Background:Posttraumatic stress disorder (PTSD) is a severe psychiatric condition associated with significant impairments in daily functioning. Although psychotherapy is the recommended first-line treatment, off-label psychotropic medications are frequently used. This study examined national treatment patterns and disparities in pediatric PTSD care using a large, diverse data set.Methods:We conducted a retrospective analysis of pediatric patients (ages: 6 to 18) diagnosed with PTSD (ICD-10: F43.1; N = 61,516) from the TriNetX Research Network. Treatment patterns were analyzed across demographic and clinical variables. Odds ratios (ORs), hazard ratios (HRs), and 95% CIs were calculated.Results:The average age at diagnosis was 11.2 years (SD = 3.67), with females comprising 58.3% of the cohort. Mood disorders (59.2%), ADHD, and anxiety disorders were common comorbidities. Antidepressants were prescribed to 51.4% of patients, most commonly sertraline and fluoxetine. Antipsychotics were used in 30.5% of cases, but only 19.2% had prior psychotherapy. Overall, psychotherapy utilization was 35.5%. Black and Hispanic youth were less likely to receive most psychotropics, and Black youth had lower odds of receiving psychotherapy (OR: 0.85, 95% CI: 0.81-0.89), though antipsychotic use did not differ significantly. After controlling for confounders, greater clinical severity was associated with increased antipsychotic use (aHR: 2.79, 95% CI: 2.68-2.90).Conclusions:This study highlights substantial variability in pediatric PTSD care, including frequent psychotropic use, often preceding psychotherapy, and significant racial and ethnic disparities. These findings emphasize the need for standardized protocols, better access to evidence-based care, and targeted strategies to reduce inequities.

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.

Caregiver strain influences service utilization and engagement. Prior work—largely centered on boys—shows that attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) strongly contribute to strain; however, less is known about these relations in girls. This study examined associations between youth psychopathology symptom dimensions (ADHD, ODD, borderline personality features [BPF], a problem more commonly identified in girls) and caregiver strain facets (objective, subjective internalized, subjective externalized, total strain) among caregivers of 10- to 15-year-old girls (N = 197, Mage = 12.06), and whether these associations changed over one year. ADHD, ODD, BPF, and subjective externalized strain increased over time (ΔMrange = 0.03-0.36, 95

BACKGROUND:Posttraumatic stress disorder (PTSD) is a severe psychiatric condition associated with significant impairments in daily functioning. Although psychotherapy is the recommended first-line treatment, off-label psychotropic medications are frequently used. This study examined national treatment patterns and disparities in pediatric PTSD care using a large, diverse data set. METHODS:We conducted a retrospective analysis of pediatric patients (ages: 6 to 18) diagnosed with PTSD (ICD-10: F43.1; N = 61,516) from the TriNetX Research Network. Treatment patterns were analyzed across demographic and clinical variables. Odds ratios (ORs), hazard ratios (HRs), and 95% CIs were calculated. RESULTS:The average age at diagnosis was 11.2 years (SD = 3.67), with females comprising 58.3% of the cohort. Mood disorders (59.2%), ADHD, and anxiety disorders were common comorbidities. Antidepressants were prescribed to 51.4% of patients, most commonly sertraline and fluoxetine. Antipsychotics were used in 30.5% of cases, but only 19.2% had prior psychotherapy. Overall, psychotherapy utilization was 35.5%. Black and Hispanic youth were less likely to receive most psychotropics, and Black youth had lower odds of receiving psychotherapy (OR: 0.85, 95% CI: 0.81-0.89), though antipsychotic use did not differ significantly. After controlling for confounders, greater clinical severity was associated with increased antipsychotic use (aHR: 2.79, 95% CI: 2.68-2.90). CONCLUSIONS:This study highlights substantial variability in pediatric PTSD care, including frequent psychotropic use, often preceding psychotherapy, and significant racial and ethnic disparities. These findings emphasize the need for standardized protocols, better access to evidence-based care, and targeted strategies to reduce inequities.

