Children with eczema could have a higher chance of being diagnosed with ADHD, or attention deficit hyperactivity disorder. A growing body of research is showing a significant link between atopic eczema and symptoms of ADHD, especially when the eczema is severe. But exactly how the itchy skin rash and the psychological disorder are related is a chicken or egg question.
"It has long been known that children with eczema have a higher incidence of behavioral disturbances, but we are starting to realize that they are also at greater risk for symptoms of ADHD as well," says Eric Simpson, MD, MCR, associate professor in the department of dermatology at the Oregon Health and Science University in Portland. But he explains that, since current studies have collected health data at only one time point (known as cross-sectional), "we do not know whether eczema causes ADHD or whether ADHD can lead to eczema."
Worldwide, 10 to 20 percent of children have atopic eczema - the most common form of eczema. The majority are diagnosed before age 5. Atopic eczema causes red, sore, itchy rashes. Scratching can cause skin damage, infection, and sleep loss. Children with eczema are also at higher risk of developing asthma and other allergic conditions.
People with ADHD generally have problems staying focused and paying attention. They may act impulsively and could be hyperactive (overactive). The disorder affects between 5 and 8 percent of school-age children and as many as 4 percent of adults. ADHD can cause a host of problems, including school and work difficulties and social and family problems. People with ADHD sometimes have sleep problems as well.
The Research on ADHD, Children and Eczema
Simpson and his team analyzed information from the 2007 National Survey of Children's Health, a review that looked at the health of more than 90,000 American kids under age 17. The researchers found that children diagnosed with atopic eczema were at significantly greater risk for ADHD than those with no eczema.
Overall, 8 percent of children without atopic eczema were also diagnosed with ADHD, compared with 13 percent of children with eczema. Dr. Simpson notes that there was a striking increase in ADHD among kids with more severe eczema. More than a quarter of children with serious eczema also carried an ADHD diagnosis - 28 percent compared to 11 percent of kids with mild eczema and 13 percent of those with moderate disease.
Simpson's findings are stronger but similar to a 2009 German study. Those researchers compared roughly 1,400 children with eczema and an equal number of those without the rash. They found that 5 percent of those with eczema also had ADHD, while only 3 percent of those without eczema had the behavior disorder.
More Questions to Answer
The German researchers had several theories behind the eczema-ADHD connection. One was that atopic eczema occurs before ADHD and leads to sleep loss, which could interfere with concentration and memory and could lead to ADHD or ADHD- like symptoms, Simpson says.
Simpson's research could not make a connection between eczema-related sleep problems and a worsening of ADHD, but, he added, "I think many parents would say the worse the eczema is, the less sleep the child gets, the more irritable the child is, and the more ADHD-type symptoms emerge."
Simpson suggests more information is needed to answer the cause-and-effect question between eczema and ADHD. "We also don't know if the symptoms of ADHD these children experience are actually true ADHD or just a behavioral manifestation of eczema. Therefore, we don't know whether treating one will help the other," he says.
Still, he recommends that if a child develops eczema, parents should seek out aggressive therapy and not shy away from topical anti-inflammatory medication. Says Simpson, "I think there are real risks from the under-treatment of eczema, and ADHD may be one of them, although this has not yet been established." Likewise, if a child with ADHD develops eczema, he says that good eczema treatment should improve sleep and reduce the chances of making the ADHD worse.
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