Atopic Dermatitis Associated with Poor Behaviors, Difficulties in School-Age Children

Jonathan I. Silverberg, MD, PhD, MPH,

In a recent letter to the editor, investigators detailed the complications of atopic dermatitis in children and adolescent populations in educational settings.

The team of investigators led by Jonathan I. Silverberg, MD, PhD, MPH, George Washington University School of Medicine, noted that atopic dermatitis was associated with behavioral difficulties in school-age children and adolescents.

Additionally, the team called for the development of behavioral interventions in classroom settings, which they believed could help to minimize poor behaviors.

In earlier studies, atopic dermatitis had been associated with behavioral problems with children including fighting, threatening other children and school board members, and nervousness.

Despite this, little was known about the impact of atopic dermatitis on school behavior such as task completion, impulsivity, and connectedness. These questions prompted the current study.

The Methods

For their study, Silverberg and colleagues analyzed data from the Fragile Families and Child Wellbeing Study.

The study included a longitudinal birth cohort of 4898 children, all of whom were born in 20 urban cities across the United States.

Parents of eligible children were asked if their child had eczema or skin allergy in the 12 months leading up to the study. This was assessed at ages 5, 9, and 15 years in parental-questionnaires.

Additionally, school behaviors were assessed by self-reported difficulty in getting along with teachers at school, and validated scales for task completion, trouble at school, connectedness at school, and impulsivity were also recorded.

Silverberg and investigators also used logistic regression models to test associations of 1-year history of atopic dermatitis with highest-quartile of school behavior scales (≥75th percentile indicated poorer outcomes) and difficulty with teachers (SAS v9.4.3, SAS Institute, Cary, NC).

Finally, 2-way statistical interactions of atopic dermatitis with sleep disturbance or asthma were tested as predictors of school behaviors, and crude and adjusted odds ratios and 95% confidence intervals were estimated.

The Findings

Silverberg and investigators found that at 9 years of age, atopic dermatitis was associated with ≥75th percentile for poor task completion in multivariable models (adjusted OR [95% CI]: 1.25 [1.00-1.54]).

This was especially true in ‘not keeping things orderly’ (1.38 [1.10-1.73]), difficulty playing (1.74 [1.00-3.00]) and ‘lack of temper control in conflict with peers’ (1.29 [1.00-1.65]).

By 15 years, atopic dermatitis was associated with difficulty getting along with teachers (1.41 [1.17-1.70]), ≥75th percentile on the trouble at school in multivariable models (1.26 [1.02- 1.54]), and poor school connectedness (crude OR [95% CI]: 1.21 [1.03-1.57]) and impulsivity (1.22 [1.01-1.49]) in bivariable models.

However, these were only marginally significant associations in multivariable models.

Finally, significant 2-way interactions were found of atopic dermatitis with sleep disturbance as predictors of ≥75th percentile for poor task completion at age 9 and “getting along with teachers” at age 15.

Participants with atopic dermatitis and sleep disturbance were recorded as having the highest rates of poor behavior, and those with atopic dermatitis and asthma had the highest odds of ≥75th percentile for trouble at school, connectedness and “getting along with teachers” at age 15.

Though the severity of atopic dermatitis was not directly assessed in the study, investigators believed these findings reflected more severe cases.

They concluded with a request for behavioral interventions in educational settings.

“Education of school teachers, nurses and administrators about AD may enhance psychosocial support for and reduce conflict with students who have AD,” the team wrote.

The study, “Association of atopic dermatitis with poor school behaviors in US children and adolescents,” was published online in the Journal of The European Academy of Dermatology and Venereology.