Bidirectional association between atopic dermatitis and attention deficit hyperactivity disorder: a systematic review and meta-analysis

Abstract

Background

Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

Materials and Methods

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger’s test.

Results

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25–1.44, p < 0.01; HRs = 1.42, 95% CI 1.20–1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21–1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76–3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18–7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14–2.76, p < 0.01) simultaneously.

Conclusion

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.