Is there really a syndrome involving the co-occurrence of neurodevelopmental disorder talent, non-right handedness and immune disorder among children?

Association between childhood asthma and attention deficit hyperactivity or autism spectrum disorders: A systematic review with meta-analysis

BACKGROUND

Children with asthma are at risk of depression and anxiety and growing evidence suggest they may also be at risk of attention deficit hyperreactivity disorder (ADHD) and autism spectrum disorder (ASD). Here, we conducted a systematic review with meta-analysis of studies investigating association between asthma and ADHD or ASD in children.

METHODS

A comprehensive search using PubMed, EMBASE and Cochrane Library databases was completed in March 2019. Observational human studies published in English, clinic-based or population-based with a healthy comparator group, evaluating asthma-ADHD or asthma-ASD overlap in children 18 years or younger using categorical diagnoses (yes/no) were considered for inclusion. Random effects meta-analysis models were used to analyse data. The Newcastle Ottawa Scale was used to evaluate risk of bias.

RESULTS

A total of 25 asthma-ADHD studies were included of which 17 showed significant positive associations and one a negative association: 17/25 studies were population-based, 19/25 were cross-sectional or cohort studies and 7/25 had a low risk of bias. We performed a meta-analysis of 23 of the studies, which showed a significant association between asthma and ADHD: odds ratio (OR) 1.52 (1.42-1.63), P < .001, I2 = 60%. All studies were adjusted for age and sex and a large proportion; that is, 19/23 were further adjusted for relevant confounders. Seventeen asthma-ASD studies were included, whereof 7 showed a positive association and 3 a negative association; 8/17 were population-based with a cross-sectional study design and 4/17 had a low risk of bias. We performed a meta-analysis of 14 of the studies, which did not show a significant association between asthma and ASD: OR 1.12 (0.93-1.34), P = .24, I2 = 89%. All studies were adjusted for age and sex and 10/14 were further adjusted for relevant confounders.

CONCLUSIONS

This systematic review with meta-analyses shows a significant overlap between asthma and ADHD, but not between asthma and ASD in children. Clinicians taking care of children with asthma or ADHD should be aware of such association to aid an early diagnosis and treatment of such comorbidity.

Associations of atopic dermatitis and asthma with child behaviour: Results from the PROBIT cohort

BACKGROUND

Conflicting findings from studies evaluating associations of allergic disease with child behaviour require longitudinal studies to resolve.

OBJECTIVE

To estimate the magnitude of associations of atopic dermatitis (AD) in infancy, and symptoms of asthma and AD at 6.5 years, with child behaviour at 6.5 years.

METHODS

Secondary cohort analysis of the Promotion of Breastfeeding Intervention Trial (PROBIT). PROBIT enrolled 17 046 infants at birth and followed them up at 6.5 years (n = 13 889). Study paediatricians collected data on infantile AD at repeated follow-up examinations during the first year of life. At 6.5 years, paediatricians performed skin prick tests and parents reported asthma and AD symptoms during the prior year. In addition, parents and teachers completed the Strength and Difficulties Questionnaire, which includes scales on hyperactivity/inattention, emotional problems, conduct problems, peer problems and prosocial behaviours.

RESULTS

Physician-diagnosed AD in the first year of life was not associated with increased risk for behavioural problems at 6.5 years. Emotional problems at 6.5 years were more common among children with AD symptoms (OR: 2.24, 95% CI: 1.62-3.12) and asthma symptoms (OR: 1.45; 95% CI: 1.07-1.96) during the past year at 6.5 years and ORs for children with symptoms of more severe AD and asthma were also higher. AD in the past year was also associated with probable hyperactivity/inattention disorder at 6.5 years (OR: 2.05; 95% CI: 1.09-3.84). Other subscales of the SDQ were not related to asthma or AD symptoms during the past year.

CONCLUSIONS AND CLINICAL RELEVANCE

Children with AD symptoms were at higher risk for concomitant hyperactivity/inattention and emotional disorder, and children with asthma symptoms were at higher risk of having concomitant emotional problems. However, AD during infancy did not predict childhood behaviours.

