faraone, S. V., Biederman, J., & others. (2013). Posttraumatic stress disorder in adult attention-deficit/
Wozniak, J., Crawford, M. H., Biederman, J., et al. (2012). Attention-deficit/
Wang, H., et al. (2025). Sex differences in the comorbidity between attention deficit-hyperactivity disorder and posttraumatic stress disorder: A systematic literature review and meta-analysis.
Levy, H. C., & others. (2015). Examining the association between posttraumatic stress disorder and attention-deficit/