Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults.
BACKGROUND
Atopic dermatitis (AD) is associated with chronic itch, allergic disease and sleep disturbance, all of which might increase the risk of attention deficit (hyperactivity) disorder (ADD/ADHD). Previous analyses have found a consistent association between AD and ADD/ADHD, although the underlying factors contributing to such an association remain underexplored. Additionally, the relationship has been underexplored in adults.


OBJECTIVE
To determine if childhood and adult AD and AD severity are associated with ADD/ADHD and to delineate the factors contributing to such an association.


METHODS
We analysed data on 354 416 children aged 2-17 years and 34 613 adults age 18+ years from 19 U.S. population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children's Health 2003/4 and 2007/8.


RESULTS
In multivariate models adjusting for age, sex, sociodemographics, allergic disease and healthcare utilization, AD was associated with ADD/ADHD in both children [adjusted odds ratio (95% confidence interval), 1·14 (1·03-1·26)] and adults [1·61 (1·25-2·06)]. Children with both severe AD and only 0-3 nights of adequate sleep per week had much higher odds of ADD/ADHD [16·83 (7·02-40·33)] than those with 0-3 nights of adequate sleep per week [1·83 (1·47-2·26)] or mild-moderate AD alone [1·56 (1·22-1·99)]. AD was most strongly associated with severe ADHD. AD unaccompanied by other allergic disease was also associated with increased risk of ADD/ADHD in children. Among children with AD, history of anaemia, headaches and obesity were associated with even higher odds of ADD/ADHD. Asthma, insomnia and headaches increased the odds of ADHD in adults with AD, although underweight body mass index was protective.


CONCLUSIONS
Atopic dermatitis is associated with increased odds of ADD/ADHD in adults and children. Several factors increase the risk of ADHD in adults and children with AD.
Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.
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Strom
Department of Allergy & Immunology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.|Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.
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Fishbein
Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.|Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A.|Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A.
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Paller
Department of Dermatology, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A. jonathanisilverberg@gmail.com.|Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A. jonathanisilverberg@gmail.com.|Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A. jonathanisilverberg@gmail.com.|Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Suite 1600, 676 N. St. Clair St, Chicago, IL, 60611, U.S.A. jonathanisilverberg@gmail.com.
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Silverberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult