All ADHD symptoms are also functional symptoms of “mere” severe acute stress, while in other disorders some of these stress symptoms have become dysfunctional (e.g. functional: increased need for caution during stress / dysfunctional: anxiety disorder; functional: increased need for security during stress / dysfunctional: obsessive-compulsive disorder; functional: dysphoria only during inactivity / dysfunctional: depression). While all ADHD symptoms are also stress symptoms, not all stress symptoms are also ADHD symptoms. More on this at ⇒ ADHD symptoms are stress symptoms.
We refer to the advantages of functional stress symptoms as “stress benefits”. ⇒ Stress benefits - the survival-promoting purpose of stress symptoms
Nevertheless, ADHD and severe chronic stress are different things. ADHD is something fundamentally different than a mere reaction to existing stressors.
While the symptoms caused by “merely” severe acute stress disappear again once the stressors (the stress triggers) have disappeared, the symptoms of ADHD persist even without an adequate stressor.
In our opinion, ADHD can be caused by a chronic overreactivity (triggered genetically or by gene-environment interactions) or a deficient shutdown of the stress regulation systems. However, this only affects a subset of those affected.
For ADHD as a whole, ADHD and severe chronic stress mediate their symptoms neurophysiologically in the same way **** (dopamine and noradrenaline deficiency) and therefore show similar symptoms. However, the causes of the dopamine and noradrenaline deficiency differ.
Due to the similarity of symptoms, ADHD and chronic stress are not always easy to distinguish. The confusability of symptoms is the reason why an ADHD diagnosis requires the symptoms to occur over a longer period of time and in several areas of life. However, we doubt whether the 6 months required by the ICD is sufficient. Someone who has been in a severe life crisis for some time, i.e. who has been experiencing severe self-esteem or existence-threatening (= cortisolergic) stress for one or two years, will typically have stress symptoms during this entire long period of time with a severity and frequency that could be confused with ADHD. On the other hand, stimulants are also likely to help these sufferers to compensate for the reduced dopamine levels. We believe it is quite plausible that stimulants will be used as an acute medication for severe stress states in a few years’ time - as a kind of painkiller for the soul.
In order to distinguish ADHD from symptoms of severe chronic stress, it helps to look at the respective life history. The similarity between the symptoms of ADHD and severe chronic stress and the neurophysiological mediation of these symptoms must be distinguished from the fact that ADHD can be caused by early childhood stress if this activates/manifests a genetic ADHD disposition. If the affected person already had the (then still childhood) typical symptoms of massive cortisol-related stress in childhood/school, without corresponding stressors being present the entire time, ADHD can be assumed with some probability. However, if the symptoms were not recognizable in the first 12 years of life, and if they first appeared in the last 6 to 12 months, since a certain stressor existed, a “mere” acute stress overload is more likely.
Late-onset ADHD, which first becomes a burden in adulthood, is possible in women in particular. More on this under Gender differences in ADHD.
It is also conceivable that latent ADHD exists, which the affected person normally copes with “on board”. However, if a chronic stressor is added, even less drastic stress experiences together with the mild (subclinical) ADHD can lead to an overall burden that requires treatment, as their influences on the dopamine and noradrenaline balance add up. This is in line with long-term studies that were unable to diagnose adults who were initially clearly diagnosed with ADHD (or unstable PS) for several years. This also explains why it makes sense to try to discontinue medication every year.
With children, it is much more difficult to distinguish whether they suffer from ADHD or chronic severe stress (which can come from the school environment or from the home) because you cannot look back on a complete school career and other years. ⇒ ADHD diagnosis methods.
Other frequently occurring symptoms do not stem from ADHD itself, but from disorders that often occur together with ADHD, so-called typical comorbidities.
More information on this can be found at ⇒ ADHD - Comorbidity and the subpages on individual comorbidities.
In order to determine whether a symptom results from ADHD or another disorder, a differential diagnosis is required
More information on this can be found at ⇒ Differential diagnostics for ADHD And the subpages on individual differential diagnoses.