Children With AD, Neurodevelopmental Comorbidities at Greater Odds of Learning, Memory Difficulties

Pediatric atopic dermatitis (AD) is linked to higher odds of learning and memory difficulties, particularly among children with neurodevelopmental comorbidities like attention-deficit/hyperactivity disorder (ADHD) or learning disabilities, according to a study published in JAMA Dermatology.

The researchers explained that previous studies reported cognitive dysfunction among children with AD, but they often relied on neurodevelopmental diagnoses rather than symptoms as proxy measures of cognitive impairment. Also, it is unknown whether specific subgroups of children with AD are more susceptible to cognitive dysfunction.

Because of this, the researchers investigated the association of AD with symptoms of cognitive impairment, namely learning and memory difficulties, among US children; they also examined whether this association varies according to the presence or absence of neurodevelopmental comorbidities, specifically ADHD, developmental delays, or learning disabilities.

Child with atopic dermatitis (AD) on arms | Image Credit: Юля Шевцова - stock.adobe.com

To do so, the researchers used data from the 2021 National Health Interview Survey (NHIS), which captures a representative sample of US households. They included all children aged 17 years or younger without intellectual disability or autism from the NHIS in their study population. Also, they diagnosed patients with AD, learning disabilities, developmental delays, and ADHD based on responses to related direct questions.

Because the NHIS randomly selects 1 child per surveyed household for whom a parent or adult caregiver provides information, the researchers used weight adjustments to obtain population estimates. Consequently, the 7957 children sampled represented a weighted total of 69,732,807 children. Of the weight-adjusted population, 9,233,013 children (13.2%) had AD.

Compared to those without AD, the researchers found the following to be more common in children with AD ADHD (11.3% [95% CI, 9.1-14.0] vs 7.2% [95% CI, 6.6-8.0]), developmental delays (7.8% [95% CI, 6.1-10.1] vs 4.1% [95% CI, 3.5-4.7]), and learning disabilities (7.5% [95% CI, 5.7-9.7] vs 4.5% [95% CI, 4.0-5.2]). Also, in comparison to children without AD, those with AD had a greater chance of experiencing difficulties with learning (10% [95% CI, 7.8-15.8] vs 5.9% [95% CI, 5.1-6.9]; P < .001) and memory (11.1% [95% CI, 8.0-15.9] vs 5.8% [95% CI, 4.9-6.9]; P < .001).

In multivariable logistic regression models adjusted for asthma, food allergies, sociodemographic factors, and seasonal allergies or hay fever, the researchers found that AD was associated with increased odds of memory difficulties (adjusted odds ratio [AOR], 1.69; 95% CI, 1.19-2.41) and learning (AOR, 1.77; 95% CI, 1.28-2.45). Additionally, the researchers performed analyses stratified by neurodevelopmental comorbidities. Through these, they discovered that AD was associated with 2- to 3-fold greater odds of memory difficulties among children with any neurodevelopmental disorder (AOR, 2.26; 95% CI, 1.04-4.00).

Overall, AD was not associated with memory or learning difficulties among children without neurodevelopmental conditions. Consequently, 58.7% (95% CI, 49.9-66.9) of children with AD and any neurodevelopmental comorbidity reported no learning difficulty compared with 96.4% (95% CI, 94.4-97.7) of children with AD and no neurodevelopmental comorbidities. Similarly, 60.4% (95% CI, 51.5-68.6) of children with AD and any neurodevelopmental comorbidity reported no memory difficulties compared with 96.3% (95% CI, 94.1-97.7) of children with AD and no neurodevelopmental comorbidities.

The researchers acknowledged their study’s limitations, one being that they were limited by its cross-sectional design and their reliance on caregiver reports. Although these reports have been validated and widely used to study AD epidemiology in the US, the researchers noted that caregiver-perceived cognitive difficulties may be biased. Despite its limitations, they explained how their findings could be used to help treat children with AD.

“These findings may improve the risk stratification of children with AD for cognitive impairment and suggest that evaluation for cognitive impairment should be prioritized among children with AD and comorbid ADHD or a learning disability,” the authors concluded.

Reference

Ma EZ, Chang HR, Radtke S, Wan J. Symptoms of cognitive impairment among children with atopic dermatitis. JAMA Dermatol. doi:10.1001/jamadermatol.2024.0015