After the experience of a traumatic event, children and adolescents are especially vulnerable to developing
debilitating symptoms of Posttraumatic Stress Disorder (PTSD). Criteria for diagnosing this disorder in the pediatric
population have proven insufficiently sensitive for children, especially those who are very young. Age-related PTSD
symptom expression suggests PTSD assessment and treatment requires developmental consideration. Preschool age
children, school age children, adolescents, and adults also possess potentially distinct differences from one another in
pharmacokinetics, psychosocial influences, and neurobiology. Pharmacotherapy is often indicated for use in the treatment
of pediatric PTSD. Extrapolation of evidence in adult literature for safety, tolerability, and efficacy is nonlinear and
should not substitute for dedicated drug trials in pediatric PTSD. This paper reviews all identified randomized controlled
trials (RCTs), uncontrolled and open label trials, and case reports/series regarding pharmacotherapy in this population.
Emphasis is placed on methodologic rigor and developmental consideration. These trials are discussed in sufficient detail
to inform readers of their relative strengths and weaknesses, and of the generalizability of the studies’ conclusions. This
review summarizes reports by drug class and developmental cohorts (preschool age, school age, and adolescents). The
review will help clinicians a) decide when medications are needed, b) understand current evidence-based alternatives and
c) utilize a developmental approach in the selection of medication.
Keywords: Adolescents, children, development, medication, pediatric, pharmacotherapy, PTSD, review, UCLA PTSD-I, Tricyclic Antidepressants (TCAs), hyperarousal, Beta-Blockers, Antiepileptics, or AEDs, propranolol, Quetiapine.
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