Atopic Diseases Linked to Behavioral Difficulties in Children, Adolescents

The study findings show that atopic dermatitis is associated with internalizing and externalizing problems, with younger children experiencing emotional problems and adolescents with other atopic diseases having relationship problems.

New study findings are adding more insight into the relationship between atopic diseases and behavioral difficulties among younger children and adolescents.

They show that atopic dermatitis (AD) is linked with internalizing and externalizing problems in younger children, while in adolescents, bronchial asthma (BA) and other allergies are linked with internalizing problems.

“On the one hand, our study confirms the existing data on associations between atopic disorders and behavioural difficulties in children and adolescents,” said the researchers. “On the other hand, it also shows that this connection cannot be generalized across different age groups and may depend on who is providing the information.”

The researchers compiled data on over 2500 patients aged between 3 to 18 years, relying on medical history data and scores from the Strengths and Difficulties Questionnaire.

Data from the questionnaire showed higher scores for younger children with AD, with the disease showing a strong association with more emotional and conduct problems, as well as more symptoms of hyperactivity/inattention.

According to the researchers, this finding mirrors previous research, citing a large cross-sectional study that found AD, in addition to BA, was associated with more emotional, conduct, and hyperactivity/inattention problems.

When parents filled out the questionnaires for their adolescent with BA or other allergies, they reported higher scores for emotional problems and peer relationship problems. When the adolescents themselves answered the questionnaire, they reported higher scores of just peer relationship problems.

“A possible underlying mechanism in the relationship between BA and internalizing problems is that young people who suffer from BA may be frustrated because of restricting symptoms such as shortness of breath, wheezing and coughing, which could make depressive or anxious symptoms more likely,” wrote the researchers. “Since the association between behavioural difficulties and atopic diseases is probably bidirectional, it should also be mentioned that stress caused by behavioural difficulties and other forms of adversity can lead to asthma attacks.”

The relationship between other allergies, such as allergic rhinitis and allergic conjunctivitis, and peer relationship problems, as described by parents of adolescents and adolescents themselves, has been documented previously. The researchers suggest that diminished health-related quality of life and lifestyle limitations could be an explanation for the association between other allergies and internalizing problems.


Keller W, Vogel M, Prenzel F, et al. Atopic diseases in children and adolescents are associated with behavioural difficulties. BMS Pediatr. 2021;21:197.

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