Dr. Nicole Brown, a resident at Johns Hopkins Hospital in Baltimore, was troubled by the number of pediatric patients she saw who had ADHD diagnoses. She didn’t doubt that some of them had ADHD. They were described by their parents as hard to manage and their teachers as disruptive and/or inattentive. But they were also kids whose homes and neighborhoods were marked by poverty, violence, and substance abuse.

Dr. Brown was frustrated that the standard treatments for ADHD—behavioral therapy and stimulant medication—weren’t helping many of these kids get their symptoms under control. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience,” she says.

Dr. Brown tested her hypothesis with a study that confirmed the link she observed: Kids who endured four or more adverse childhood events were three times more likely to use ADHD medication.

Dr. Brown’s experience is detailed in an excellent piece in the Atlantic exploring the concern that kids who experience high levels of stress display symptoms that overlap those of ADHD, and that may be leading to misdiagnoses. Inattentive, hyperactive, and impulsive behavior can be the result of chaos, neglect or abuse, and many doctors prescribing ADHD meds may not have, or take, the time to find out what’s happening to kids at home.

“We need to think more carefully about screening for trauma and designing a more trauma-informed treatment plan,” says Dr. Brown.