Handedness and Writing Performance

The present study investigated possible differences in left- and right-handers' writing performance. An equal number of left- and right-handed Greek children ( N = 182) ages 7 to 12 years were examined using the Greek adaptation of Luria-Nebraska's neuropsychological battery in spontaneous writing, copying, and writing to dictation. Analysis showed a significant effect of age in writing performance and writing speed, while handedness was not significantly related to writing performance or writing speed. However, the incidence of right-handers was slightly higher among proficient writers, whereas the left-handers were clearly overrepresented among poor writers. The results are discussed on the grounds of neuropathological as well as hormonal-developmental theories of handedness.

Left handedness: Facts and Figures across Cultures

Approximately 10% of human beings are left handed, although the incidence rate dif fers as a function of sex, age, and culturelgeographical locations. Studies reveal that (a) the incidence of left handedness is more common in Euro-American than in Orien tal ( India, Japan, China) cultures, (b) the prevalence of left handedness throughout the historical era is best explained by genetic models, (c) left handedness is associated more with immune and psychopathological disorders, and (d) sanctions against left hand use are rooted to the belief system and social construction in a given culture. These obser vations were made in this article to ascertain the issues related to left handedness, espe cially in socio-cultural contexts.

Association Between Atopic Dermatitis and Autism Spectrum Disorders: A Systematic Review

BACKGROUND

Atopic dermatitis (AD) is an allergic disorder caused by both immunological dysregulation and epidermal barrier defect. Several studies have investigated the association between AD and mental health disorders. Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions characterized by impairments in social communication and restricted, stereotyped interests and behaviors. The concurrent increased prevalence of AD and ASD in the last decades has led many scientists to investigate the relationship between the two diseases.

OBJECTIVE

The aim of this systematic review was to examine the association between AD and ASD.

METHODS

A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and ScienceDirect were searched up to March 2015 for all reports examining the association between ASD and AD. Descriptive statistics of the studies are reported.

RESULTS

The review included 18 studies assessing the association between ASD and AD. Of these studies, two focused on ASD in relation to AD alone, 14 discussed ASD in relation to both AD and other atopic disorders, and two evaluated AD in parents of children with ASD. Most of these studies found a positive association between the two disorders, although there were some studies going in the opposite direction. The entity of the association is somewhat inconsistent among the different studies given that the frequencies of AD in ASD compared with a control group ranged from 7 to 64.2%. In addition, odds ratios (ORs) or hazard ratios (HRs) gave different results as three studies found a weak association with an OR below 2 and a nonsignificant p value, and three other studies found a moderate or strong association with an OR ranging from 1.52 to 7.17 and a significant p value. When all atopic disorders were considered when evaluating the risk of ASD, the association was strong with an HR of 3.4 or an OR of 1.24 and p < 0.001.

CONCLUSIONS

Overall, the results of this systematic review seem to reveal an association between ASD and AD, suggesting that subjects with ASD have an increased risk of presenting with AD compared with typically developing controls, and vice versa. This association is supported by clinical/epidemiological aspects, shared genetic background and common immunological and autoimmune processes. However, the variability in study population and design, and the presence of other risk factors acting as confounding factors, sometimes contribute to inconsistent results. Further studies are needed to clarify the underlying pathophysiologic mechanism explaining the association between ASD and AD and to explore the causal association between the two conditions.

Lung disease as a determinant of cognitive decline and dementia

Almost 40 million people currently live with dementia but this is estimated to double over the next 20 years; despite this, research identifying modifiable risk factors is scarce. There is increasing evidence that cognitive impairment is more frequent in those with chronic lung disease than those without. Chronic obstructive pulmonary disease affects 210 million people, with cognitive impairment present in 60% of certain populations. Co-morbid cognitive dysfunction also appears to impact on important outcomes such as quality of life, hospitalisation and survival. This review summarises the evidence of an association between cognition, impaired lung function and obstructive lung disease. It goes on to examine the contribution of neuro-imaging to our understanding of the underlying pathophysiology. While the mechanisms of brain pathology and cognitive impairment are likely to be complex and multi-factorial, there is evidence to suggest a key role for occult cerebrovascular damage independent of traditional vascular risk factors, including smoking.

