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Association of atopic dermatitis severity with learning disability in children

Researchers at the Perelman School of Medicine at the University of Pennsylvania found that greater atopic dermatitis (AD) severity is associated with higher odds of reported learning disabilities. This association was independent of socioeconomic characteristics, AD onset age and the presence of other related disorders.

The findings, published online ahead of print in JAMA Dermatology (Apr. 14, 2021), suggest that children with severe AD should be screened for learning difficulties so that interventions that can mitigate the consequences of an LD can be started.

Those with mild, moderate, or severe disease were significantly more likely to report a learning disability diagnosis by a health care practitioner compared with those with clear or almost clear skin,” the study’s authors wrote. “Worsening severity was associated with higher rates of learning disability in a dose-dependent manner.”

To evaluate the association of AD severity with learning problems in children with AD, the study’s authors conducted a cross-sectional study analyzing data of U.S. participants enrolled in the Pediatric Eczema Elective Registry (PEER) between Nov. 1, 2004 and Nov. 30, 2019. Participants were children aged two to 17 years at registry enrollment with a physician-confirmed diagnosis of AD and had completed 10 years of follow-up in PEER.

AD severity was measured by both the Patient-Oriented Eczema Measure (POEM) score and self-report. The POEM scores ranged from 0 to 28, with strata of clear or almost clear skin (0-2), mild (3-7), moderate (8-16), severe (17-24), and very severe (25-28). Self-reported AD severity was categorized as clear skin or no symptoms, mild, moderate, or severe.

Among the 2,074 participants with AD (1,116 girls [53.8%]; median [interquartile range (IQR)] age, 16.1 [13.9-19.5] years at 10-year follow-up), 169 (8.2%) reported a diagnosis of a learning disability.

The results showed children with a learning disability versus those without were more likely to have worse AD severity, as measured by the median (IQR) total POEM score, POEM severity category and self-report.

In multivariable logistic regression models adjusted for sex, age and ethnicity, annual household income, age of AD onset, family history of AD, and comorbid conditions, participants with mild AD (odds ratio [OR], 1.72; 95% CI, 1.11-2.67), moderate AD (OR, 2.09; 95% CI, 1.32-3.30), and severe to very severe AD (OR, 3.10; 95% CI, 1.55-6.19) on the POEM were all significantly more likely to have reported a learning disability than those with clear or almost clear skin.

The study’s authors concluded that further prospective and mechanistic studies are needed to clarify the association of AD with learning.

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