Our study determined psychological, autism trait, somatic, and demographic variables associated with maternal ratings of stomachaches, constipation, diarrhea, and bowel incontinence in autistic children. Mothers of 1,093 autistic children rated their children on the Pediatric Behavior Scale. In regression analyses, the somatic symptom score (i.e., headaches, other aches/pains excluding stomachaches, complains of feeling sick) was the strongest predictor of stomachaches, constipation, and diarrhea. Scores on the other variables (autism severity, externalizing symptoms, internalizing symptoms, autism traits, sleep problems, demographics) each contributed less than 2% more to explained variance. Decreasing age and decreasing IQ were predictors of bowel incontinence. Only 1 of the 30 significant correlations between GI symptoms and the independent variables was large (stomachaches and other somatic symptoms), one was medium (stomachaches and sadness), and four were small to medium (stomachaches and anxiety and increasing age; bowel incontinence and decreasing age and decreasing IQ). The association between GI problems and psychopathology, autism symptoms, and demographics is weak. Findings suggest that researchers and clinicians need to look beyond these variables and consider medical, physiological, neurobiological, and genetic reasons why GI problems are so common in autism relative to children with other neurodevelopmental disorders and neurotypical children.Lay AbstractThis study explored the reasons why autistic children often experience stomachaches and other digestive issues. We found that other physical symptoms, like headaches, were the biggest predictors of stomach problems, while factors like autism severity, age, or IQ had less influence. The researchers suggest that there may be medical or physical reasons behind these issues, beyond what is currently understood.

OBJECTIVE:Pharmacotherapy guideline concordance for the treatment of major depressive disorder (MDD) is associated with improved symptom severity, but it is unclear whether such associations vary by patients' characteristics or their comorbidity burden. We sought to determine whether guideline concordance varied significantly by 1) sociodemographic characteristics or 2) comorbidity. METHODS:This study evaluated 1,403 U.S. adults (67% female, 85% non-Hispanic/Latino White, mean age of 43 years) with non-psychotic MDD and complete data (n = 1,241/1,403). We used a guideline concordance algorithm (GCA-8) to measure pharmacotherapeutic concordance with the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines and multivariable general linear and proportional odds models to examine associations between this GCA-8 score and patients' characteristics. RESULTS:Being male was significantly associated with higher guideline concordance, but guideline concordance did not vary significantly by any other sociodemographic characteristics. Similarly, no comorbidities examined by this study presented substantial evidence of associations with guideline concordance. Within this sample, the GCA-8 algorithm consistently measured the degree of guideline concordance across different patient types. CONCLUSIONS:This study suggests that guideline concordance for MDD pharmacotherapy, as measured by the GCA-8, does not significantly vary by the comorbidities or sociodemographic characteristics analysed in this study, except for patient-reported gender.

OBJECTIVE:To examine whether thyroid functioning is associated with Clinically Relevant Depression (CRD) in a sample from a psychiatric clinic. METHOD:Patients (≥18 years) treated at a psychiatric clinic with a thyroid-stimulating hormone (TSH) level and PHQ-9 within 6 months were studied. Data on demographic variables and covariates (diagnoses of mood and thyroid disorders), drug, comorbidity, relevant laboratory information and thyroid hormone therapy (THT) were extracted from the electronic medical record. CRD was defined as a PHQ-9 score ≥ 10. Logistic regression models assessed the relationship between TSH categories and CRD, with subgroup analysis by gender, age, mood and thyroid disorder and THT. RESULTS:The study cohort included 1467 patients with 92 % White, 70 % women and the mean age of 44.3 years. The sample's TSH measurements were distributed between normal (90 %), high (7 %), and low (3 %), and 55 % had CRD. Compared to those with normal TSH levels, those with low TSH had 2.50 (95 % CI: [1.17, 5.36]) times greater odds of having CRD while those with high TSH levels had 1.69 (95 % CI: [1.03, 2.79]) times greater odds of having CRD. This U-shaped association between TSH levels and CRD was observed among women (low TSH: 3.53 [1.37, 9.1]; high TSH: 1.95 [1.02, 3.73]) but not men. Post-hoc analyses of TSH and PHQ-9 items, specific depression symptoms showed differential associations with thyroid function. CONCLUSION:CRD was associated with both low and high TSH, independent of mood and thyroid disorders, psychotropic use and THT. Our findings highlight the utility of serum TSH in identifying patients vulnerable to depressive disorders and the need for further longitudinal research.

