High rate of ADHD found among kids with sickle cell disease
SCD children may be more likely than peers to have attention issues: Study
Children with sickle cell disease (SCD) may be more likely than their peers to have attention-deficit hyperactivity disorder (ADHD), according to a new study that found that the prevalence of ADHD in SCD kids may be more than double the expected rate in the general population.
Based on these findings, the study’s authors are calling on clinicians caring for pediatric SCD patients to perform routine screenings for ADHD so that children with this psychiatric condition can receive appropriate support.
“Systematic screening in specialty care settings may be helpful to support the early identification and treatment of ADHD among youth with chronic health conditions that elevate risk for ADHD,” the team wrote, noting that “children with SCD show relatively high rates of ADHD with many cases not detected through routine care.”
The study, “Comorbid ADHD and Pediatric Sickle Cell Disease: Prevalence and Risk Factors,” was published in the Journal of Clinical Psychology in Medical Settings.
Little data available to date on ADHD rate in SCD
SCD is a genetic disorder that affects blood cells, which can result in problems with blood flow, as well as increased inflammation throughout the body.
Previous research has shown that individuals with sickle cell tend to perform worse on cognitive tests than their similarly-aged peers without the disease. Cognitive problems are especially prevalent in sickle cell patients who have had infarcts, or tissue death driven by a lack of blood supply, in the brain.
ADHD is a psychiatric condition that’s marked by problems regulating attention and executive function — a person’s ability to make plans, organize thoughts and activities, prioritize tasks, and make decisions. In the general population, ADHD is estimated to affect about 5% of people. A few studies have suggested that ADHD might be more common in sickle cell patients, but data on this association are limited.
To gain further insight, a team of U.S. researchers reviewed data from standard psychological screening assessments that were completed by caregivers of 107 children with SCD, ages 7 to 11. The team noted that they focused on this specific age group because this is typically the age when ADHD symptoms first become apparent.
“Early identification of ADHD symptoms and formal diagnoses [are] essential for connecting families with intervention services, including accessing appropriate accommodations through the school system,” the researchers wrote.
More than 1 in 4 screening tests — 26.2%, from a total of 28 children — revealed symptoms indicative of ADHD, prompting further testing. Additional tests confirmed the diagnosis of ADHD in half of these children, who made up 13.1% of the total group, which is more than double the expected rate in the general population.
Early identification of ADHD symptoms and formal diagnoses [are] essential for connecting families with intervention services, including accessing appropriate accommodations through the school system.
Among children found to have ADHD through this process, most had not been previously diagnosed with the condition.
“Only one-fourth of youth with ADHD in our study had received a prior diagnosis, suggesting many patients go undetected with current practices,” the researchers wrote.
This was particularly notable given that most of the children had participated in routine psychological screenings at a young age, suggesting that “additional monitoring and screening for neurodevelopmental conditions are likely needed in SCD after six years of age,” the researchers wrote.
A few children in the study did not screen positive for ADHD, but had previously been diagnosed with the condition, the researchers found. While the team did not have access to detailed medical information for these children, they said one plausible explanation for this finding might be that these youngsters were already receiving appropriate care for ADHD, so their caregivers didn’t report notable problems in the screening. Counting with these outliers brought the total prevalence of ADHD in the group up to 15.9%.
Exploratory analyses also revealed an association between a marker of chronic inflammation, called NLR, and ADHD. This suggests that chronic inflammation may play a role in predisposing children with sickle cell to developing ADHD, the researchers noted. According to the team, these data highlight a need for additional studies to explore this association.
Analyses also showed that problems with attention, a common ADHD symptom, were generally more pronounced in children whose families scored lower in standardized tests of familial function. That implies that social factors also may influence the development of ADHD in children with SCD, the researchers noted.
“Further investigation of risk factors for ADHD within pediatric SCD is needed to inform detection, treatment, and prevention efforts within this population,” the team concluded.
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