High Risk for Attention-Deficit Hyperactive Disorder in Pediatric inpatients with Strabismus in Tianjin, China: Hospital-based Cross-sectional Study

Abstract

Background The hospital-based cross-sectional study aimed to explore the high risk for Attention-Deficit Hyperactive Disorder (ADHD) in Pediatric inpatients with Strabismus. Methods Using data from the Tianjin Eye Hospital, we performed a study comparing the incidence, risk factors, and severity of ADHD in children with and without strabismus by the SNAP-IV tool. Results A total of 401 patients with strabismus (exotropia:313; esotropia:42; vertical deviation:46) that ranged from 4 to 24 yrs and 200 healthy controls. SNAP screening detected that incidence of ADHD with strabismus was higher than controls (P=0.005).'' Inattentiveness '', as one subitem of SNAP, showed higher score in strabismic patients than control groups (P=0.027) and significantly associated with age (r=-0.126, P=0.011) and gender (r=-0.129, P=0.010). ADHD with exotropia was higher than other strabismus types(P=0.019), especially in intermittent exotropia patients (P=0.025). Additionally, the incidence of ADHD was significantly greater in male (HR = 0.539; 95% CI 0.331 - 0.331; P = 0.013) and left eye corrected visual acuity (the most dominant eyes) (HR = 0.097; 95% CI 0.012 - 0.775; P = 0.028) for strabismus patients. Subitems analysis of SNAP, except for inattentiveness, were only influenced by gender in strabismus group. Concomitant strabismic patients were more likely presented with oppositional defiant (P=0.009). Conclusions Patients with strabismus, especially in those with exotropia, had a high possibility of ADHD, which were closely linked to gender and the dominant eye‘s visual acuity, and might have an increased risk for ADHD .