This study investigated whether a compliance-contingent, shortened time-out (TO) improves behavioral and emotional responses compared to a standard punishment-escalation TO among youth with conduct problems (CP) and varying callous-unemotional (CU) traits. Forty-six 7-12-year-olds in an 8-week summer treatment program completed a counterbalanced within-subject crossover: Standard TO (10-minute start; misbehavior doubled duration; fixed release criteria) vs. Modified TO (10-minute start; compliance enabled reduction to 5 minutes; additional supportive questions). Independent observers coded behavior and affect during TO episodes; staff logged TO characteristics. Analyses used zero-inflated negative binomial and mixed-effects models with covariates. Higher CU predicted fewer TO assignments but less compliance in the Standard TO condition. Contrary to predictions, the Modified TO condition showed higher aggression, lower compliance, and less calm behavior relative to Standard TO. Post-TO, higher CU was related to greater perceived aversiveness in Standard but not Modified TO. Making TO duration behaviorally negotiable did not enhance compliance and may signal rule flexibility for youth with CP and elevated CU traits. Findings of this study support emphasizing structured, consistent, non-negotiable consequences when treating youth with CP and CU.

Objectives: Disruptive mood dysregulation disorder (DMDD), along with other internalizing disorders, is associated with greater impairment in youth with attention-deficit/hyperactivity disorder (ADHD). However, it remains unclear whether DMDD is associated with differences in treatment course and outcomes among youth with ADHD and comorbid internalizing disorders. Using real-world data, this study compared treatment patterns and clinical outcomes among youth with ADHD and internalizing disorders with and without comorbid DMDD. Methods: A retrospective cohort study analyzed electronic health records from the TriNetX U.S. Collaborative Network, including 340,225 youth aged 6-18 years with ADHD and at least one internalizing disorder (major depressive disorders or anxiety disorder), of whom 25,580 (7.5%) had comorbid DMDD. Outcomes included treatment patterns and clinical outcomes. Propensity score matching and Cox proportional hazards models adjusted for confounding were used to estimate relative risks (RR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) over 1 year. Results: Youth with ADHD, internalizing disorders, and DMDD exhibited greater psychiatric comorbidity and higher healthcare utilization than those without DMDD. They received more ADHD medications, with a marked shift toward nonstimulants (RR 1.73, 95% CI 1.69-1.77), and other psychotropic medications, including antidepressants, antipsychotics, and mood stabilizers (RR range 1.36-3.02). New central nervous system (CNS) stimulant prescriptions did not differ between youth with and without DMDD. Compared with nonstimulants, CNS stimulants were associated with lower risks of all adverse outcomes-including suicidal ideation/attempts, inpatient hospitalization, emergency visits, and subsequent antipsychotic or mood stabilizer initiation-in youth both with and without DMDD (aHR range 0.33-0.73). Conclusions: Comorbid DMDD adds clinical complexity among youth with ADHD and internalizing disorders, influencing treatment patterns toward nonstimulants and other psychotropics. Despite this shift, CNS stimulants were associated with the most favorable outcomes across cohorts.

This study aimed to examined whether multidimensional callous-unemotional (CU) traits and conduct problems (CP) yield distinct latent profiles in a clinically referred sample of youth, and if these profiles differ on externalizing symptoms, aggression, irritability, and CU-related impairment. Participants were 290 clinically referred youth (57.9

