Pediatric transplant recipients must maintain stable immunosuppression to prevent rejection and organ loss, yet medication nonadherence rates are unacceptably high. 1,2 Adolescent recipients are more likely to become nonadherent as they age 2-4 ; however, intervention efforts have shown limited success. 5 A promising (but understudied) approach is related to the association between nonadherence and posttraumatic stress symptoms (PTSS).In posttraumatic stress disorder (PTSD), psychiatric symptoms emerge following exposure to a potentially traumatic event (PTE). To meet the definition of a disorder, individuals must endorse symptoms from four clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, and changes in arousal/reactivity) as well as substantial distress and/or dysfunction. 6 While these diagnostic criteria are important for identifying individuals most in need of psychiatric treatment, subthreshold symptomatology (i.e., PTSS) may still be associated with increased risk for clinically significant distress or impairment. 7,8