Nonallergic comorbidities of atopic eczema: an overview of systematic reviews

The aims of this overview are to synthesize the current evidence of published systematic reviews (SRs) on nonallergic comorbidities of atopic eczema (AE). EMBASE and MEDLINE were searched for SRs published from inception to November 2012. SRs were selected independently based on predefined inclusion criteria. Methodological quality of SRs included was assessed by two independent reviewers using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. Nine SRs met all inclusion criteria. Six reviews addressing the association between AE and cancer suggest a decreased risk of glioma, meningioma, and acute lymphoblastic leukemia in patients with current or previous AE. One SR reported a consistent positive association of AE with attention-deficit hyperactivity disorder (ADHD). Diabetes mellitus type 1 and multiple sclerosis (MS) were not significantly related to AE in reviews based on cross-sectional and case-control studies. Patients with AE appear to be at decreased risk of brain tumors. The relationship of AE with Th1- and Th17-mediated (auto-)inflammatory conditions such as diabetes mellitus type 1 and MS should be clarified in prospective observational studies. Children with AE are at increased risk of ADHD. SRs on the risk of depression and Th17-mediated disorders such as inflammatory bowel disease of patients with AE are missing.

Prevalence of attention-deficit/hyperactivity disorder in patients with pediatric allergic disorders: a nationwide, population-based study

BACKGROUND

Allergic disorders are common, chronic conditions in pediatric populations. The characteristic symptoms of allergic disorders mainly include bronchial asthma (BA), allergic rhinitis (AR), and atopic dermatitis (AD), all of which may disturb sleep, leading to daytime inattention, irritability, and hyperactivity, which are also components of attention-deficit/hyperactivity disorder (ADHD). Conflicting data exist in the literature regarding the relationship between ADHD and allergic disorders. The aim of this nationwide, population-based study is to examine the prevalence and risk of developing ADHD among allergic patients in a pediatric group.

METHODS

Data from a total of 226,550 pediatric patients under 18 years of age were collected from Taiwan's National Health Insurance Research Database recorded from January 1 to December 31, 2005 and analyzed. We calculated the prevalence of allergic diseases based on various demographic variables, including ADHD. We also used multivariable logistic regression to analyze the risk factors of ADHD.

RESULTS

In 2005, the period prevalence rates of allergic disorders and ADHD in persons under the age of 18 were 21.5% and 0.6%, respectively. Pediatric patients with allergic disorder(s) had a substantially increased rate of developing ADHD (p < 0.001) in terms of period prevalence and odds ratio (OR). This significance existed across various demographic groups regardless of age, gender, location, or degree of urbanization of their residence. BA and AR, but not AD, were determined to be risk factors for ADHD. Co-morbidities of allergic disorders, including AR+AD, AR+BA and AR+BA+AD, but not BA+AD, were also determined to increase the risk of ADHD.

CONCLUSION

Allergic disorders appear to increase the risk of ADHD in pediatric patients. Our detailed analysis shows that the main contributing factor is AR. Co-morbidity with AD, BA, and BA+AD in AR patients further increases the risk of ADHD.

Discrepancy in improvement of hearing loss between left and right ears after postmenopausal hormone therapy

Physiological levels of estrogen would seem to have a possible protective effect on hearing function and estrogen replacement therapy may delay hearing loss in menopausal women. Treatment of healthy menopausal women with Tibolone for 6 months resulted in improvement in audiometry results at low frequencies which was more prominent on the right side. The reason of better improvement on the right side is not known. There might be some other factors modifying the condition or effect of the drug such as laterality. There might be hearing lateralization in menopausal women. Especially significant improvement on right ear might be explained by differences in distribution of estrogen receptor (ER) in the ear, in another words lateralization of ER concentration. ER-α and -β might be more dense in the right ear, so give better response to estrogen treatment. Another reason might be difference in bone mineral density of sides of body which is lower on the right side. Similarly lower bone mineral density right ear bones would cause better response to estrogen therapy and better improvement in audiometry results on that side.

