Exploring the Association between Legg-Calvé-Perthes Disease and Attention Deficit Hyperactivity Disorder in Children
Julia Berman1, Adi Aran2, Tamar Berenstein-Weyel3
1Hebrew University-Hadassah Medical School, Shaare Zedek Medical Center affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Insights
Attention deficit hyperactivity disorder (ADHD) markers were equally prevalent in children with Legg-Calvé-Perthes disease (LCPD) and their siblings. This study found no direct association between LCPD and ADHD, suggesting shared environmental or genetic factors may be involved.
Area of Science:
- Pediatric Orthopedics
- Child Psychology
- Genetics
Background:
- Legg-Calvé-Perthes disease (LCPD) is a childhood hip condition of unknown cause, affecting children under 15.
- Hyperactivity has been hypothesized to contribute to LCPD through mechanical stress or vascular damage in the hip joint.
- Investigating potential links between LCPD and attention deficit hyperactivity disorder (ADHD) is crucial for understanding etiology.
Purpose of the Study:
- To determine if children with LCPD exhibit higher markers of ADHD compared to their siblings.
- To differentiate the role of hyperactive behavior from shared environmental or genetic factors in LCPD development.
- To assess the prevalence of ADHD in LCPD patients and their unaffected siblings.
Main Methods:
- Children diagnosed with LCPD and their siblings were recruited from a pediatric orthopedic clinic.
- Attention deficit hyperactivity disorder (ADHD) was assessed using the TOVA computerized test and DSM-IV criteria.
- Quality of life, sleep disorders, and daytime sleepiness were evaluated using validated questionnaires.
Main Results:
- Children with LCPD and their siblings showed similarly elevated TOVA scores, indicating ADHD range performance in 73% and 53% of each group, respectively.
- These rates are significantly higher than the general population's 3.6% incidence of ADHD.
- No significant differences in ADHD markers or ancillary test results were found between LCPD patients and their siblings.
Conclusions:
- The study's findings do not support a direct association between Legg-Calvé-Perthes disease (LCPD) and attention deficit hyperactivity disorder (ADHD).
- Elevated ADHD markers in both LCPD patients and their siblings suggest potential shared genetic or environmental influences.
- Further research is needed to elucidate the complex etiology of LCPD.
Background:
Legg-Calvé-Perthes disease (LCPD) is an idiopathic hip osteonecrosis prevalent in children < age 15 years. The etiology remains incompletely understood, partly because of multiple potential environmental risk factors and partly because of lack of genetic markers. It has been hypothesized that hyperactivity may induce mechanical stress and/or vascular damage at a fragile joint.
Objectives:
To assess children with LCPD for markers of attention deficit hyperactivity disorder (ADHD) relative to their unaffected comparably aged siblings to exclude the contribution of hyperactive behavior versus environmental and/or genetic factors in LCPD.
Methods:
All children followed in the Pediatric Orthopedic Clinic, and their comparably aged siblings, were recruited. ADHD was assessed using the TOVA computerized test and DSM-IV criteria. Quality of life and sleep disorders as ancillary tests were assessed using the Child Health Questionnaire (Parent Form 50), Pediatric Outcomes Data Collection Instrument, and Pediatric Daytime Sleepiness Scale.
Results:
Sixteen children with LCPD (age 9.1 ± 3.3, 75% males) were compared with their closest-aged siblings (age 9.3 ± 2.6, 30% males). Mean TOVA scores of children with LCPD (-3.79 ± 2.6) and of their non-LCPD siblings (-3.6 ± 4.04) were lower relative to the general population (0 ± 1.8, P < 0.0001). Both group means were in the ADHD range (≤ -1.8) implying that 73% of this LCPD cohort and 53% of their non-LCPD siblings performed in the ADHD range, relative to 3.6% incidence expected in the general population (P < 0.0001). Other test results were similar in both groups.
Conclusions:
Our findings in a small cohort of children with LCPD and their comparably aged siblings do not support an association between LCPD and ADHD. ADHD markers were equally high in the LCPD children and siblings.
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