title: Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis examining the relationship between attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD).
  
  
  METHODS
  We reviewed literature through PubMed and PsycINFO without a specified date range, utilizing the search (posttraumatic stress disorder OR PTSD) AND (ADHD OR attention deficit hyperactivity disorder OR ADD OR attention deficit disorder OR hyperkinetic syndrome OR minimal brain dysfunction). References from relevant articles were reviewed.
  
  
  METHODS
  We identified 402 articles; 28 met criteria. We included original human research in English that operationalized diagnoses of ADHD and PTSD, evaluated the relationship between the disorders, and included controls. We excluded articles that failed to differentiate ADHD or PTSD from nonspecific or subsyndromal deficits or failed to compare their relationship.
  
  
  METHODS
  We extracted sample size, age, diagnostic methods, design, referral status, control type, and number of subjects with and without ADHD and PTSD alone and combined. We computed meta-analyses for 22 studies examining ADHD in PTSD and PTSD in ADHD using a random effects model and meta-analytic regression. We assessed for heterogeneity and publication bias and adjusted for intrastudy clustering.
  
  
  RESULTS
  The relative risk (RR) for PTSD in ADHD was 2.9 (P < .0005); in samples using healthy controls, the RR was 3.7 (P = .001); and in samples using traumatized controls, the RR was 1.6 (P = .003). The RR for ADHD in PTSD was 1.7 (P < .0005); in samples using traumatized controls, the RR was 2.1 (P < .0005). The association was not significant in samples using psychiatric controls.
  
  
  CONCLUSIONS
  Results indicate a bidirectional association between ADHD and PTSD, suggesting clinical implications and highlighting the need for neurobiological research that examines the mechanisms underlying this connection.
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit St, Warren 625, Boston, MA 02114 aespencer@partners.org.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Spencer
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.forename: Olivia E
authors.initials: OE
authors.lastname: Bogucki
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Pope
authors.forename: Mai
authors.initials: M
authors.lastname: Uchida
authors.forename: Mohammed R
authors.initials: MR
authors.lastname: Milad
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Spencer
authors.forename: K Yvonne
authors.initials: KY
authors.lastname: Woodworth
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D006801:Humans; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*