Treatment patterns and clinical outcomes in youth with comorbid ADHD and PTSD: Insights from real-world data

Objectives: Attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) often co-occur in youth, complicating the clinical presentation. However, little is known about how PTSD influences treatment selection or outcomes in youth with ADHD. This study examined prescribing patterns and clinical outcomes among youth with ADHD, with and without comorbid PTSD.

Methods: This retrospective cohort study used electronic health record data from the TriNetX Research Network, including over 714,000 youth (ages 6–18) diagnosed with ADHD (F90), of whom 30,341 (4.25%) also had comorbid PTSD (F43.1). Outcomes included treatment trends, emergency visits, hospitalizations, and subsequent antipsychotic or mood stabilizer prescriptions. Relative risks (RR), hazard ratios (HR), and 95% confidence intervals were calculated using propensity score matching and Cox proportional hazards models adjusted for sociodemographic and psychiatric variables.

Results: Among youth with ADHD, those with comorbid PTSD were older, had more psychiatric comorbidities, and were more likely to receive non-stimulants (RR 1.54, 95% CI 1.51–1.57), antidepressants, antipsychotics, mood stabilizers (RRs 1.29–1.70), and psychotherapy (RR 1.55, 95% CI 1.51–1.60). Methylphenidate prescriptions were slightly lower (RR 0.97, 95% CI 0.95–0.99), while amphetamine use remained stable. Among youth with ADHD and PTSD, CNS stimulants were associated with the most favorable outcomes across all clinical measures, including hospitalizations, emergency visits, and subsequent antipsychotic and mood stabilizer use (aHRs 0.52–0.74), compared with non-stimulants and antidepressants.

Conclusions: Youth with ADHD and PTSD are clinically complex and receive broader treatment interventions. Clinicians appear to de-prioritize stimulants after PTSD diagnosis, despite evidence of superior clinical outcomes. Findings underscore the need for prospective studies and evidence-based treatment guidelines for this high-risk population.