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Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder--a prospective birth cohort study
Jon Genuneit1, Stefanie Braig, Stephanie Brandt
1Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Insights
Early childhood atopic eczema (AE) is linked to a higher risk of attention-deficit/hyperactivity disorder (ADHD). This association appears strongest in early life and diminishes over time, suggesting a potential early-life vulnerability.
Area of Science:
- Pediatric comorbidity research
- Epidemiology of neurodevelopmental disorders
- Allergy and immunology
Background:
- Childhood atopic eczema (AE) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur.
- The temporal relationship between AE and ADHD onset remains unclear.
Purpose of the Study:
- To investigate the temporal relationship between childhood atopic eczema (AE) and attention-deficit/hyperactivity disorder (ADHD).
- To determine if early AE increases the risk for developing ADHD later in life.
Main Methods:
- Analysis of a population-based, prospective birth cohort study of 770 children followed up to age 11.
- Data on AE, rhinoconjunctivitis, and ADHD diagnoses collected via parental questionnaires and physician reports.
- Adjusted relative risks (aRR) calculated using modified Poisson regression.
Main Results:
- Parental reports indicated a strong association between early AE (up to age 4) and early ADHD (aRR: 5.17).
- No significant association was found between early AE and late ADHD, or between late AE and late ADHD.
- The observed pattern was independent of rhinoconjunctivitis presence.
Conclusions:
- The comorbidity of AE and ADHD may stem from a shared vulnerability, potentially greater in early life.
- This vulnerability appears to decrease over time since AE onset.
- Findings suggest considering temporal relationships in research on underlying mechanisms and in clinical screening for ADHD in children with AE.
Background:
Comorbidity between childhood atopic eczema (AE) and attention-deficit/hyperactivity disorder (ADHD) has been observed, but temporal relationships remain unclear.
Methods:
We analyzed data of a population-based, prospective birth cohort study among 770 children included at baseline in 2000/2001 with follow-up up to age 11. Information on age at diagnosis of AE, rhinoconjunctivitis, and ADHD was obtained by questionnaires administered to parents and for AE also to caring physicians. Adjusted relative risks (aRR) with 95% confidence intervals (95% CI) were modeled with a modified Poisson regression.
Results:
Early AE up to age 4 yr was reported for 14.8% of the children by the parents and for 26.0% by the physicians with only fair agreement between these reports (kappa = 0.36). Based on parental reports, the association of early AE with early ADHD was strong (aRR: 5.17, 95% CI: 2.18; 12.28), but absent for late ADHD [aRR: 0.50 (0.13; 2.02)]. The association of late AE with late ADHD [aRR: 3.03 (0.75; 12.29)] was not statistically significant. This pattern was independent of the presence of rhinoconjunctivitis.
Conclusions:
The observed comorbidity between AE and ADHD may indicate vulnerability to develop ADHD symptoms in response to AE symptoms or through a common underlying mechanism. This vulnerability seems to decrease with time since AE onset and may be greater in early life. These temporal relationships should be considered in future research investigating mechanisms linking both diseases and in clinical efforts to screen for and prevent ADHD symptoms in children with AE.
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