Association between childhood asthma and attention deficit hyperactivity or autism spectrum disorders: A systematic review with meta‐analysis

Abstract

Background: Children with asthma are at risk of depression and anxiety and growing evidence suggest they may also be at risk of attention deficit hyperreactivity disorder (ADHD) and autism spectrum disorder (ASD). Here, we conducted a systematic review with meta-analysis of studies investigating association between asthma and ADHD or ASD in children. Methods: A comprehensive search using PubMed, EMBASE and Cochrane Library databases was completed in March 2019. Observational human studies published in English, clinic-based or population-based with a healthy comparator group, evaluating asthma-ADHD or asthma-ASD overlap in children 18 years or younger using categorical diagnoses (yes/no) were considered for inclusion. Random effects metaanalysis models were used to analyse data. The Newcastle Ottawa Scale was used to evaluate risk of bias. Results: A total of 25 asthma-ADHD studies were included of which 17 showed significant positive associations and one a negative association: 17/25 studies were population-based, 19/25 were cross-sectional or cohort studies and 7/25 had a low risk of bias. We performed a meta-analysis of 23 of the studies, which showed a significant association between asthma and ADHD: odds ratio (OR) 1.52 (1.42-1.63), P < .001, I2 = 60%. All studies were adjusted for age and sex and a large proportion; that is, 19/23 were further adjusted for relevant confounders. Seventeen asthma-ASD studies were included, whereof 7 showed a positive association and 3 a negative association; 8/17 were population-based with a cross-sectional study design and 4/17 had a low risk of bias. We performed a meta-analysis of 14 of the studies, which did not show a significant association between asthma and ASD: OR 1.12 (0.93-1.34), P = .24, I2 = 89%. All studies were adjusted for age and sex and 10/14 were further adjusted for relevant confounders. Conclusions: This systematic review with meta-analyses shows a significant overlap between asthma and ADHD, but not between asthma and ASD in children. Clinicians taking care of children with asthma or ADHD should be aware of such association to aid an early diagnosis and treatment of such comorbidity. | 229 KAAS et Al.

Association of Food Allergy, Respiratory Allergy, and Skin Allergy with Attention Deficit/Hyperactivity Disorder among Children

“…Previous studies examining the association between allergic conditions and ADHD are predominately focused on respiratory allergy and skin allergy [ 17 , 18 ]. For example, a meta-analysis including 25 studies about asthma and ADHD found a significant association between asthma and ADHD, with an odds ratio of 1.52 [ 19 ]. Hospital-diagnosed atopic dermatitis was found to be associated with ADHD in a case-control study in Danish children [ 20 ].…”

Early Sensory and Temperament Features in Infants Born to Mothers With Asthma: A Cross-Sectional Study

“…Prenatal maternal immune activation is posited to be one mechanism underlying the relationship between maternal and offspring asthma (Barrett, 2008). Children with asthma have been reported to have more difficulties with cognitive capabilities (e.g., executive functioning; Irani et al, 2017) and behaviour (e.g., attention-deficit/hyperactivity disorder; Kaas et al, 2021). There is also some evidence that children with asthma differ in temperament from the general population (Kim et al, 1980;Lilljeqvist et al, 2002).…”

What Is The Impact of Atopic Diseases On Symptoms Dimension of Attention-Deficit/Hyperactivity Disorder: A Systematic Review And Meta-Analysis

“…Asthma had a signi cant association only with the severity of total ADHD symptoms. Considering that previous studies have reported that children with asthma had an increased risk of developing severe ADHD symptoms 18,21,35 , this result may be attributed to the small number of included studies (n = 3). The results of the subgroup analysis of different types of atopic diseases indicated that all atopic diseases were signi cantly associated with the severity of total ADHD symptoms; however, inconsistent heterogeneity was observed in the association between atopic diseases and the severity of hyperactivity/impulsivity and inattention.…”

“…A previous study investigated the relationship between atopic diseases and ADHD 15 . A higher risk of ADHD was noted in patients with all three atopic diseases, namely atopic dermatitis, asthma, and atopic rhinitis (i.e., atopic march) 16,17 . In addition, children with both atopic diseases and ADHD had an increased risk of developing more severe ADHD symptoms compared with those with only ADHD 18 .…”

“…Although several meta-analyses and systematic reviews have strongly supported the relationship between atopic diseases and ADHD 17,19−21 , they still had many limitations. The heterogeneity observed in some systematic reviews might have affected their ndings; for instance, some reviews did not include studies with standard inclusion and exclusion criteria, and whether the atopic and control groups included patients diagnosed as having ADHD remained unclear 16,19 . In addition, few studies have reported a relationship between atopic diseases and subthreshold ADHD.…”