D1.237 - Mental Health and Neurodevelopmental Comorbidities in Pediatric Atopic Dermatitis: A Retrospective Study and Literature-Based Perspective

Mental health and neurodevelopmental comorbidities, such as anxiety, attention-deficit/hyperactivity disorder (ADHD), autism, and insomnia, are increasingly recognized in children with atopic dermatitis (AD). Sleep disruption has been proposed as a key mediator linking AD severity with psychological distress.

We retrospectively analyzed 74 pediatric patients from a tertiary allergy clinic: 19 with moderate-to-severe AD and 55 with mild disease. Data on comorbidities, sleep quality, and corticosteroid use were extracted from clinical records.

Twenty one patients (28%) had at least one mental health or neurodevelopmental comorbidity: anxiety (n=11), ADHD (n=4), insomnia (n=3), and autism (n=1). Two had hearing difficulties, noted as non-psychiatric comorbidities. In the moderate-to-severe group, 53% (10/19) had comorbidities versus 20% (11/55) in the mild group. Statistical analysis showed a significant difference between groups (p = 0.030). Fifteen of 17 patients with comorbidities required at least two 30g tubes of corticosteroids, indicating greater disease burden. Poor documentation limited formal sleep quality analysis.

These findings align with literature showing AD patients often have poorer sleep quality, frequent awakenings, and daytime dysfunction. In adults, each AD flare may disrupt sleep for over eight nights, totaling more than 80 nights annually. Sleep disturbance is linked to increased ADHD risk, although AD alone may independently predict hyperactivity and inattention.

Mental health and neurodevelopmental comorbidities are common in pediatric AD, particularly in moderate-to-severe cases. These should be actively screened in clinical practice. Sleep disturbance remains a key contributor to impaired quality of life. An integrated, multidisciplinary approach—including routine psychological assessment— may help improve long-term outcomes in children with severe AD.