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      Incidence and risk of attention‐deficit hyperactivity disorder in children with amblyopia: A nationwide cohort study

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          Abstract

          Importance

          The association between visual deficits and attention disorders has been reported but remains unproven.

          Background

          The objective of this study was to evaluate the risk of attention‐deficit hyperactivity disorder (ADHD) in children with amblyopia.

          Design

          Population‐based, cohort study.

          Participants

          The dataset from the Taiwan National Health Insurance Research Database in 2000 to 2010.

          Methods

          A total of 6817 patients aged <18 years with newly diagnosed amblyopia were identified. Four age‐ and sex‐matched controls without amblyopia were included for each patient, that is, 27268 controls.

          Main Outcome Measures

          The primary outcome was the risk of ADHD. The secondary outcomes were age at ADHD onset and use of ADHD medication.

          Results

          During a mean observation period of 7.18 years, the incidence of ADHD per 1000 person‐years was 7.02 in the amblyopia group and 4.61 in the control group ( P < 0.0001). The ADHD risk in the amblyopia group was 1.81 times that in the control group (hazard ratio 1.81; 95% confidence interval 1.59‐2.06). After stratification by amblyopia subtype, the greatest risk was in the deprivation type (hazard ratio 2.14; 95% confidence interval 1.56‐2.92) followed by the strabismic (hazard ratio 2.09; 95% confidence interval 1.15‐3.79) and refractive (hazard ratio 1.76; 95% confidence interval 1.54‐2.02) types. Age at ADHD onset was younger in the amblyopia group (median 8.14 vs 8.45 years; P = 0.0096). The average duration of neuropsychiatric medication use was comparable between groups ( P = 0.98).

          Conclusions and Relevance

          The ADHD risk is higher in children with amblyopia.

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          Most cited references21

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          Environmental risk factors for attention-deficit hyperactivity disorder.

          Tania Das Banerjee, Frank Middleton, Stephen V. Faraone (2007)
          Attention-deficit hyperactivity disorder (ADHD) is the most common cognitive and behavioural disorder diagnosed among school children. It is characterized by deficient attention and problem solving, along with hyperactivity and difficulty withholding incorrect responses. This highly prevalent disorder is estimated to affect 5-10% of children and in many cases, persists into adulthood, leading to 4% prevalence among adults. Converging evidence from epidemiologic, neuropsychology, neuroimaging, genetic and treatment studies shows that ADHD is a valid medical disorder. The majority of studies performed to assess genetic risk factors in ADHD have supported a strong familial nature of this disorder. Family studies have identified a 2- to 8-fold increase in the risk for ADHD in parents and siblings of children with ADHD. Various twin and adoption studies have also highlighted the highly genetic nature of ADHD. In fact the mean heritability of ADHD was shown to be 0.77, which is comparable to other neuropsychiatric disorders such as schizophrenia or bipolar disorder. However, several biological and environmental factors have also been proposed as risk factors for ADHD, including food additives/diet, lead contamination, cigarette and alcohol exposure, maternal smoking during pregnancy, and low birth weight. Many recent studies have specifically examined the relationships between ADHD and these extraneous factors. This review describes some of these possible risk factors. Although a substantial fraction of the aetiology of ADHD is due to genes, the studies reviewed in this article show that many environmental risk factors and potential gene-environment interactions also increase the risk for the disorder.
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            Cortical abnormalities in children and adolescents with attention-deficit hyperactivity disorder.

            Arthur Toga, Elizabeth R. Sowell, Gloria M A Thompson … (2003)
            Results of structural brain imaging studies of patients with attention-deficit hyperactivity disorder have shown subtle reductions in total brain volume and in volumes of the right frontal lobe and caudate nucleus. Although various conventional volumetric and voxel-based methods of image analysis have been used in these studies, regional brain size and grey-matter abnormalities have not yet been mapped over the entire cortical surface in patients with this disorder. We aimed to map these features in patients with attention-deficit hyperactivity disorder. We used high-resolution MRI and surface-based, computational image analytic techniques to map regional brain size and grey-matter abnormalities at the cortical surface in a group of 27 children and adolescents with attention-deficit hyperactivity disorder and 46 controls, who were group-matched by age and sex. Abnormal morphology was noted in the frontal cortices of patients with attention-deficit hyperactivity disorder, with reduced regional brain size localised mainly to inferior portions of dorsal prefrontal cortices bilaterally. Brain size was also reduced in anterior temporal cortices bilaterally. Prominent increases in grey matter were recorded in large portions of the posterior temporal and inferior parietal cortices bilaterally. The frontal, temporal, and parietal regions are heteromodal association cortices that constitute a distributed neural system, which subserves attention and behavioural inhibition. We have identified region-specific anatomical abnormalities in cortical components of attentional systems, which may help better account for the symptoms of attention-deficit hyperactivity disorder.
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              Incidence and types of childhood exotropia: a population-based study.

