Attention-deficit/hyperactivity disorder in children with hearing loss
Diya Ramanathan1, Pavel Kipnis1, Patricia Klaas2
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Children with hearing loss (HL) have higher Attention-Deficit/Hyperactivity Disorder (AD/HD) rates. However, after adjusting for comorbidities and covariates, AD/HD rates are similar between children with and without HL.
Area of Science:
- Pediatric Audiology
- Neurodevelopmental Disorders
- Clinical Research
Background:
- Attention-Deficit/Hyperactivity Disorder (AD/HD) is a common neurodevelopmental disorder.
- Hearing loss (HL) can impact cognitive development and may be associated with AD/HD.
- Understanding the relationship between HL, AD/HD, and comorbidities is crucial for early intervention.
Purpose of the Study:
- To compare AD/HD diagnosis rates in pediatric patients with normal hearing (NH) versus those with hearing loss (HL).
- To evaluate the influence of comorbidities on AD/HD rates in both NH and HL pediatric cohorts.
- To investigate the impact of covariates on the association between HL and AD/HD.
Main Methods:
- Retrospective cohort study of pediatric patients with a history of tympanostomy tube placement (2019-2022).
- Data collected included demographic information, hearing status (type, laterality, severity), and comorbidities (prematurity, genetic syndromes, neurological impairment, ASD).
- AD/HD rates were compared between NH and HL groups, with and without comorbidities, using Fisher's exact test and covariate-adjusted analysis.
Main Results:
- Overall, 141 HL patients and 778 NH patients were analyzed.
- The rate of AD/HD was significantly higher in HL children (12.1%) compared to NH children (3.6%) (p < 0.001).
- In children without comorbidities, HL children still showed higher AD/HD rates (8.0% vs 1.9%, p=0.02), but this significance was lost after covariate adjustment (p=0.72).
Conclusions:
- The initial finding of higher AD/HD rates in children with HL is consistent with prior research.
- After adjusting for comorbidities and covariates, no significant difference in AD/HD rates was observed between HL and NH pediatric patients.
- Clinicians should maintain a low threshold for referring children with HL, especially those with comorbidities, for neurocognitive testing due to potential developmental challenges.
Objective:
To evaluate rates of Attention-Deficit/Hyperactivity Disorder (AD/HD) diagnosis among pediatric patients with normal hearing (NH) and hearing loss (HL) with and without comorbidities.
Study Design:
Retrospective cohort study of NH and HL patients following chart review of all pediatric patients with a history of tympanostomy tube placement treated at the Cleveland Clinic Foundation between 2019 and 2022.
Methods:
Patient demographic information, hearing status (type of HL, laterality, severity), and comorbidities including prematurity, genetic syndromes, disorders with neurological impairment, and autism spectrum disorder (ASD) were collected. Rate of AD/HD amongst HL and NH cohorts with and without comorbidities were compared using Fisher's exact test. Covariate-adjusted analysis was also completed (sex, current age, age at tube placement, and OSA). The primary outcome of interest was rates of AD/HD among children with NH and HL, and the secondary outcome of interest was the impact of comorbidities on rates of AD/HD diagnosis in these cohorts.
Results:
Of the 919 screened patients between 2019 and 2022, there were 778 NH patients and 141 HL patients (80 bilateral, 61 unilateral). HL ranged from mild (n = 110) to moderate (n = 21) to severe/profound (n = 9). Overall, the rate of AD/HD was significantly higher in HL children (12.1% HL vs 3.6% NH, p < 0.001). Of the 919 patients, 157 had comorbidities. In children without comorbidities, HL children still had significantly higher rates of AD/HD compared to NH children (8.0% vs 1.9%, p = 0.02), but there was loss of significance after covariate adjustment (p = 0.72).
Conclusion:
The rate of AD/HD among children with HL (12.1%) is higher than the rate of AD/HD in NH children (3.6%), consistent with previous findings. After excluding patients with comorbidities and adjusting for covariates, there are similar rates of AD/HD between HL and NH patients. Given high rates of comorbidities and AD/HD in HL patients and potential for augmented developmental challenges, clinicians should have a low threshold to refer children with HL for neurocognitive testing, particularly those with any of the comorbidities or covariates described in this study.
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