High Risk for Attention-Deficit Hyperactive Disorder in Children with Strabismus: A Nationwide Cohort Study from the National Health Insurance Research Database.

Chia-Ying Tsai,Chien-Chia Su,Tzu-Hsun Tsai,Yao-Lin Liu,I-Ju Tsai

doi:10.3390/life11111139

Abstract

Strabismus is associated with amblyopia and a lower quality of life. Attention-deficit hyperactivity disorder (ADHD) is common among children and adolescents, and influences their academic, vocational, and social life. Previous studies have suggested an association between strabismus and ADHD. Using data from the Taiwan National Health Insurance Research Database between 2000 and 2010, we performed a large-scale cohort study comparing the incidence, risk factors, and severity of ADHD in children with and without strabismus. A total of 2049 patients <18 years old with newly diagnosed strabismus (esotropia: 404; exotropia: 1645) were identified, and 8196 age- and sex-matched controls without strabismus were also included. After an average of 6.5 ± 2.9 years of follow-up, the incidence of ADHD per 1000 person-years was 5.39 in the strabismus group (esotropia: 9.93; exotropia: 4.11) and 3.23 in the control group. The cumulative incidence of ADHD was significantly greater in the esotropia (hazard ratio [HR]: 2.04; 95% confidence interval [CI]:1.36–3.06; p = 0.0007) and exotropia groups (HR: 1.44; 95% CI: 1.03–2.03; p = 0.038) than in the controls. Patients with strabismus had more comorbidities than those without (p < 0.05). In summary, this large-scale study found a higher cumulative incidence of ADHD in patients with strabismus, especially in those with esotropia.

Highlights

Strabismus is a common ocular alignment disorder that affects 1–5% of children worldwide [1,2,3,4]
The results showed that only five patients with strabismus and seven patients without strabismus were diagnosed with Attention-deficit hyperactivity disorder (ADHD) under five years of age
Our results indicated that patients under 18 years of was 4.43 months in the strabismus group and 3.54 months in the control group, with no age with horizontal strabismus, and especially esotropia, had a higher incidence of ADHD

Summary

Introduction

Strabismus is a common ocular alignment disorder that affects 1–5% of children worldwide [1,2,3,4]. In addition to eye deviation, strabismus may lead to amblyopia or lack of stereopsis [6,7], and some patients require surgical treatment to improve cosmetic appearance and binocular vision. Strabismus has been found to be related to a reduced quality of life in both patients and their parents [9], lower health-related quality of life in children and adolescents [10], and higher rates of mental health problems or psychiatric disease, especially in patients with intermittent exotropia [11]. Using functional magnetic resonance imaging (fMRI), neuroimaging studies have revealed changes in the activities in the central nervous system in subjects with amblyopia [12] and strabismus [13]

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Discussion

Conclusion