Is atopic disease a risk factor for attention-deficit/hyperactivity disorder? A systematic review

The increase in prevalence and burden of atopic diseases, i.e. eczema, rhinitis, and asthma over the past decades was paralleled by a worldwide increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses. We systematically reviewed epidemiologic studies investigating the relationship between atopic diseases and ADHD. Electronic literature search in PubMed and PsycINFO (until 02/2010) supplemented by handsearch yielded 20 relevant studies totaling 170,175 individuals. Relevant data were abstracted independently by two reviewers. Six studies consistently reported a positive association between eczema and ADHD with one study suggesting effect modification by sleeping problems. Twelve studies consistently found a positive association between asthma and ADHD, which, however, appeared to be at least partly explained (confounded) by concurrent or previous eczema. Rhinitis and serum-IgE level were not related to ADHD symptomatology. We conclude that not atopic disease in general, but rather that eczema appears to be independently related to ADHD. Conclusions about temporality and whether the observed association constitutes a causal relationship are impossible, as most studies were cross-sectional (n = 14; 70%) or case-control studies without incident exposure measurement (n = 5; 25%). Another methodological concern is that the criteria to define atopic disease and ADHD were inadequate in most studies. A failure to adjust for confounders in the majority of studies was an additional limitation so that meta-analysis was not indicated. Future interdisciplinary high-quality prospective research is needed to better understand the mechanisms underlying the relationship between eczema and ADHD and to eventually establish targeted preventive and treatment strategies.

Left-handedness as a risk factor for fractures

Left-handedness has been associated with increased fracture risk in a small number of previous studies. This study reports risks for fractures at the proximal humerus, distal forearm, pelvis, foot, and shaft of the tibia/fibula according to handedness in a case-control study conducted from October 1996 to May 2001 among members of Northern California Kaiser Permanente. Handedness was assessed by questionnaire for 2,841 cases and 2,192 controls, and subjects were categorized as left-handed, right-handed, ambidextrous, or forced to switch from the left to the right hand. Compared to right-handedness, left-handedness was most strongly associated with an increased risk for proximal humerus fractures (adjusted odds ratio (OR)=2.00, 95% confidence interval (CI) 1.33 to 3.01) and less definitively with fractures of the distal forearm (adjusted OR=1.28, 95% CI 0.92 to 1.80), foot (adjusted OR=1.17, 95% CI 0.82 to 1.65), and pelvis (adjusted OR=1.40, 95% CI 0.71 to 2.74). Ambidextrous individuals had elevated risks for fractures of the distal forearm (adjusted OR=2.99, 95% CI 1.42 to 6.30), foot (adjusted OR=2.59, 95% CI 1.13 to 5.97), shaft of the tibia/fibula (adjusted OR=3.91, 95% CI 1.01 to 15.17), and proximal humerus (adjusted OR=2.37, 95% CI 0.85 to 6.65) when compared with right-handed individuals. Those individuals forced to use the right hand demonstrated no increased risk for fractures at any site. These results suggest that handedness does influence fracture risk, but the reasons for this increased risk are unclear.

A family aggregation study: the influence of family history and other risk factors on language development

Substantial evidence continues to accrue for familial transmission of specific language impairment (SLI). The incidence in families with a history of SLI is estimated at approximately 20%-40%, whereas in the general population the estimated incidence is about 4%. Typical aggregation studies compare data on the speech and language status of parents and siblings of individuals with SLI (the probands) to similar data from family members of control individuals with no speech or language disorder history. In the present study, family aggregation of SLI was examined for a unique sample of children who were ascertained before 6 months of age and thus did not have SLI, but were born into a family with a positive history of SLI (FH+). No study to date has examined the pattern of affectance in families of children ascertained at such a young age. In addition, the ratio of boys to girls born into such families was investigated, as previous studies have suggested alterations in the expected gender ratios. Consistent with prior research, SLI was found to aggregate in families; the average affectance rate in FH+ families was 32%, with significantly more boys (41%) reported as having SLI than girls (16%). A comparison of FH+ and control families (FH-) on sociodemographic factors and medical history revealed differences in the overall rate of autoimmune diseases; FH+ families reported a significantly higher incidence (35%) compared to FH- families (9%). Finally, the 3-year language abilities of a subset of 32 children from FH+ families were compared with those of 60 children from FH- families. Children from FH+ families scored significantly lower on standardized measures of language and were more likely to fall below the 16th percentile (28%) than children from FH- families (7%). These results provide converging evidence that children from FH+ families are indeed at greater risk of developing language delay compared to children from control families.

