Does Atopic Dermatitis Affect Attention in Teenagers?

What you need to know

• Adolescents with moderate-to-severe atopic dermatitis (AD) did not show significant attention problems compared to the general population.
• AD had substantial negative effects on sleep, quality of life, anxiety, and depression in the study participants.
• Many participants reported being unusually sensitive to or avoidant of sensory stimuli across different senses.

Background on atopic dermatitis and attention

Atopic dermatitis (AD), also known as eczema, is a chronic skin condition that causes intense itching. It can significantly impact a person’s quality of life, especially when symptoms are moderate to severe. People with AD often experience sleep disturbances and may have higher rates of anxiety and depression.

Some parents and teachers have reported that children with AD seem to have attention problems. However, it wasn’t clear if this was due to AD itself or other factors. This study aimed to objectively measure attention abilities in teenagers with moderate-to-severe AD who did not have a diagnosis of attention-deficit/hyperactivity disorder (ADHD).

How the study was conducted

The researchers recruited 44 adolescents aged 12-17 years with moderate-to-severe AD. All participants had significant AD symptoms, including:

• Eczema affecting at least 10% of their body surface area
• Moderate to severe itch (scoring at least 4 out of 10 on an itch scale)

Importantly, none of the participants had been diagnosed with ADHD or other conditions that could affect attention, such as autism spectrum disorder.

The study used several methods to assess participants:

1. Objective attention tests:

   • Conners Continuous Performance Test (CPT-3): This computerized test measures various aspects of attention over 14 minutes.
   • Stroop Color and Word Test: This test assesses selective attention and the ability to ignore distracting information.

2. Questionnaires about AD symptoms and their impact:

   • Itch and skin pain severity
   • Sleep quality
   • Quality of life
   • Anxiety and depression symptoms

3. Sensory processing assessment:

   • Adult/Adolescent Sensory Profile: This questionnaire looks at how people respond to different types of sensory input (e.g., touch, sound, movement).

Key findings on attention

The main result of this study was that the adolescents with AD performed similarly to what would be expected in the general population on the attention tests. Specifically:

• The average score on the main attention measure (CPT-3 detectability) was very close to the expected average for teenagers without AD.
• Only 13.6% of participants showed significant attention problems on this test, which is similar to what would be expected in any group of teenagers (about 15.9%).
• When two psychologists reviewed all the attention test results for each participant, they found clear evidence of attention problems in only 2 out of 44 participants.

These findings suggest that AD itself does not necessarily lead to attention difficulties, at least in a controlled testing environment.

Impact of AD on quality of life and mental health

While attention abilities seemed largely unaffected, the study found that AD had substantial negative effects on other aspects of the participants’ lives:

• Sleep disturbance: Participants had an average score of 61.1 on a sleep disturbance scale, where higher scores indicate more problems (50 is average).
• Quality of life: The average score on a dermatology-specific quality of life measure indicated moderate impact on daily life.
• Anxiety and depression: Participants showed elevated levels of both anxiety and depressive symptoms.

These results highlight the significant burden that moderate-to-severe AD can place on adolescents’ overall well-being, even if it doesn’t directly impair their attention abilities.

Sensory processing findings

An interesting aspect of this study was its examination of sensory processing in adolescents with AD. The researchers found that many participants reported atypical responses to sensory stimuli:

• 38.6% reported being more sensitive to sensory input than most people
• 50% reported more avoidance of sensory experiences than typical
• 36.4% reported “low registration” of sensory input, meaning they might be less responsive to some sensations

These findings suggest that AD may be associated with broader changes in how the nervous system processes sensory information, beyond just skin sensations.

Limitations of the study

It’s important to note some limitations of this research:

• The study only included 44 participants, which is a relatively small sample size.
• The attention tests were done in a controlled environment, which might not reflect real-world situations where there are more distractions.
• The study excluded adolescents who were already diagnosed with ADHD, which might have left out some AD patients who do have attention problems.
• The researchers didn’t compare the AD group directly to a control group of teens without AD.

What this means for patients and families

If you’re a teenager with AD or the parent of one, here are some key takeaways:

1. Attention abilities: This study suggests that having moderate-to-severe AD doesn’t necessarily mean you’ll have problems with attention. If you are experiencing attention difficulties, it may be worth discussing with your doctor to see if there are other factors involved.

2. Overall well-being: The study highlights that AD can have significant impacts on sleep, mood, and quality of life. If you’re struggling in these areas, it’s important to discuss them with your healthcare provider. There may be treatments or strategies that can help manage both your skin symptoms and these related issues.

3. Sensory sensitivities: Many participants reported being more sensitive to or avoidant of certain sensory experiences. If you notice this in yourself or your child with AD, it might be helpful to discuss strategies for managing sensory overload with a healthcare provider or occupational therapist.

4. Holistic care: While this study focused on attention, it’s clear that AD affects many aspects of a person’s life. Working with your healthcare team to address all of these areas – not just skin symptoms – may lead to better overall outcomes.

Conclusions

• Adolescents with moderate-to-severe atopic dermatitis did not show significant attention problems compared to what would be expected in the general population.
• AD still had major impacts on sleep, quality of life, and mental health in this group of teenagers.
• Many participants reported atypical sensory processing, suggesting AD might affect how the nervous system responds to various types of sensory input.
• More research is needed to fully understand the relationship between AD and cognitive functioning in real-world settings.