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Greater risk-taking in attention-deficit/hyperactivity disorder (ADHD) leads to more trauma exposures, and dysfunctions in frontal lobe circuits are involved in both ADHD and post-traumatic stress disorder (PTSD). These associations suggest a possible link between the two disorders. After a careful meta-analysis, the current researchers summarized evidence from 22 studies that used structured interviews and normal and trauma controls.
In nine pediatric and six adult study samples, the relative risk for PTSD in ADHD patients was 3.7 compared with normal controls and 1.6 compared with trauma controls. Referral status and adult vs. child cohort did not affect relative risk; still, the risk was greater in older populations. The relative risk for ADHD in PTSD patients was examined in 11 pediatric and 5 adult study samples. The relative risk was 2.1 in the 10 studies using comparisons with trauma controls, but was not significant in comparisons with psychiatric or normal controls (4 and 2 studies, respectively). Age and referral status were unrelated to risk.
Spencer AE et al. Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. J Clin Psychiatry 2015 May 18; [e-pub]. (http://dx.doi.org/10.4088/JCP.14r09479)
Comment
This straightforward meta-analysis has important implications for clinicians. Because evaluation and treatment formulation for each condition can be complex and time-consuming and because the prominence of the presenting problem may obscure the existence of the second condition, clinicians may neglect screening for both. Heightened PTSD risks in ADHD patients compared with trauma controls rules out the hypothesis that ADHD impulsivity simply increased trauma exposure. The authors speculate that commonalities in prenatal nicotine exposure, dopaminergic and prefrontal cortical dysfunction, and genetic polymorphisms involving the dopamine transporter and cannabinoid receptor may underlie the association.