Drs Spencer and Biederman Reply

See letter by Fluegge and article by Spencer et al

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Drs Spencer and Biederman Reply

To the Editor: We thank Mr Fluegge for his commentary on our recently published article. Our meta-analysis showed a robust and bidirectional association between ADHD and PTSD and included only studies that operationalized the diagnoses of ADHD and PTSD using standardized tools and DSM criteria. Therefore, our study did not address any connection between PTSD-like or ADHD-like symptoms that do not meet DSM criteria or that may be considered atypical presentations of either disorder. We also did not show a specific association with environmental toxins in our meta-analysis.

All subjects with PTSD had, by definition, experienced trauma. Trauma is necessary for the development of PTSD, but not all individuals who are traumatized develop PTSD. Our findings that the association between ADHD and PTSD was not fully explained by trauma indicate that among groups of people who have experienced similar trauma, those with ADHD are more likely to develop PTSD, and those who develop PTSD are more likely to have ADHD. The link we discovered was not between ADHD and trauma, but rather specifically between ADHD and the development of PTSD following a traumatic experience. This finding suggests that individuals with ADHD may have a vulnerability to developing PTSD following a traumatic experience and certainly warrants future investigation.

Andrea E. Spencer, MDa,b

[email protected]

Joseph Biederman, MDa

aClinical & Research Program in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston

bHarvard Medical School, Boston, Massachusetts

Potential conflicts of interest: None.

Funding/support: None.

J Clin Psychiatry 2016;77(9):e1150

dx.doi.org/10.4088/JCP.16lr10630a

© Copyright 2016 Physicians Postgraduate Press, Inc.