OBJECTIVE:Irritability and temper outbursts are common presenting concerns in pediatric mental health settings, but systematic monitoring can be difficult to sustain with broad, repeated assessment batteries. This study evaluated the temper outbursts/irritability-2 (TOI-2), an ultra-brief, two-item screener assessing temper outbursts and frequently irritable mood in youth. METHODS:Participants were 1515 youth aged 5-17 years (M = 11.80, SD = 3.60) referred to an outpatient child psychiatry clinic. Female caregivers (90.4% biological mothers) completed the TOI-2 and criterion measures at intake. Convergent and discriminant validity were assessed via correlations with the Affective Reactivity Index (ARI), administered with a current-state timeframe, oppositional defiant disorder (ODD) symptom dimensions, attention-deficit/hyperactivity disorder, conduct disorder (CD), depression, and anxiety. Screening accuracy was evaluated using receiver operating characteristic analysis, with elevated irritability defined as ARI ≥ 4. Clinical utility was examined using screen-positive and screen-negative comparisons and known-group analyses. RESULTS:The TOI-2 showed strong convergence with the ARI and ODD-Irritability symptoms (rs = 0.82). Its association with ODD-Irritability was significantly stronger than with ODD-Behavioral symptoms (r = 0.70; p < 0.001), supporting relative specificity to irritability within the broader disruptive behavior spectrum. ROC analysis indicated excellent classification accuracy, area under the curve = 0.91. Cut scores of ≥2.5 and ≥3.0 both optimized overall performance, Youden's J = 0.66. A threshold of ≥3.0 is recommended for specialty-clinic triage, whereas ≥2.5 may be preferable when maximizing case detection is the priority. Youth who screened positive showed greater symptom severity and poorer adjustment across clinical domains. Known-groups analyses showed the largest TOI-2 elevations among youth meeting symptom-count thresholds for ODD and CD. CONCLUSIONS:The TOI-2 is a psychometrically sound, ultra-brief screener for clinically significant irritability in youth. Positive screens should prompt more comprehensive clinical assessment of irritability, impairment, disruptive behavior, mood symptoms, and treatment needs.

This is the first study comparing children with and without seizures in a large clinical sample and examining differences in diagnoses, IQ, neuropsychological and achievement test scores, and psychological problems. Mothers rated 2,212 children (4-17 years) with autism and/or ADHD on the Pediatric Behavior Scale. A subgroup 6-16 years had neuropsychological and academic achievement test data (n = 820). In the autism/ADHD sample, 2.8% had mother-reported seizures with falling and loss of consciousness, whereas only 0.8% of the population-based contrast sample did. Differences between children with autism, ADHD-Combined, and ADHD-Inattentive were nonsignificant. Seizures were strongly associated with lower IQ, cognitive disengagement syndrome/CDS, and incoordination. Controlling for IQ, the remaining variables were nonsignificant, including working memory, processing speed, verbal comprehension, perceptual reasoning, graphomotor, attention, reading and math scores and maternal ratings of attention deficit, hyperactivity/impulsivity, autism, irritability/tantrums, oppositional behavior, conduct problems, anxiety, depression, insomnia, and social impairment. Findings have implications for understanding associations between seizures and psychological functioning, future studies (e.g., the importance of controlling for IQ), and clinical practice (e.g., assessing for CDS, motor incoordination, and low IQ in children with seizures and providing targeted intervention if these problems are present).

Objective:This study examined temporal trends in mental health diagnoses and treatment patterns among children and adolescents across the COVID-19 pre-pandemic, pandemic, and post-pandemic periods in the United States. Method:This retrospective cohort study used the TriNetX U.S. Collaborative Network, including 13.3 million children and adolescents aged 3 to 18 years with health care encounters from October 2018 to December 2022. Using 2 complementary approaches-rolling monthly health care-seeking incidence and treatment-engaged cohorts (≥2 encounters per phase)-we assessed psychiatric diagnoses, psychotropic medication initiation, and psychotherapy use across 3 phases: pre-pandemic (October 2018 to February 2020), pandemic (March 2020 to July 2021), and post-pandemic (August 2021 to December 2022). Analyses were stratified by age, sex, race, and ethnicity. Results:Incidence rates declined sharply during early pandemic lockdowns, rebounded by March 2021, and remained elevated post-pandemic. Compared with pre-pandemic levels, psychiatric diagnoses increased 24%, psychotropic medications 35%, and psychotherapy 26%. Antidepressants had the largest increases (58%-94%), with female children and adolescents showing steeper rises (65%-137%) compared with male children and adolescents (41%-57%). Attention-deficit/hyperactivity disorder (ADHD) medication use also increased, with the greatest rise in preschoolers (147%), whereas male adolescents showed minimal change or decreases. Racial and ethnic disparities persisted. Among treatment-engaged youth, adolescents had higher antidepressant use (32%-36%) and hydroxyzine use (7%-10%), with reduced benzodiazepine use (7%-4%). Conclusion:Substantial and sustained increases in pediatric behavioral health treatment persisted beyond the acute pandemic period, concentrated among female individuals and driven primarily by antidepressant prescribing. These patterns warrant monitoring and targeted interventions to address sex disparities and persistent racial and ethnic inequities.

