Trauma, the Body, and ADHD: A Polyvagal Perspective - Luuk L. Westerhof, MSc

Introduction

Trauma is a pervasive yet often invisible force that profoundly shapes human behavior, health, and relationships. It leaves imprints on the mind, body, and nervous system, influencing how individuals respond to stress, process emotions, and engage with the world. For many, these imprints manifest as behavioral or psychological challenges, including attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD).

Recent advances in neuroscience, particularly Dr. Stephen Porges' Polyvagal Theory [1], offer a groundbreaking framework for understanding how trauma affects the autonomic nervous system. This lens reveals that behaviors associated with ADHD/ADD are often adaptive responses to unresolved trauma rather than intrinsic neurodevelopmental disorders. This insight challenges the over-medicalization of these conditions and advocates for trauma-informed approaches that emphasize healing and regulation.

This article explores the intersection of trauma, the body, and ADHD/ADD from a polyvagal perspective. We will discuss how trauma disrupts the nervous system [1], reframe ADHD/ADD as survival strategies, and present alternative approaches for supporting children and adults. Finally, we will explore how schools and society can foster environments that promote regulation, making punitive and medicalized responses redundant.

Trauma and the Body: A Polyvagal Lens

Understanding Trauma's Impact

Trauma is not defined solely by the nature of an event but by the individual’s nervous system response to it. Experiences like abuse, neglect, or chronic stress can overwhelm the body’s capacity to cope, leading to a state of dysregulation. Trauma affects multiple systems, including the brain, where the amygdala (fear center) becomes hyperactive, the hippocampus (memory center) struggles to contextualize danger, and the prefrontal cortex (logic and decision-making) has a reduced capacity to exert control.

This dysregulation does not remain confined to the brain. As Dr. Bessel van der Kolk[2] noted in The Body Keeps the Score, the body remembers trauma through persistent physiological responses. Chronic dysregulation can manifest as physical symptoms, emotional instability, or behavioral challenges, all rooted in a body that remains "stuck" in survival mode.

Overview of the Polyvagal Theory

Dr. Stephen Porges’ Polyvagal Theory[1] defines how the autonomic nervous system (ANS) orchestrates responses to safety, danger, and life threats. The ANS has three primary states:

1. Ventral Vagal State: This state is associated with safety, connection, and social engagement and enables calmness, curiosity, and connection.
2. Sympathetic State: This state is activated during perceived danger, triggering the fight-or-flight response. It manifests as hypervigilance, anxiety, or physical restlessness.
3. Dorsal Vagal State: Engaged during overwhelming danger, resulting in shutdown or dissociation. It often manifests as lethargy, disconnection, or numbness.

The nervous system constantly scans the environment for cues of safety or danger, a process known as "neuroception." Trauma disrupts neuroception, causing the system to misinterpret neutral or safe stimuli as threats. This dysregulation underpins many trauma-related behaviors.

Trauma’s Effects on Regulation

When the nervous system remains stuck in a dysregulated state, it can no longer effectively access the ventral vagal system[1]. Instead, individuals oscillate between hyperactivation (fight/flight) and hypoactivation (shutdown). While adaptive during the traumatic event, these survival states become maladaptive when prolonged, impairing emotional regulation, attention, and social engagement.

ADHD and ADD Through a Trauma-Informed Lens

Conventional Understandings of ADHD/ADD

ADHD/ADD is typically diagnosed based on symptoms of inattention, hyperactivity, and impulsivity. The prevailing narrative attributes these symptoms to neurobiological or genetic differences, often treated with medication such as stimulants. While this approach can relieve some symptoms, it does not address underlying causes.

Trauma, Dysregulation, and ADHD/ADD

A trauma-informed perspective reframes ADHD/ADD as manifestations of a dysregulated nervous system rather than standalone conditions. Studies linking adverse childhood experiences (ACEs)[3] to ADHD highlight the role of early trauma in shaping behaviors typically associated with the disorder.

