Atopic Dermatitis Increases Risk for ADHD

Atopic dermatitis (AD) was associated with increased risk for attention deficit and attention deficit hyperactivity disorders (ADD/ADHD) in both children and adults, and risk was further heightened for those with more severe AD symptoms and frequent sleep interruption, according to a new analysis of US population-based surveys.

Jonathan Silverberg, MD, PhD, MPH, department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, and colleagues hypothesized that AD disease severity and sleep disturbance act in concert to increase the risk of ADD/ADHD. Their study is published, in an article titled, “Association between Atopic Dermatitis and Attention Deficit Hyperactivity Disorder in US Children and Adults,” in the November issue of the British Journal of Dermatology.

Previous studies have documented an association between childhood AD and ADD/ADHD, but Silverberg and colleagues noted that here has been little investigation of the possible association with atopic dermatitis in adults, or of the factors that may underlie the increased risk.

To examine the association and to search for underlying clinical factors and comorbidities, the investigators assessed cross-sectional data from 19 population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children's Health 2003/4 and 2007/8.

Silverberg and colleagues found that severe atopic dermatitis and sleep disturbance independently and synergistically contribute to increased risk for ADD/ADHD in children and adults. Other conditions that appeared to further increase risk of ADD/ADHD in children with atopic dermatitis included asthma, anemia, headaches, and obesity.

In adults with atopic dermatitis, the increased risk for ADD/ADHD appeared heightened by comorbid allergic disorders, insomnia and headaches. The risk in adults with atopic dermatitis was found to be negatively related to body mass index (BMI), however, with less than average BMI characterized by the investigators as appearing “protective.”

“The reasons for these findings are still unclear,” Silverberg and colleagues indicated. “It is possible that children with severe AD have more severe symptoms of itch, causing them to exhibit more severe symptoms of inattention and hyperactivity.”

Other possible mechanisms suggested by the investigators include upregulation of neuroimmune factors in atopic dermatitis which could contribute to increased sensitivity to stimuli in ADD/ADHD.

“The relationship between AD, sleep disturbance and ADD/ADHD requires further exploration,” they concluded.

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