Objectives: This study examined sociodemographic and clinical factors associated with attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy receipt in youth and adults with co-occurring ADHD and substance use disorder (SUD). Methods: This retrospective cohort study analyzed the TriNetX US Collaborative Network (2008–2025). Among 2,219,248 patients aged 15–65 with ADHD, 529,550 had co-occurring SUD. ADHD medication prescribing was assessed within one year of diagnosis and stratified by sociodemographic variables and SUD type. Propensity score matching was used for relative risk analyses; Cox proportional hazards models identified predictors of medication receipt. Results: Patients with ADHD and SUD were older and had more psychiatric comorbidities than those with ADHD only. CNS stimulants were prescribed less frequently in patients with SUD than in those without—amphetamines (RR: 0.73, 95% CI: 0.73–0.73) and methylphenidate (RR: 0.62, 95% CI: 0.62–0.63)—and this pattern persisted across subgroups. Nonstimulant prescribing was less affected, with higher rates among adolescents and those with stimulant, opioid, or cocaine-use disorders. Black patients experienced nearly double the SUD-associated reduction in stimulant prescribing compared with white patients. Psychotic disorders were associated with a lower hazard of receiving both medication classes, anxiety disorders with a higher hazard of either class, and mood disorders with a lower stimulant but higher nonstimulant hazard. Conclusions: Concurrent SUD was associated with lower CNS stimulant prescribing across sociodemographic and clinical factors, with disproportionate reductions among minoritized patients and those with psychiatric comorbidities, while nonstimulant prescribing was comparatively less affected. These findings underscore the need for guideline updates and structural reforms to promote equitable treatment.

BACKGROUND:Women with attention-deficit/hyperactivity disorder (ADHD) are also often diagnosed with personality disorders, yet research on reliable and valid assessments of personality pathology in this population has been limited. METHODS:In this study, the psychometric properties of the Level of Personality Functioning Scale- Brief Form - 2.0 (LPFS-BF 2.0) were examined in a sample of 171 adult women with ADHD. RESULTS:A two-factor structure was identified, with one factor, LPF-self, comprised of six items, reflecting impairment in self functioning; the second factor, LPF-interpersonal, comprised of six items, reflecting impairment in interpersonal functioning. LPFS-BF 2.0 factors contributed unique variance to functional impairment beyond the effects of co-occurring depression, anxiety, and ADHD. CONCLUSIONS:These findings suggest the LPFS-BF 2.0 may be important to include in clinical care for women with ADHD, to identify those women with ADHD who may require adjunctive intervention for personality pathology.

OBJECTIVE:This study examined how comorbid major depressive disorder (MDD) influences ADHD treatment patterns and compared the associations between specific ADHD medication classes and clinical outcomes in adolescents and young adults aged 10-24 years. METHODS:This retrospective comparative cohort study analyzed electronic health records from the TriNetX US Collaborative Network (2010-2025). Among 1,026,253 patients with ADHD, 223,665 (21.8%) had comorbid MDD. Propensity score matching yielded balanced cohorts (ADHD-only and ADHD + MDD; 159,259 per cohort). ADHD treatment patterns were assessed prospectively over 12 months. Within the ADHD + MDD cohort, Cox proportional hazards regression examined whether CNS stimulants versus non-stimulants (including bupropion) differed in their associations with suicidality, antipsychotic initiation, mood stabilizer initiation, and intensive healthcare utilization. RESULTS:Compared with ADHD-only, ADHD + MDD was associated with higher overall ADHD medication prescribing, driven primarily by non-stimulants, particularly bupropion (RR 3.75, 95% CI 3.58-3.92), while racial and ethnic minority patients received fewer ADHD medications. New CNS stimulant prescriptions declined following MDD diagnosis (RR 0.92, 95% CI 0.91-0.93), especially in non-psychiatric settings. Among ADHD + MDD, CNS stimulants were associated with more favorable clinical outcomes compared with non-stimulants (aHRs 0.49-0.68). Bupropion demonstrated outcomes broadly comparable to CNS stimulants for suicidality and mood stabilizer initiation. CONCLUSIONS:Comorbid MDD is associated with substantial shifts in ADHD medication prescribing toward non-stimulants, yet CNS stimulants were associated with the most favorable clinical outcomes, with bupropion emerging as a clinically meaningful alternative when a non-stimulant is considered. These findings should be validated in future longitudinal prospective studies and randomized clinical trials.

