The Relationship between ADHD and PTSD Symptoms in Trauma Exposed Adolescents with ADHD
Authors:   , Silverstein Michael Jacob , Daly Brian P. 
Published: September 2023

Background: Attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are comorbid disorders that negatively impact multiple areas of functioning. Little research has examined the association between ADHD and PTSD symptoms and the specific impact of these symptoms on impairment in youth. Investigating these comorbid disorders is critical to inform the development of prevention and intervention efforts for youth who are vulnerable to adverse psychosocial outcomes, such as trauma exposed youth with ADHD. Aims The present study aimed to clarify the relationship between ADHD and PTSD symptom severity in adolescents. The study also sought to investigate how ADHD and PTSD symptoms are independently associated with quality of life (QoL), functional impairments, and executive functioning deficits (EFDs). It was hypothesized that (1) PTSD symptom severity would positively correlate with ADHD symptom severity, (2) ADHD and PTSD symptom severity would each independently predict functional impairments and reduced QoL, and (3) ADHD symptom severity, as compared to PTSD symptom severity, would more strongly predict EFDs. Method Adolescents (ages 11-17) were recruited from medical settings, schools, and the community. Caregivers participated in a pre-screen to confirm their youth's study eligibility by completing an ADHD screener and reporting on their child's trauma history. Youth who screened positive for ADHD and had experienced a PTE were invited to participate in the study assessment. Trained graduate-level evaluators comprehensively assessed ADHD, PTSD, and other psychiatric disorders, and youth and caregivers completed measures of the youth's QoL, functional impairments, and EFDs. Results The final sample was comprised of 17 eligible youth. Results were only sufficiently powered to examine the first hypothesis. Clinician-rated ADHD inattentive (IA) symptom count and clinician-rated PTSD symptom severity were strongly correlated, Spearman's [rho] = .53, p = .030, 95% CI [.06, .80]. Clinician-rated ADHD hyperactive-impulsive (H-I) symptom count and clinician-rated PTSD symptom severity were weakly negative correlated, but not at a statistically significant level, Spearman's [rho] = -.11, p = .689, 95% CI [-.56, .40]. There was a weak, but not statistically significant, partial correlation between clinician-rated ADHD IA symptom count and clinician-rated PTSD symptom severity, Spearman's [rho] = .12, p = .740. ADHD IA and PTSD symptoms were negatively moderately to strongly correlated with QoL and weakly to strongly correlated with functional impairment. ADHD H-I symptoms were negligibly associated with QoL and weakly associated with functional impairment. ADHD IA, ADHD H-I, and PTSD symptom severity were associated with EFDs. ADHD IA symptoms tended to be more strongly associated with EFDs than ADHD H-I symptom count and PTSD symptom severity. Discussion The preliminary results suggest that additional monitoring of IA symptoms in PTE-exposed youth would enable clinicians to better identify those at-risk for ADHD and determine if ADHD-focused interventions may also be necessary. Additionally, results suggest that in PTE-adolescents with ADHD symptoms and impairment in multiple domains, initially targeting ADHD IA symptoms as part of treatment may reduce impairment at a faster rate than focusing on ADHD H-I symptoms as well. Lastly, clinicians evaluating PTE-exposed youth for ADHD would benefit from not only comprehensively ruling out PTSD, but also considering other disorders whose symptoms can present as those of ADHD (e.g., anxiety, depression). A study with a larger sample is needed to better understand the relationship between ADHD and PTSD and their specific impact on functioning.