Utility of ADHD Medications in Children and Adolescents with Trauma-Related Presentations: A Systematic Scoping...

Post-traumatic stress disorder and trauma-related presentations in children and adolescents frequently co-occur with attention deficit hyperactivity disorder (ADHD), compounding functional impairment. Because evidence-based pediatric treatment options for trauma-related presentations remain limited and symptoms can overlap with ADHD, optimizing the choice of ADHD medications is of clinical importance.

This review aimed to map and synthesize the available evidence for the utility of different ADHD medications in children and adolescents with trauma-related presentations.

A systematic scoping review was undertaken following the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Medline, Embase, PsycINFO, and gray literature sources were searched for studies published between January 1985 and November 2025. Findings were synthesized narratively and organized by medication class.

From 3,626 identified records, 19 were included in the final analysis (15 primary studies and 4 systematic reviews). These consisted of case reports (N = 8), open-label trials (N = 4), retrospective chart reviews (N = 2), and one large-scale electronic health record study. Alpha-2 agonists (guanfacine and clonidine) were associated with the most consistently reported improvements for trauma-related symptoms. Although stimulants and atomoxetine did not show consistent improvement in trauma-related symptoms across available studies, real-world data revealed that stimulant use was associated with reduced hospitalization, emergency department visits, and secondary antipsychotic or mood stabilizer prescribing in comorbid youth. No studies evaluating viloxazine were identified.

Stimulants have been shown to benefit wider long-term psychiatric outcomes, although smaller studies demonstrated a more consistent improvement in specific trauma-related symptoms with alpha-2 agonists. Rather than following a rigid medication sequence, clinicians should adopt a trauma-informed approach that prioritizes or combines treatments based on whether ADHD or trauma is the primary driver of functional impairment. However, because the current evidence is predominantly low quality and lacks controlled trials, these findings must be interpreted with caution.