Increased Attention Deficit/Hyperactivity Symptoms Of 6-12 Years Old Chinese Children With Atopic Dermatitis

Objective:To investigate co-occurrence of ADHD symptoms of AD and the relevant risk factors,as well as its impact on the quality of life in Chinese school-aged children with AD.Methods: Outpatients aged 6–12 years with confirmed AD according to Williams criteria in the Dermatology Department of Children’s Hospital of Chongqing Medical University and healthy controls matched for age were randomly included in this study from October 2018 to October 2019.AD severity,pruritus and sleep deprivation were evaluated by dermatologists using the Severity Scoring of Atopic Dermatitis(SCORAD)scale.The children’s quality of life was evaluated by dermatologists using the Children’s Dermatology Life Quality Index(CDLQI).Parents of patients with AD use the SNAP-IV 26-item rating scale to screen children for symptoms of ADHD,such as inattention,hyperactivity/impulse and oppositional defiant disorder..Results: The study included 89 AD patients(mean age,8.30±1.69 years;61.8% male)and 184 healthy controls(mean age,8.29±1.99 years;63% male).Hyperactivity/impulse scores were higher in the AD than in the control group(P<0.05).Children with AD were more likely to have ADHD symptoms than children without AD(10.1% vs.3.8%;P<0.05),especially hyperactive/impulsive symptoms and oppositional defiant disorder(6.7% VS 1.6%,P<0.05;5.6% VS 0,P<0.01).Moreover,the hyperactivity / impulsive score in the AD group was significantly higher than that in the control group(5.85 + 4.09 VS 4.56 + 3.08,P <0.05).Gender,severity of AD,delivery mode,gestational ages,breast feeding,history of allergic rhinitis and asthma,familial history of atopy,education level of the caregiver,and use of emollients,topical glucocorticoids,topical calcineurin inhibitors,and oral antihistamines were not significantly different between AD patients with and without ADHD symptoms(P>0.05 each).The severity of itching and sleep loss in AD patients were positively correlated with inattention(P<0.05;P<0.01),hyperactivity/impulsiveness(P<0.05;P<0.05),and oppositional defiance scores(P<0.01;P<0.05).Sleep loss in AD patients was independently associated with an increased risk of ADHD symptoms(OR,1.78;95% CI,1.07–2.98;P<0.05).The mean CDLQI scores of AD patients were 6.98 ± 5.02,almost all patients with AD suffer from varying degrees of quality of life.The CDLQI scores were significantly higher in patients with ADHD symptoms than in those without ADHD symptoms(11.44 vs.6.48;P<0.05).CDLQI was also positively correlated with inattention score(r=0.41,P<0.01),hyperactivity/impulse score(r=0.28,P<0.01),and oppositional defiance score(r=0.34,P<0.01).Conclusion: AD is a prevalent chronic condition associated with an increased likelihood of ADHD symptoms in school-aged children.Sleep deprivation caused by AD may be a risk factor for ADHD.AD affects quality of life,especially in patients with ADHD symptoms.AD patients with symptoms of inattention and hyperactivity should be evaluated for ADHD.