Ocular injuries, attention deficit and hyperactivity disorder, and maternal anxiety/depression levels: Is there a link?

Abstract

Purpose: Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI).

Methods: Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.

Results: The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ² = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058).

Conclusion: ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.

Keywords: Attention deficit and hyperactivity disorder; Child; Maternal anxiety; Ocular trauma; Penetrating eye injury.

Fig. 1

Initial and final BCVA according to the location of injury (A and C) and the groups of POTS (B and D). BCVA: best corrected visual acuity, POTS: pediatric ocular trauma scores, NLP: no light perception, LP: light perception, CF: counting fingers, 0.1–0.5 (Snellen chart), >0.5 (Snellen chart).

Fig. 2

Theory 1: ADHD in children may have increased distress/anxiety in mothers. Both ADHD and high maternal anxiety may have caused penetrating ocular trauma.

Fig. 3

Theory 2: Antenatal maternal anxiety may have caused ADHD. Both ADHD and high anxiety levels of mothers may have led to ocular trauma. ADHD: attention deficit and hyperactivity disorder.

Fig. 4

Theory 3: ADHD may have increased the risk of PEI in children. The mothers of children with PEI may have become anxious after the trauma of their children. ADHD: attention deficit and hyperactivity disorder.