Mindful approaches: Association between atopic dermatitis and autism spectrum disorder and use of visual storyboards

Objectives: This study aims to compare the prevalence of atopic dermatitis (AD) in pediatric patients with autism spectrum disorder (ASD) and control patients without ASD in our population and to share a thoughtful approach to AD management in children with ASD. Study design: Cross-sectional analysis was performed of the IBM Explorys electronic medical records database in the United States between January 1, 2017-December 31, 2019. The primary outcome was ICD-10 diagnosis of AD with diagnosis of asthma or allergic rhinitis, a previously validated algorithm for identification of true AD cases. Logistic regression was used to compare crude prevalence of AD between patients with and without ASD, and to assess the relationship independent of potential confounders. Results: The study population comprised 4,727 patients with ASD and 220,446 control patients, with mean (SD) ages of 9.6 (4.3) and 9.1 (4.7), respectively. Males represented 78% of patients with ASD and 51% of control patients. Prevalence of AD among patients with ASD and controls was 5.0% and 3.6%, respectively (crude odds ratio 1.41, 95% CI 1.23-1.61). After adjusting for demographic factors and frequency of healthcare visits, the odds ratio attenuated to 1.15 (95% CI 1.01-1.32, p=0.04). Odds ratio after further adjusting for attention-deficit hyperactivity disorder diagnosis was 1.09 (95% CI 0.95-1.25, p=0.24). Conclusions: Crude prevalence of AD was higher among pediatric patients with ASD. Detection bias may be a limitation of this study. Visual aids and storyboards may be effective tools to incorporate into care management of AD in patients with ASD.