February 27, 2022
ADHD is known to be associated with cognitive impairments, including diminished ability to inhibit risky behavior patterns and diminished attentiveness. Studies have shown that youths with ADHD have higher rates of injury in general, and are more likely to be hospitalized. Burn injuries requiring medical attention are not only serious in themselves but often lead to ongoing psychological trauma.
Taiwan launched a single-payer health care system in 1995. It covers 99.5 percent of the population, ensuring that its database covers virtually the entire population.
A previous study using the national health Insurance Research Database reported a 60 percent increase in the risk of burn injury among youths with ADHD, but it excluded youths under six years old.
So another Taiwanese team of researchers returned to the database and identified all 52,705 youths under 18 with a diagnosis of ADHD between 1996 and 2013 and o prior burn injury, and matched them with an equal number of age-, sex-, and other comorbidity-matched controls.
The control and ADHD groups were matched using one-to-one propensity score matching, determined using multivariate logistic regression analysis with sex, age, urbanization level of the residence, and comorbidities. Comorbidities addressed in this way included seizures, intellectual disability, autism, conduct disorder, oppositional defiant disorder, anxiety, and depression.
The rate of burn injury in the ADHD group was 4.6 percent, versus 2.6 percent in the matched control group. Overall, youths with ADHD were over 75 percent more likely to suffer burn injuries than matched controls. For children under six years old, the risk for those with ADHD was double the risk for controls. For youths with ADHD from six to seventeen years old, the risk was about 70 percent greater than for controls. There were no significant sex differences.
The authors speculated that "The correlation between ADHD and burn injury has several potential explanations. Impulsive behavior is believed to play a major role in burn injuries. ... Additionally, carelessness related to attention deficit, overlooking danger, and impairments in motor coordination and executive function may be associated with burn injuries. However, limited attention has been paid to these possible mediating factors. A further comprehensive examination of the causal relationship between ADHD and burn injury is warranted."
They concluded, "Our findings indicate that individuals with ADHD and who were aged younger than 6 years were at higher risk of burn injury. These higher numbers of burns in early childhood may be linked to the inquisitive behavior of children who have not acquired sufficient experience regarding dangers, as well as their total dependency on parents and caregivers... The results of this study suggest that clinicians pay attention to burn risk for patients with ADHD, particularly for children aged younger than 6 years."
Jia-Yin Yeh, Tsai-Yu Hou, Wei-Ting Tseng, Vincent Chin-Hung Chen, Yao-Hsu Yang, Ting-Yu Kuo, Jun-Cheng Weng, Charles Tzu-Chi Lee, Yi-Lung Chen, Min-Jing Lee, "association between Attention Deficit Hyperactivity Disorder and Risk of Burn Injury: APropensity-Matched Cohort Study,". Neuropsychiatric Disease and Treatment(2020),16:1249-1255, https://doi.org/10.2147/NDT.S242153.