Atopic Dermatitis and Emotional and Behavioral Outcomes in Urban U.S. Children: A Birth Cohort Study

Abstract: Background: Numerous studies suggest that childhood atopic dermatitis (AD) is associated with problems with internalizing behaviors. However, results for other behavioral domains, such as externalizing behaviors, attention problems, and social competence, have been mixed. Objective: To determine whether AD is associated with emotional/behavioral problems in a racially and ethnically diverse urban birth cohort of children of mostly unwed mothers. Methods: A total of 4898 mothers were recruited in maternity wards and followed longitudinally, completing questionnaires on AD and behavior at ages 5, 9, and 15. Logistic regression models compared the odds of emotional/behavioral problems in children with and without AD. Results: Adjusted analyses indicated children with AD were more likely to have internalizing (adjusted odds ratio [aOR] = 1.42; 95% confidence interval [CI]: 1.11–1.82) and externalizing (aOR = 1.48; 95% CI: 1.16–1.89) emotional/behavioral problems. Conclusions: Our findings underscore the importance of clinicians treating children with AD to specifically ask about emotional and behavioral problems, both at baseline and follow-up visits during AD treatment. This is crucial for early identification of behavioral problems and for monitoring responses to treatment. These assessments are also clinically significant in determining whether behavioral issues during AD treatment are preexisting or newly developed and avoiding AD treatments being incorrectly blamed for behavioral problems.