Longitudinal association between early atopic dermatitis and subsequent attention-deficit or autistic disorder

Abstract

Atopic dermatitis (AD) is one of the common allergic diseases in children. The presence of allergic diseases was found to have association with the risk of developing attention-deficit hyperactivity disorder (ADHD) or autistic spectrum disorder (ASD) in children, but it is still inconclusive. This study was to investigate the longitudinal relationship between AD developed during toddlerhood and subsequent development of ADHD or ASD in later childhood. Toddlers born between 1998 and 2008 and diagnosed with AD at the age younger than 3 years and older than 1 month were retrieved from Taiwan's National Health Insurance Research Database. Age- and gender-matched toddlers with no lifetime AD were enrolled as the control group. All enrolled toddlers were followed until 2011 to identify the development of ADHD or ASD. Multivariate Cox regression analysis was performed to analyze the hazard ratios (HRs). The risks associated with allergic comorbidities were analyzed. A total of 18,473 toddlers were enrolled into the AD group. The presence of AD significantly increased the risk of developing ADHD (HR = 2.92, 95% confidence interval [CI] = 2.48–3.45) or ASD (HR = 8.90, 95% CI = 4.98–15.92) when aged 3 years or older. Children from the AD group with 3 comorbidities together, namely, allergic rhinitis, allergic conjunctivitis, and asthma, had the greatest risk of developing ADHD and ASD (ADHD: HR = 4.67, 95% CI = 3.81–5.43; ASD: HR = 16.65, 95% CI = 8.63–30.60). In conclusion, toddlers who suffer from AD at the age younger than 3 years are at a higher risk of developing ADHD and ASD during later childhood. Pediatricians taking care of toddlers with AD should have knowledge of this increased risk of developing ADHD and ASD later in life, especially when children have certain comorbidities such as allergic rhinitis, allergic conjunctivitis, and asthma.

Eczema and educational attainment: a systematic review

“…As a skin disease, its visibility and accompanying stigma might affect social interactions and performance at school. Eczema has been linked to attention‐deficit hyperactivity disorder (ADHD), possibly through its effect on sleep disturbance, suggesting another possible pathway to lower EA . However, eczema demonstrates a positive socioeconomic gradient, and risks of developing eczema strongly correlate with higher maternal education.…”

“…Eczema has been linked to attention-deficit hyperactivity disorder (ADHD), possibly through its effect on sleep disturbance, suggesting another possible pathway to lower EA. [2][3][4] However, eczema demonstrates a positive socioeconomic gradient, and risks of developing eczema strongly correlate with higher maternal education. ADHD and socioeconomic status could be associated with eczema and atopic eczema.…”

Increased attention‐deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use

“…Epidemiologic studies indicate that AD is not only associated with other atopic conditions, but also with a broad spectrum of other chronic conditions . There is robust epidemiologic evidence that children with AD are at increased risk for attention‐deficit/hyperactivity disorder (ADHD) . Although a causal relationship cannot be concluded from the existing studies, the following findings suggest a key role of AD in the development and/or manifestation of ADHD.…”

“…Atopic dermatitis (AD) constitutes the most prevalent chronic condition in infancy and causes significant morbidity and burden for patients, their families and healthcare systems . Epidemiologic studies indicate that AD is not only associated with other atopic conditions, but also with a broad spectrum of other chronic conditions . There is robust epidemiologic evidence that children with AD are at increased risk for attention‐deficit/hyperactivity disorder (ADHD) .…”

The wounded self—lonely in a crowd: A qualitative study of the voices of children living with atopic dermatitis in Hong Kong

“…Children whose skins are disfigured by AD often experience discrimination or stigmatisation (Chernyshov, ). Previous research has suggested that children living with AD have behavioural problems and experience psychological disturbances, especially psychological stress (Barilla, Felix, & Jorizzo, ), anxiety, depression (Cheng et al, ) and attention deficit hyperactivity disorder (ADHD; Lee et al, ). Generally, children living with AD have a significantly lower quality of life than their healthy peers (Lifschitz, ).…”