PEDIATRICS Vol. 122 No. 2 August 2008, pp. e452-e458 (doi:10.1542/peds.2007-3799)
ARTICLE |
Attention-Deficit/Hyperactivity–Related Symptoms Among Children With Enterovirus 71 Infection of the Central Nervous System
Departments of a Psychiatry
b Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
c Departments of Child Psychiatry and Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
BACKGROUND. No study has investigated the association between enterovirus 71 central nervous system infection and symptoms related to attention-deficit/hyperactivity disorder. In this study we evaluated attention-deficit/hyperactivity disorder–related symptoms and internalizing problems as long-term sequelae resulting from enterovirus 71 central nervous system infection in children.
METHODS. We enrolled 86 children 4 to 16 years old with virus-culture–confirmed enterovirus 71 infection and central nervous system involvement diagnosed 3 to 7 years before the study and 172 control subjects, matched for age, gender, and parents’ education levels. Their mothers and teachers were asked to report on possible attention-deficit/hyperactivity disorder–related symptoms, and their mothers were asked to report on possible internalizing problems. All of the children previously infected with enterovirus 71 received intelligence tests.
RESULTS. Forty-two (49%) of the children previously infected with enterovirus 71 had had viral meningitis; 35 (41%) had severe central nervous system involvement, such as encephalitis, poliomyelitis-like syndrome, or encephalomyelitis; and 9 (10%) had cardiopulmonary failure and central nervous system involvement. The children previously infected with enterovirus 71 had higher scores than matched control subjects on teacher- and mother-rated scales of inattention, hyperactivity-impulsivity, oppositional symptoms, and attention-deficit/hyperactivity disorder index. The rate of elevated attention-deficit/hyperactivity disorder–related symptoms among children with enterovirus 71 central nervous system infection was 20%, whereas that rate among matched control subjects was only 3%. They also had more internalizing problems. Their verbal and performance IQs, as well as verbal comprehension indices, were significantly inversely correlated with symptoms of inattention, hyperactivity-impulsivity, and attention-deficit/hyperactivity disorder index scores.
CONCLUSIONS. Enterovirus 71 central nervous system infection may affect long-term regulation of attention and emotion and cause hyperactivity-impulsivity in children.
Key Words: enterovirus 71 • central nervous system • attention deficit • intelligence • children
Abbreviations: EV71—enterovirus 71 • CNS—central nervous system • ADHD—attention-deficit/hyperactivity disorder • CSF—cerebrospinal fluid • WISC-III—Wechsler Intelligence Scale for Children-Third Edition • CPRS-R:S—Conners’ Parent Rating Scale-Revised: Short Form • CTRS-R:S—Conners’ Teacher Rating Scale-Revised: Short Form • SDQ—Strengths and Difficulties Questionnaire • ICC—intraclass correlation • PIQ—performance IQ • VIQ—verbal IQ • VCI—verbal comprehension index • POI—perceptual organization • FDI—freedom-from-distractibility index • PSI—process speed index • CI—confidence interval
Accepted Mar 27, 2008.
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