Aggressive behavior in childhood is a major developmental and educational concern, but school discipline records provide limited information about how aggression is identified and managed in everyday settings. This study used direct observation to characterize office discipline referral (ODR) events among kindergarten through fifth-grade students in 2007, with each of 14 schools observed for one designated week near the end of a randomized school-based intervention trial. Observers recorded 348 referrals involving 296 students. Aggressive or destructive behavior—physical aggression, verbal aggression, or property destruction—accounted for 46.8% of referrals, with physical aggression alone accounting for 38.5%. Aggressive/destructive referrals involved descriptively longer office stays than other referrals, although the within-school difference was smaller and imprecisely estimated after accounting for school-level clustering. Fifth grade had the highest overall referral rate, whereas kindergarten referrals were proportionally most likely to involve aggressive/destructive behavior. Exploratory matched-pair comparisons provided little evidence of differences between intervention and comparison schools in aggressive/destructive referral rates, although some differences in referral composition and prolonged office stays remained imprecisely estimated. ODRs capture a consequential but selective subset of childhood aggression: behavior that is observed, interpreted, and formalized through school disciplinary procedures.

Objective The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) is common and associated with greater clinical complexity. This study evaluated real-world treatment patterns and outcomes among children and adolescents with ADHD, comparing those with and without comorbid ASD. Method A retrospective comparative cohort study analyzed electronic health records from the TriNetX Research Network, including 869,510 children and adolescents aged 3 to 18 years with ADHD, of whom 155,543 (17.9%) had ASD. Outcomes included treatment patterns and clinical outcomes. Analyses used propensity score matching and Cox proportional hazards models adjusted for sociodemographic and psychiatric factors, estimating relative risks (RRs), hazard ratios (HRs), and 95% confidence intervals over 1 year. Results Children and adolescents with ADHD+ASD had higher psychiatric comorbidity and health care use than those without ASD. They received fewer CNS stimulant prescriptions (RR = 0.82, 95% CI = 0.81-0.83) but a higher proportion of non-stimulant prescriptions (RR = 1.52, 95% CI = 1.50-1.54) compared with those without ASD. Slightly higher ADHD prescribing occurred among Hispanic youth (RR = 1.03) and preschoolers (RR = 1.23) with ASD compared to those without ASD. Within the ADHD+ASD cohort, CNS stimulants were associated with the most favorable outcomes, including reduced hospitalization, emergency visits, suicidal behaviors, and subsequent antipsychotic/mood stabilizer initiation (adjusted HRs 0.33-0.83). Atomoxetine showed relatively favorable outcomes among non-stimulants. Conclusion Comorbid ASD in children and adolescents with ADHD increases clinical burden and shifts treatment from CNS stimulants to non-stimulants and other psychotropics. Despite lower use, CNS stimulants are associated with improved outcomes, underscoring the need for prospective studies examining the risk-to-benefit ratio in this population.

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a 41-item rating scale that measures anxiety problems in youth. The SCARED has versions for multiple informants and strong psychometric support. A five-item version (SCARED-5) has been proposed as a brief anxiety screening tool, but limited research has examined its psychometric properties. This study evaluated the SCARED-5 in two samples of youth (Study 1: N = 109 youth, Mage = 12 years; Study 2: N = 175 youth, Mage = 8 years). Results supported the one-factor structure and internal consistency reliability of the SCARED-5 across informants. Total scores from the SCARED-5 were significantly associated with total scores from the full SCARED. Mother and child ratings on the SCARED-5 successfully distinguished anxious and non-anxious youth, but father ratings did not. Receiver operating characteristic analyses supported a clinical cutoff score of 2 on the SCARED-5 for screening purposes. These findings provide preliminary validation for the SCARED-5 as an efficient anxiety screening tool in clinical and research settings. Future research should examine the SCARED-5 in more diverse samples and validate informant-specific cutoff scores, particularly for father ratings.