              Brian Mohney, M Govindan, Allen P Burke … (2004)
              To determine the incidence and types of childhood exotropia in a defined population. Retrospective, population-based cohort. All pediatric ( or=10 prism diopters) from January 1, 1985 through December 31, 1994. The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed. Incidence and types of childhood exotropia. Two hundred five cases of childhood exotropia were identified during the 10-year period, yielding an annual age- and gender-adjusted incidence of 64.1 (95% confidence interval: 55.2-72.9)/100,000 patients younger than 19 years. This rate corresponds to a prevalence of approximately 1.0% of all children younger than 11 years, with a significant decrease in the incidence during the second decade of life (P<0.001). Eighty-six percent of the children had intermittent exotropia, convergence insufficiency, or an exotropia in the setting of an abnormal central nervous system. The incidence of childhood exotropia from this population-based study is comparable to the prevalence rates in prior reports. Exotropia is most prevalent during the first decade of life, with intermittent exotropia and convergence insufficiency occurring most frequently.
              Article 0 comments Cited 82 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tzu‐Hsun Tsai:
                ORCID: https://orcid.org/0000-0002-2320-4458
                lucia_tsai@yahoo.com.tw
                Journal
                Journal ID (nlm-ta): Clin Exp Ophthalmol
                Journal ID (iso-abbrev): Clin. Experiment. Ophthalmol
                Journal ID (doi): 10.1111/(ISSN)1442-9071
                Journal ID (publisher-id): CEO
                Title: Clinical & Experimental Ophthalmology
                Publisher: John Wiley & Sons Australia, Ltd (Melbourne )
                ISSN (Print): 1442-6404
                ISSN (Electronic): 1442-9071
                Publication date (Electronic): 14 February 2019
                Publication date (Print): March 2019
                Volume: 47
                Issue: 2 ( doiID: 10.1111/ceo.2019.47.issue-2 )
                Pages: 259-264
                Affiliations
                [ 1 ] Department of Ophthalmology National Taiwan University Hospital, National Taiwan University Taipei Taiwan
                [ 2 ] Graduate Institute of Clinical Medicine, College of Medicine National Taiwan University Taipei Taiwan
                [ 3 ] Department of Ophthalmology Fu Jen Catholic University Hospital, Fu Jen Catholic University New Taipei City Taiwan
                Author notes
                [*] [* ] Correspondence

                Dr Tzu‐Hsun Tsai, Department of Ophthalmology, National Taiwan University Hospital. 12F, No. 7, Zhongshan S. Rd, Taipei City, 100, Taiwan, R.O.C.

                Email: lucia_tsai@ 123456yahoo.com.tw

                Author information
                https://orcid.org/0000-0002-2320-4458
                Article
                Publisher ID: CEO13465
                DOI: 10.1111/ceo.13465
                PMC ID: 6594075
                PubMed ID: 30663207
                SO-VID: 462df14a-f239-4c60-8513-8bc5fcd04ab6
                Copyright © © 2019 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 August 2018
                Date revision received : 11 December 2018
                Date accepted : 28 December 2018
                Page count
                Figures: 2, Tables: 3, Pages: 6, Words: 4059
                Funding
                Funded by: Ministry of Science and Technology
                Award ID: 107‐2410‐H‐002‐126‐MY2
                Funded by: National Taiwan University Hospital
                Award ID: NTUH 105‐N3255
                Categories
                Subject: Original Article
                Subject: ORIGINAL ARTICLES
                Subject: Clinical Science
                Custom metadata
                source-schema-version-number 2.0
                component-id ceo13465
                cover-date March 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:26.06.2019

                Keywords: amblyopia,attention‐deficit hyperactivity disorder,children,incidence
                Data availability:
                Keywords: amblyopia, attention‐deficit hyperactivity disorder, children, incidence

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