1. Hyperactivity and Impulsivity: These behaviors often reflect a sympathetic-dominant state, where the body is stuck in fight/flight mode. This hyperarousal manifests as constant movement, difficulty focusing, and impulsive actions.
2. Inattentiveness: For those in a dorsal vagal state, inattentiveness may result from shutdown or dissociation, where the nervous system disengages from external stimuli as a survival mechanism.

Reframing ADHD/ADD as Adaptive Responses

From a polyvagal lens[1], behaviors labeled as ADHD/ADD are not deficits but adaptive responses to an environment perceived as unsafe. Hypervigilance, impulsivity, and inattentiveness emerge as survival strategies. Recognizing this adaptive function shifts the focus from pathology to understanding and healing.

Supporting Individuals Beyond Medicalization

The Problem with Over-Medicalization

Medicalizing trauma-related behaviors risks masking symptoms rather than addressing their root causes. While medications can provide short-term relief, they do not resolve the nervous system dysregulation driving the behaviors. Over-reliance on medication can also stigmatize individuals and reduce opportunities for relational healing.

Alternatives for Children and Adults

Building Safety and Co-Regulation

Trauma recovery begins with safety[1]. Environments that foster predictability, empathy, and connection help regulate the nervous system. Caregivers and educators play a crucial role as co-regulators, modeling calmness and attunement.

Somatic Therapies

Body-based approaches address the physiological roots of trauma:

• EMDR (Eye Movement Desensitization and Reprocessing)[2]: Helps reprocess traumatic memories.
• Somatic Experiencing[5]: Focuses on releasing stored trauma through body awareness.
• Neurofeedback[4]: Trains the brain to regulate itself.

Polyvagal-Informed Practices

Simple techniques can support regulation:

• Deep, diaphragmatic breathing activates the ventral vagal system.
• Grounding exercises (e.g., noticing sensory inputs) promote present-moment awareness.
• Safe touch, when appropriate, can provide comfort and co-regulation.

Mindfulness and Movement-Based Interventions

Mindfulness, yoga, and movement therapies like martial arts or dance help individuals reconnect with their bodies, fostering regulation and resilience.

The Role of Relationships

Healing often happens in relationships[4]. Caregivers, therapists, and educators who provide attuned, consistent support can act as "external regulators," helping individuals transition from survival to safety.

Redesigning Schools and Society for Regulation

Recognizing Dysregulation in Schools

Traditional school environments often misunderstand trauma-related behaviors, interpreting hyperactivity or inattentiveness as defiance or laziness. Punitive measures like detention or suspension exacerbate dysregulation, reinforcing feelings of unsafety.

Trauma-Informed Educational Practices

Educators trained in trauma-informed care can recognize the signs of dysregulation and respond with compassion rather than punishment. Strategies include:

• Creating predictable routines.
• Offering sensory breaks and movement opportunities.
• Using calm, empathetic communication to de-escalate conflict.

Societal Shifts

A trauma-informed society destigmatizes mental health challenges and prioritizes systemic interventions. Policies addressing poverty, domestic violence, and inequality are critical for preventing trauma and its ripple effects.

Conclusion and Call to Action

Understanding ADHD/ADD through the lens of trauma and the polyvagal theory offers a compassionate alternative to medicalization. By recognizing these behaviors as adaptive responses to dysregulation, we can shift from symptom management to holistic healing. Schools, caregivers, and society at large must embrace trauma-informed practices that promote regulation, resilience, and connection.

The journey from dysregulation to safety requires collective effort and systemic change. By fostering environments of safety and co-regulation, we can help individuals survive and thrive.

References

1. Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.
2. van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
3. Felitti, V. J., et al. (1998). "Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults." American Journal of Preventive Medicine.
4. Siegel, D. J. (2012). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are.
5. Levine, P. A. (1997). Waking the Tiger: Healing Trauma.