Atopic Dermatitis Associated With Poor School Behavior in Childhood, Adolescence

Data from the Fragile Families and Child Wellbeing Study was reviewed for relationships between atopic dermatitis (AD) and poor school behaviors in younger students.

Atopic dermatitis in childhood and adolescence is associated with poor school behaviors and difficulty getting along with teachers, according study findings published in the Journal of the European Academy of Dermatology and Venereology.

Investigators evaluated associations among atopic dermatitis, comorbid sleep disturbance, asthma, and school behavior using data from the Fragile Families and Child Wellbeing Study, a cohort of 4898 children who were born in 20 urban US cities.

Atopic dermatitis was identified in the participants at ages 5, 9, and 15 years from parental questionnaires, and school behaviors were assessed by self-reported difficulty getting along with teachers and validated scales for task completion, trouble at school, connectedness at school, and impulsivity.

Logistic regression models were used to analyze associations of a 1-year history of atopic dermatitis with the highest quartile of school behavior scales (≥75th percentile; indicates poorer outcomes) and difficulty getting along with teachers. Multivariable models included sex and race/ethnicity.

Atopic dermatitis was associated with 75th or greater percentile for poor task completion at age 9 years according to multivariable models (adjusted OR [95% CI], 1.25 [1.00-1.54]), particularly “not keeping things orderly” (1.38 [1.10-1.73]), difficulty playing (1.74 [1.00-3.00]), and “lack of temper control in conflict with peers” (1.29 [1.00-1.65]).

In addition, atopic dermatitis was associated with difficulty getting along with teachers at age 15 years (1.41 [1.17-1.70]), 75th or greater percentile regarding trouble at school in multivariable models (1.26 [1.02-1.54]), and poor school connectedness (crude OR [95% CI], 1.21 [1.03-1.57]) and impulsivity (1.22 [1.01-1.49]) in bivariable models. However, multivariable models showed only marginally significant associations.

Participants who had atopic dermatitis and sleep disturbance had the highest rates of poor behavior. In those with atopic dermatitis with sleep disturbance, significant 2-way interactions were found as predictors of 75th or greater percentile for poor task completion at age 9 and “getting along with teachers” at age 15. Children with atopic dermatitis and asthma had the highest odds of 75th or greater percentile for trouble at school, connectedness, and “getting along with teachers” at age 15.

“Comorbid sleep disturbance and asthma may help clinicians identify children and adolescents with atopic dermatitis at greater risk of poor school behaviors,” the study authors commented. “These likely reflect more severe atopic dermatitis, though atopic dermatitis severity was not directly assessed in the study.”

Study limitations include use of caregiver-reported diagnosis of atopic dermatitis, which was not verified by a clinician.

“Additional research is necessary to confirm these associations and determine optimal mitigation strategies,” stated the researchers.


Manjunath J, Silverberg NB, Silverberg JI. Association of atopic dermatitis with poor school behaviors in US children and adolescents. J Eur Acad Dermatol Venereol. Published online November 28, 2021. doi:10.1111/jdv.17840