Atopic Dermatitis and Academic Achievement—More to Learn

Abstract

Education is one of the strongest factors associated with longterm health and well-being. 1 Chronic health conditions can affect multiple aspects of a child's education, including school readiness, attention, learning, school experience and engagement, attendance, test scores, and graduation rates. Moreover, the consequences of chronic illness may persist even after the child's health has recovered. 2 Interventions designed to address the unique challenges of chronic health conditions can have important and long-lasting benefits.Relatively little research has been conducted on atopic dermatitis (AD, also known as atopic eczema) and education; a 2017 systematic review identified only 1 study that examined the association between AD and educational attainment (ie, graduation rates). 3 In contrast, dozens of studies exist on other, less common childhood conditions, and the Centers for Disease Control and Prevention has specific guidance for managing asthma, diabetes, epilepsy, food allergies, obesity, and oral health in schools. 4 Two new studies in this issue of JAMA Dermatology address this research gap. 5,6 Their results suggest an association among AD, learning, and education, yet a lot remains to be understood about this topic.The study by Schmidt et al 5 aimed to evaluate the association of AD with educational attainment over the past 4 decades in Denmark. Using nationwide data on children with a hospital diagnosis of AD who were matched to control participants from the general population, the authors found that those with AD had a 50% (risk ratio, 1.50; 95% CI, 1.26-1.78) greater likelihood of not completing lower secondary education (equivalent to junior high graduation in the US) and a 16% (risk ratio, 1.16; 95% CI, 1.09-1.18) greater likelihood of not completing upper secondary education (equivalent to high school graduation in the US), but no statistically significant difference in higher educational attainment was found. Schmidt et al 5 defined a separate cohort for each analysis, ensuring that attainment of each level was conditional on the completion of the preceding levels. Strengths of the study included the use of reliable codes for physician diagnosis of AD that were linked to complete educational data for the country as well as the careful control for potential time and attrition bias in the study design. Moreover, Schmidt et al 5 were able to compare those with AD with healthy siblings in an effort to identify whether the outcome was independent of familylevel factors, such as parental educational level and socioeconomic status. The results of the sibling analysis were similar, although the effect sizes were attenuated and failed to reach statistical significance likely because the number of sibling pairs reduced the sample size by about 90% (from approximately 60 000 to 7000 individuals). Therefore, it is still unclear whether AD has an independent association with educational attain-

Melatonin and Sleep Disturbances in Children With Atopic Dermatitis

“…Children with severe AD are known to have lower achievements in school than non-DA children. 22 In this study, disturbed sleep quality was found to be more frequent in the AD group, as measured by CSHQ score. The mean and standard deviation of melatonin levels in the case and control groups were 320.18±49.92 and 383.78 ±74.53 pg/mL, respectively.…”

Phenotypic Overlap between Atopic Dermatitis and Autism

“…The prevalence of autism spectrum disorders (ASD) is approaching 2% in populations of all racial, ethnic and socioeconomic groups, with a fourfold male predominance www.videleaf.com (https://www.tacanow.org/family-resources/latest-autismstatistics-2/ and https://www.cdc.gov/ncbddd/autism/data.html). Autism is diagnosed when a patient demonstrates deficits in social interactions; a lack of social or emotional reciprocity; and learning disabilities [1]. While the diagnosis of ASD is not firmly established until 24 months of age, abnormalities in fMRI scans; preferences for geometric patterns; aberrant social communications; changes in fine motor skills; and/or characteristic eye movements can often be detected as early as 6 months of age [2,3].…”