title: Attention-deficit/hyperactivity-related symptoms among children with enterovirus 71 infection of the central nervous system.
abstract: BACKGROUND
  No study has investigated the association between enterovirus 71 central nervous system infection and symptoms related to attention-deficit/hyperactivity disorder. In this study we evaluated attention-deficit/hyperactivity disorder-related symptoms and internalizing problems as long-term sequelae resulting from enterovirus 71 central nervous system infection in children.
  
  
  METHODS
  We enrolled 86 children 4 to 16 years old with virus-culture-confirmed enterovirus 71 infection and central nervous system involvement diagnosed 3 to 7 years before the study and 172 control subjects, matched for age, gender, and parents' education levels. Their mothers and teachers were asked to report on possible attention-deficit/hyperactivity disorder-related symptoms, and their mothers were asked to report on possible internalizing problems. All of the children previously infected with enterovirus 71 received intelligence tests.
  
  
  RESULTS
  Forty-two (49%) of the children previously infected with enterovirus 71 had had viral meningitis; 35 (41%) had severe central nervous system involvement, such as encephalitis, poliomyelitis-like syndrome, or encephalomyelitis; and 9 (10%) had cardiopulmonary failure and central nervous system involvement. The children previously infected with enterovirus 71 had higher scores than matched control subjects on teacher- and mother-rated scales of inattention, hyperactivity-impulsivity, oppositional symptoms, and attention-deficit/hyperactivity disorder index. The rate of elevated attention-deficit/hyperactivity disorder-related symptoms among children with enterovirus 71 central nervous system infection was 20%, whereas that rate among matched control subjects was only 3%. They also had more internalizing problems. Their verbal and performance IQs, as well as verbal comprehension indices, were significantly inversely correlated with symptoms of inattention, hyperactivity-impulsivity, and attention-deficit/hyperactivity disorder index scores.
  
  
  CONCLUSIONS
  Enterovirus 71 central nervous system infection may affect long-term regulation of attention and emotion and cause hyperactivity-impulsivity in children.
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Susan Shur-Fen
authors.initials: SS
authors.lastname: Gau
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
authors.forename: Tsui-Yen
authors.initials: TY
authors.lastname: Fan
authors.forename: Yu-Yu
authors.initials: YY
authors.lastname: Wu
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D015984:Causality; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016001:Confidence Intervals; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology; D029821:Enterovirus A, Human / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology