Atopic Dermatitis Associated With Behavioral Issues in Children and Adolescents

Incidence of atopic dermatitis (AD) may increase risk of behavioral issues among children and adolescents, according to study findings published yesterday in Archives of Dermatological Research.

Affecting more than 1 in 10 US children, AD has been associated with psychosocial distress and multiple behavioral problems such as cognitive dysfunction, social problems, and aggression. Moreover, researchers note that previous studies have found links with delinquent behavior and oppositional defiant disorders in children with AD.

“These studies characterized associations of AD and general behavioral domains in the pediatric population but did not examine specific delinquent behaviors,” said the study authors. “Additionally, we hypothesized that children with persistent AD throughout childhood have increased risk of delinquent behaviors in late childhood or adolescence.”

Seeking to examine associations of AD with a myriad of high-risk or delinquent behaviors during childhood and adolescence, they analyzed data of the Fragile Families and Child Wellbeing Study (FFCWS), a prospective, longitudinal birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities.

In the analysis, 1-year history of AD was determined by the caregiver's positive response to whether their child had eczema or skin allergy in the past 12 months, which was collected at the age 5, 9, and 15 surveys.

At age 9, children were asked if they ever performed any of 17 delinquent behaviors on a designed subscale: damaged/destroyed property, stole an item, stole money, cheated on a test, was involved in a fist fight, hurt an animal, trespassed, ran away from home, skipped school without an excuse, secretly took a sip of alcohol, smoked marijuana, smoked a cigarette/used tobacco, suspended from school, vandalized, set fire, avoided paying for items, and threw items.

Additionally, adolescents aged 15 years were polled on how many times they performed any of 13 delinquent behaviors in the past year: vandalized, damaged property, stole from a store, got into a serious physical fight, hurt someone badly, drove a car without permission, stole an item worth more than $50, went into a house or building to steal, used/threatened to use a weapon, sold marijuana, stole item worth less than $50, took part in a fight where one friend group was against another, and was loud/rowdy in a public place (never, 1 or 2 times, 3 or 4 times, or 5 or more times).

In their findings, 1-year history of AD was significantly associated with greater than or equal to the 75th percentile of mean delinquent behavior scores at age 9 (adjusted OR [AOR], 1.39; 95% CI, 1.14-1.68), but not age 15 (AOR, 1.05; 95% CI, 0.86-1.29). A 1-year history of AD at age 9 was also associated with a higher number of delinquent behaviors (adjusted risk ratio, 1.12; 95% CI, 1.03-1.23).

Regarding risk of delinquent behaviors in late childhood or adolescence among children with persistent AD, those at ages 5 (AOR, 1.31; 95% CI, 1.04-1.64) and 9 (AOR, 1.38; 95% CI, 1.14-1.67) were associated with the highest quartile of mean delinquent behavior scores at ages 9 or 15. Moreover, children with AD persisting at multiple age groups had significantly increased odds of being in at least the 75th percentile of mean delinquent behavior scores at age 15 (AOR, 1.41; 95% CI, 1.09-1.81).

AD was found to be significantly associated with the following delinquent problems:

• Damaging property (AOR, 1.38; 95% CI, 1.08-1.77)
• Cheating on a test (AOR, 1.62; 95% CI, 1.17-2.26)
• Fist fight involvement (AOR, 1.47; 95% CI, 1.21-1.79)
• School suspension (AOR, 1.36; 95% CI, 1.08-1.71)

“This study suggests that childhood AD may precede the onset of delinquent and high-risk behaviors later in childhood and adolescence,” concluded researchers.

Reference

Manjunath J, Silverberg NB, Silverberg JI. Association of atopic dermatitis with delinquent behaviors in US children and adolescents. Arch Dermatol Res. Published online January 10, 2021. doi:10.1007/s00403-021-02314-y