A once-daily preparation of guanfacine (guanfacine extended release; Intuniv®) is available and is currently FDA approved for PFI-2 use in ADHD in 6–17 year old children. An open label study of GXR suggests effectiveness for symptoms of traumatic stress and PTSD in children (Connor et al., 2013). In an 8-week open-label design, and using an average GXR daily dose of 1.19 mg ± 0.35 mg and an average weight adjusted daily dose of 0.03 mg/kg ± 0.01 mg/kg significant improvement was found in reexperiencing, avoidant, and overarousal rating scale child trauma symptoms. Of study completers, 71% met a priori criteria for response. This open-label study suggests

that the α2A-adrenoceptor agonist GXR may have therapeutic effects in the treatment of PTSD symptoms

in traumatically stressed children and adolescents and that the effective dose may be lower than that found for ADHD (Connor et al., 2013). As described above, the α1-antagonist, prazosin, has been shown to be effective in treating PTSD in controlled trials of adult subjects. At present, the data on the use of prazosin for symptoms of traumatic stress in the pediatric years is limited to open case reports, generally describing use in adolescents (Brkanac et al., 2003, Fraleigh et al., 2009, Oluwabusi et al., 2012 and Strawn et al., 2009). There is one case report of successful treatment of a seven-year-old AZD8055 solubility dmso child with PTSD using 1 mg of prazosin (Strawn and Keeshin, 2011). Case reports suggest that in daily doses between 1 mg and 4 mg prazosin appears helpful in reducing trauma nightmares in adolescents and possibly in children with MTMR9 PTSD. Although prazosin is used in doses up to 15 mg/day to treat pediatric

hypertension, these case reports suggest possible PTSD effectiveness at lower doses. However, conclusions on the suggested efficacy of prazosin for symptoms of PTSD and traumatic stress await data from more controlled clinical trials. It is especially important to assay and develop treatments for childhood PTSD, as it can have such far-reaching effects. The epidemiology of pediatric trauma exposure reveals that outcomes vary, from resilience to psychopathology, and early death. Influencing outcomes are child specific factors such as antecedent mental health vulnerabilities, family factors such as intact caregiving relationships that serve to buffer stress, and characteristics of the trauma such as proximity, presence of injury, chronicity, and characteristics of the agent (natural disaster versus caregiver inflicted). When psychopathology is an outcome, comorbidity is the rule. The sequelae of childhood traumatic stress include a range of possible outcomes encompassing persistence of posttraumatic symptoms, alterations in developmental trajectories with subsequent impairment in emotional and behavioral control, learning disabilities, persistent aggression and/or violence which increases risk for juvenile justice involvement, substance abuse, and early death (Deans et al.