Children with Eczema Struggle More with Comorbid ADHD Symptoms

Children with atopic dermatitis and neurodevelopmental comorbidities including ADHD or other learning disabilities are up to 3 times more likely to struggle with memory than children with any neurodevelopmental condition.

The data, presented by a team of US-based investigators at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, last week, suggest that young patients with eczema should be considered for cognitive evaluation—particularly those with learning or neurodevelopmental disabilities.

Led by Hannah R. Chang, BA, of the University of Texas Southwestern Medical School in Dallas, investigators sought to understand the relationship between atopic dermatitis and learning or memory difficulties, as well as the varied association between the 2 based on children’s comorbid neurodevelopmental conditions including ADHD, developmental delay, and learning disability. They noted that prior research has linked pediatric eczema to sleep disturbance, inattention and learning disabilities.

“Cognitive dysfunction has been reported among children with atopic dermatitis, but whether specific subgroups are more susceptible is unknown,” the team wrote. “Additionally, previous studies often relied on caregiver reported diagnoses of ADHD or developmental delay as proxies of cognitive dysfunction rather than examining symptoms of cognitive impairment.”

The team conducted a cross-sectional, population based study using data of US children aged ≤17 years old with diagnosed atopic dermatitis from the 2021 National Health Interview Survey (NHIS). Patients were stratified by presence or absence of clinician-reported neurodevelopmental conditions; Chang and colleagues sought a primary outcome of difficulty with learning and/or memory compared with a control cohort of healthy children.

The final analysis included approximately 9.2 million pediatric patients with atopic dermatitis, of whom 49.2% were male, 71.1% were White, and mean age was 8.4 years old. Among the control cohort of 60.5 million children without atopic dermatitis, 50.4% were male, 77.9% were White, and mean age was 8.7 years old.

Investigators observed that 10.5% of children with atopic dermatitis and any neurodevelopmental comorbidities had “a lot of difficulty” with learning (95% CI, 5.4 – 19.5). Another 8.2% of the same cohort reported having a lot of difficult with remembering information (95% CI, 4.4 – 14.7). Comparatively, among children with any neurodevelopment disability but without atopic dermatitis, only 5.1% reported a lot of difficulty with learning (95% CI, 3.6 – 7.1) and 3.4% reported a lot of difficulty with remembering information (95% CI, 2.1 – 5.4).

Among children with atopic dermatitis but no neurodevelopmental comorbidities, 0.1% reported a lot of difficulty learning (95% CI, 0.0 – 0.7) and 0.3% reported a lot of difficulty with memory (95% CI, 0.1 – 1.2). These rates were similar to the control cohort of children without atopic dermatitis nor neurodevelopmental disorders.

All children with atopic dermatitis were 77% more likely to report difficulties with learning new information (OR, 1.77; 95% CI, 1.28 – 2.45), and 69% more likely to report difficulties with memory (OR, 1.69; 95% CI, 1.19 – 2.41).

Children with atopic dermatitis and comorbid ADHD were particularly challenged with cognitive difficulties; they were 78% more likely to struggle with learning (OR, 1.78; 95% CI, 0.97 – 3.26) and nearly three-fold more likely to struggle with memory (OR, 2.90; 95% CI, 1.60 – 5.24).

Chang and colleagues concluded that pediatric atopic dermatitis and comorbid neurodevelopmental disabilities are associated with significantly increased risk of cognitive difficulties.

“Our findings improve the risk stratification of patients with AD for cognitive dysfunction and suggest that evaluation for cognitive difficulties should be prioritized among children with comorbid ADHD or learning disability,” the team wrote. “The identification of high-risk subgroups will facilitate efficient neuropsychological screening of children with AD so that affected individuals can benefit from interventions such as educational accommodations or behavioral therapies.”

References

^{Chang HA, Ma EZ, Radtke SR, Wan J. Cognitive symptoms among U.S. children with atopic dermatitis: a population-based study. Paper presented at: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}