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Pediatric atopic dermatitis was associated with increased risks of learning and memory difficulties, especially in kids with comorbid neurodevelopmental disorders, a cross-sectional study suggested.

In a weighted sample of over 69 million children, those with atopic dermatitis were more likely to experience learning difficulties compared with kids without the condition (10.8% vs 5.9%, P<0.001), along with memory difficulties (11.1% vs 5.8%, P<0.001), reported Joy Wan, MD, MSCE, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

After adjusting for sociodemographic factors, asthma, food allergies, and seasonal allergies or hay fever, atopic dermatitis was still associated with increased odds of difficulties in learning (adjusted OR 1.77, 95% CI 1.28-2.45) and memory (aOR 1.69, 95% CI 1.19-2.41), the group detailed in .

Importantly, "this association was primarily limited to children with neurodevelopmental comorbidities," such as attention deficit-hyperactivity disorder (ADHD) or learning disabilities, Wan and team wrote.

Kids with atopic dermatitis were more likely to have ADHD (11.3% vs 7.2%), developmental delay (7.8% vs 4.1%), and learning disability (7.5% vs 4.5%).

"These findings may improve the risk stratification of children with AD [atopic dermatitis] for cognitive impairments and suggest that evaluation for cognitive difficulties should be prioritized among children with AD and neurodevelopmental disorders," the authors added.

Indeed, among children with atopic dermatitis, no learning difficulties were reported by 58.7% of those with any neurodevelopmental comorbidity, compared with 96.4% of those with no neurodevelopmental comorbidity, and no memory difficulties were reported by 60.4% of those with any neurodevelopmental comorbidity, compared with 96.3% of those with none.

"Our results also suggest that memory and learning difficulties related to AD may vary by neurodevelopmental condition," Wan and co-authors noted. After stratification of outcomes by neurodevelopmental condition, memory difficulties were two to three times more likely among children with atopic dermatitis and:

• Any neurodevelopmental disorder (aOR 2.26, 95% CI 1.43-3.57)
• ADHD (aOR 2.90, 95% CI 1.60-5.24)
• Learning disabilities (aOR 2.04, 95% CI 1.04-4.00)

Learning difficulties were also observed among children with atopic dermatitis and neurodevelopmental disorders (aOR 1.52, 95% CI 1.00-2.32), particularly ADHD (aOR 1.78, 95% CI 0.97-3.26), but this finding was not statistically significant.

Adjusted analyses also showed that older children had slightly increased odds of difficulties in learning (aOR 1.07, 95% CI 1.05-1.10) and memory (aOR 1.11, 95% CI 1.08-1.13), while female sex was linked with lower odds of learning difficulties (aOR 0.76, 95% CI 0.60-0.96).

Given linking childhood atopic dermatitis with , inattention, and learning disabilities, as well as , Wan and co-authors set out to clarify the nature of the associations between atopic dermatitis and learning or memory difficulties, and neurodevelopmental comorbidities such as ADHD, developmental delay, or learning disability.

Wan and colleagues suggested several possible explanations for their findings: pediatric patients with atopic dermatitis and concomitant learning disabilities may be more likely to be identified and receive appropriate intervention; or atopic dermatitis may have varying effects on different aspects of cognition, "with perhaps a greater impact on memory than on learning. For example, sleep disturbances from AD may contribute to greater difficulties with memory in this context," they wrote.

For the study, the researchers used data on 69,732,807 children from the 2021 National Health Interview Survey (NHIS), 13.2% of whom had atopic dermatitis. Mean age was 8.6 years, 50.3% were boys, and 77% were white. Children with atopic dermatitis were more likely to be of Black or non-Hispanic race and ethnicity, have poorer health, and have other atopy.

Participants' status was based on parent or caregiver reports of atopic dermatitis symptoms, learning and memory problems, and a current or confirmed diagnosis of atopic dermatitis.

Limitations noted by the authors included use of caregiver-perceived cognitive difficulties, and the absence of NHIS data on atopic dermatitis severity, age at diagnosis, and sleep. These studies have relied primarily on neurodevelopmental diagnoses (rather than symptoms) as proxy measures of cognitive function, they added. "It remains unknown if certain subpopulations of children with AD are at greater risk of cognitive impairment."

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