Long-term psychiatric outcomes in youth with enterovirus A71 central nervous system involvement

Area of Science:

• Neurology
• Neurodevelopmental Disorders
• Psychiatry

Background:

• Enterovirus A71 (EV-A71) central nervous system (CNS) infection can lead to long-term neurological and neurodevelopmental issues.
• The impact of early-life EV-A71 CNS infection on the subsequent development of psychiatric disorders remains under-investigated.
• No prior longitudinal studies have systematically examined these long-term psychiatric consequences.

Purpose of the Study:

• To investigate the long-term psychiatric sequelae of childhood EV-A71 CNS infection.
• To compare the prevalence of psychiatric disorders in EV-A71 CNS-infected youth with national and community-based cohorts.
• To assess emotional, behavioral, and cognitive outcomes in a cohort of youth with a history of EV-A71 CNS infection.

Main Methods:

• A naturalistic longitudinal follow-up study of 43 youth with a history of EV-A71 CNS involvement (6-18 years prior).
• Psychiatric assessment via diagnostic interviews, parent/self-rated questionnaires, and neuropsychological testing.
• Comparison of psychiatric disorder prevalence to a national cohort and comparison of emotional/behavioral/cognitive function to matched ADHD and healthy control groups.

Main Results:

• Youth with a history of EV-A71 CNS involvement had a threefold increased odds of receiving an Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis compared to the national sample (34.9% vs. 10.1%).
• No other psychiatric diagnoses were found to be more common in the EV-A71 CNS-infected group.
• EV-A71 CNS-infected youth with psychiatric disorders exhibited comparable ADHD symptoms, oppositional behaviors, autistic features, and attention deficits to community-based ADHD youth, all more severe than healthy controls.
• Autistic features were similarly present in EV-A71 CNS-infected youth (with or without psychiatric disorders) and ADHD youth.

Conclusions:

• Childhood EV-A71 CNS infection is associated with a significantly higher risk of developing ADHD in later life.
• Long-term psychiatric outcomes may include ADHD, alongside social, communication, and emotional difficulties, and autistic features.
• Earlier identification and intervention for these developmental and psychiatric problems in children with a history of EV-A71 CNS infection are recommended.