Neurological

Pediatric Ischemic Stroke Tied to Attention-Deficit/Hyperactivity Disorder Risk

Pediatric ischemic stroke was associated with an increased risk for attention-deficit/hyperactivity disorder (ADHD), according to study findings published in JAMA Network Open.

Survivors of pediatric ischemic stroke are at increased risk for neurological disabilities such as epilepsy, cerebral palsy, and hemiplegia. ADHD had been reported among up to 50% of the pediatric ischemic stroke population; however, the level of risk for ADHD in pediatric stroke remains unclear.

Data for this study were sourced from the Swedish national cohort study, National Patient Register, and Medical Birth Register. Children with ischemic stroke between 1969 and 2016 were evaluated for incidence of ADHD. For each ischemic stroke case (n=1320), 10 nonstroke control individuals (n=13,141) were age- and gender-matched for the comparator group.

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The stroke and control cohorts comprised of 53.1% and 53.0% boys, 9.3% and 5.1% were born preterm (earlier than 37 weeks), 5.9% and 2.6% were small-for-gestational age, median maternal age at birth was 29.2 ( interquartile range [IQR]25.5-33.1) and 29.2 (IQR, 25.4-33.1) years, and paternal age at birth was 31.9 (IQR, 27.8-36.0) and 31.7 (IQR, 27.8-36.0) years, respectively.

ADHD was diagnosed among 5.7% of the stroke and 2.9% of the control individuals (adjusted hazard ratio [aHR], 2.00; 95% CI, 1.54-2.60).

ADHD risk was increased among boys (aHR, 1.78; 95% CI, 1.27-2.49), girls (aHR, 2.45; 95% CI, 1.61-3.72), those who had perinatal stroke (aHR, 2.75; 95% CI, 1.65). -4.60), childhood stroke (aHR, 1.82; 95% CI, 1.34-2.48), stroke in 1997-2005 (aHR, 2.12; 95% CI, 1.39-3.23), and stroke in 2006-2016 (aHR, 3.19; 95% CI, 2.10-4.86). Stroke before 1986 (aHR, 0.38; 95% CI, 0.05-2.92) and between 1987 and 1996 (aHR, 1.04; 95% CI, 0.53-2.02) was not associated with ADHD.

Compared with control individuals, risk for ADHD was similar among patients with (aHR, 2.10; 95% CI, 1.35-3.27) and without (aHR, 1.95; 95% CI, 1.40-2.71) adverse motor outcomes but children who were developing epilepsy at higher risk (aHR, 3.54; 95% CI, 2.13-5.90) ​​than those who did not develop epilepsy (aHR, 1.69; 95% CI, 1.24-2.31).

Among the cohort of children with perinatal stroke, children with epilepsy (aHR, 5.69; 95% CI, 2.28-14.20) and adverse motor outcomes (aHR, 5.73; 95% CI, 2.34-14.03) were at particularly high risk for ADHD. Therefore for childhood stroke, risk for ADHD was associated with epilepsy (aHR, 2.93; 95% CI, 1.56-5.48) but not adverse motor outcomes (aHR, 1.60; 95% CI, 0.95-2.70).

First-degree family members of children with stroke were at increased risk for ADHD overall (aHR, 1.46; 95% CI, 1.23-1.73). Risk was increased among siblings (aHR, 1.38; 95% CI, 1.09-1.74) but not parents (aHR, 1.30; 95% CI, 0.92-1.83) or offspring (aHR, 1.32; 95% CI, 0.70-2.50). Similar patterns were observed among the subset of patients without ADHD.

This study may have been limited by the differences in the diagnosis accuracy for both pediatric stroke and ADHD over time.

This study found that pediatric ischemic stroke was associated with double the risk for ADHD compared with the general population. “The risk increases after childhood strokes regardless of comorbidities,” the researchers concluded.

Reference

Bolk J, Simatou E, Söderling J, Thorell LB, Persson M, Sundelin H. Association of Perinatal and Childhood Ischemic Stroke With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open. Published online April 26, 2022. doi:10.1001/jamanetworkopen.2022.8884

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