Children with attention-deficit/hyperactivity disorder (ADHD) appear to be at higher risk of infectious diseases, according to a large population-based case control study published in the Journal of the American Academy of Child and Adolescent Psychiatry.
The study, involving more than 50,000 children and adolescents in a large HMO in Israel, found that ADHD was associated with significantly higher rates of all types of pediatric infectious diseases, use of all kinds of anti-infective agents, and high rates of visits to primary care physicians and specialists.
“Since ADHD is a highly prevalent disorder worldwide and represents the most common behavioral problem in clinical practice, a vulnerability to infectious diseases represents a significant public health concern,” wrote lead author Eugene Merzon, M.D., of Leumit Health Services, Tel Aviv, and colleagues. “Such vulnerability is critical in situations of a pandemic such as that posed by COVID-19.”
The researchers analyzed data on 18,756 youth aged 5 to 18 with ADHD and 37,512 age-matched controls enrolled in Leumit Health Services between January 1, 2006, and June 30, 2021. Children with underlying cancer or a primary or secondary immune deficiency were excluded from the study because of the high rate of infections associated with these disorders. ADHD diagnosis was based on DSM-IV or DSM-5 criteria, depending on the year of the diagnosis. The main outcomes were infectious diseases of all types, use of anti-infectious agents, and physician visits.
Children with ADHD were 1.4 times more likely to have respiratory infections, 1.3 times more likely to have acute gastroenteritis, and 1.2 times more likely to have bronchopneumonia than children without ADHD. They were also more likely to have specific bacterial, viral, parasitic, and fungal infections—in particular, salmonella infections.
Children with ADHD were more likely than those without to be prescribed all anti-infectious agents, including anti-bacterial, anti-viral, anti-fungal, anti-parasitic, and combination agents. They were 1.5 times more likely to be prescribed ciprofloxacin.
Finally, children with ADHD had significantly higher rates of visits with primary care physicians and specialists than children without ADHD. They were 1.4 times more likely to visit a pediatrician, 1.6 times more likely to see an ear nose and throat physician, and 1.3 times more likely to see a dermatologist.
“We suggest that subjects with ADHD suffer from an aberrant immunological response, resulting in a higher vulnerability to being infected by microorganisms,” the researchers wrote. “We did not examine the effect of stimulant treatment on the rates of infections in children with ADHD. This necessitates a distinct study design and might be planned in future research.”
For related information, see the Psychiatric News article “Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood.”
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