Impaired processing of brief, rapidly presented auditory cues in infants with a family history of autoimmune disorder

Studies have shown that individuals with language disorders, such as developmental dyslexia and specific language impairment, exhibit impairments in the processing of brief, successive, or rapidly changing auditory information. It is also the case that a higher rate of autoimmune disorders have been identified in those with language-based learning disorders and, conversely, that individuals with autoimmune disorders show a higher incidence of language-related disorders. The rapid auditory processing (RAP) deficits described for older individuals with language impairments may also be used as a behavioral marker to identify infants at higher risk for language delays. Thus, we were interested in examining RAP abilities in a subset of infants with a positive family history of autoimmune disorders. Eleven infants from our ongoing prospective longitudinal studies were identified based on parental response to a question about the presence of a family history of autoimmune disease and compared to 11 matched controls. The RAP threshold of each infant was assessed at 6 and 9 months of age using a conditioned head-turn procedure (using tone pairs with brief interstimulus intervals) and an auditory-visual habituation-recognition memory task using computer-generated consonant-vowel syllables (/ba/ vs. /da/). A visual habituation-recognition memory task that did not require processing of brief temporal cues was also administered. Group differences emerged on the infant RAP tasks, and on language outcome measures at 12 and 16 months of age. Infants from families with a history of autoimmune disorder had significantly higher (i.e., poorer) RAP thresholds and lower language scores than did control infants, whereas visual discrimination scores did not differ between family history infants and controls. Moreover, when brief auditory cues were necessary for the discrimination of /ba/ vs. /da/, infants with a family history of autoimmune disorder performed significantly more poorly than did controls. These findings lend support to the hypothesis that a similar mechanism, perhaps a neural-immune interaction, may underlie the observed co-occurrence of autoimmune disorders and learning impairments.

Differences in language performance in variations of lateralization

Language proficiency was studied in 489 primary-school-aged children classified as extreme left-, extreme right-, mild left-, and mild right-handers on the basis of both hand-preference and hand-skill, using a test battery of seven measures. An ANOVA run on factor scores showed neither significant association of language proficiency with variations of lateralization regarding hand-preference and hand-skill nor differences in factor structure derived from a principal component analysis between extreme vs. mild hand-preference and hand-skill groups. Moreover, low language proficiency was not significantly associated with specific patterns of lateralization in hand-preference subgroups. In contrast, low language performers with poor hand-skill were significantly overrepresented both in the extreme left-handed group alone and when combined with the extreme right-handed, in comparison to mild left- and mild right-handed with respect to population. The data are not consistently accommodated by the theory of balanced polymorphism (mainly Annett, 1978, 1985 Annett & Manning, 1989 ). Alternately, factors such as lag of maturation ( Bishop, 1980, 1984, 1990a, 1990b ), delay of growth ( Geschwind & Galaburda, 1985b ), and developmental instability associated with unique patterns of variations in lateralization ( Yeo, Gangestad, & Daniel, 1993 ) are discussed as possible factors accounting for the present results.

Dyslexia, gender, and brain imaging

Future brain imaging studies of dyslexia should have a sufficient number of males and females to detect possible gender differences in the neurological underpinning of this disorder. Detailed knowledge about such differences may clarify our understanding of the structural and functional impairments which lead to the phonological deficits that characterize dyslexia. Functional brain imaging studies have shown that males and females exhibit different patterns of brain activation during phonological processing. Further differences between the brains of males and females have been suggested by studies of normal brain development, morphology, and functional activation during reading. Animal studies have shown that lesions, similar to those seen in postmortem studies of dyslexia, affect rapid auditory processing in males, but not in females. The large body of research on gender differences in brain development, functional organization, and activation during reading tasks urges separation of males and females in dyslexia research in order to minimize variance and to detect subtle, but functionally-relevant, differences. Well-controlled studies, with large numbers of male and female dyslexics, may produce more sensitive and accurate identification of the neurological substrates of dyslexia.