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Eur Child Adolesc Psychiatry. 2017 Nov;26(11):1351-1359. doi: 10.1007/s00787-017-0989-8. Epub 2017 Apr 17.

Additive effect of congenital heart disease and early developmental disorders on attention-deficit/hyperactivity disorder and autism spectrum disorder: a nationwide population-based longitudinal study.

Tsao PC1,2,3,4, Lee YS2,3,5, Jeng MJ2,3,4, Hsu JW6,7, Huang KL6,7, Tsai SJ6,7, Chen MH6,7, Soong WJ2,3, Kou YR8,9.

Author information

1
Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan.
2
Division of General Pediatrics, Pediatrics Department, Taipei Veterans General Hospital, Taipei, Taiwan.
3
Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
4
Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
5
Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
6
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
7
Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan.
8
Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan. yrkou@ym.edu.tw.
9
Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. yrkou@ym.edu.tw.

Abstract

In this retrospective nationwide population-based case-control study, we investigated the impact of congenital heart disease (CHD) on the development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which remains unclear. Children aged <18 years that were diagnosed with CHD (n = 3552) between January 1, 1997 and December 31, 2009 were identified from the National Health Insurance Research Database in Taiwan. Non-CHD controls (n = 14,208) matched for age and sex (1:4) were selected from the same dataset. All subjects were observed until December 31, 2011 or their death. Comorbid perinatal conditions and early developmental disorders (EDD) that were diagnosed before ADHD and ASD diagnosis were also analyzed. The incidence rates of perinatal comorbidities, EDD, ADHD, and ASD were higher in the CHD group than in the control group. Multivariate Cox regression analysis revealed that the CHD group had an increased risk of developing ADHD (adjusted hazard ratio [aHR] 2.52, 95% confidence interval CI 1.96-3.25) and ASD (aHR 1.97, 95% CI 1.11-3.52) after adjusting for confounding comorbidities. EDD, but not perinatal comorbidities were also independent risk factors for ADHD and ASD after adjustment. Subgroup analysis indicated that the risk for ADHD (HR 16.59, 95% CI 12.17-22.60) and ASD (HR 80.68, 95% CI 39.96-176.12) was greatly increased in CHD subjects with EDD than in non-CHD subjects without EDD. These findings suggested that CHD at birth and EDD during early childhood were two independent risk factors for ADHD and ASD and that concurrent CHD and EDD might additively increase these risks.

KEYWORDS:

Attention-deficit/hyperactivity disorder; Autism spectrum disorder; Congenital heart diseases; Early developmental disorders

PMID:
28417257
DOI:
10.1007/s00787-017-0989-8
[Indexed for MEDLINE]

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