Emotion and behavior in children with atopic dermatitis: Comparing teacher and parent reports

Summary: Abstract Body: Atopic dermatitis (AD), affecting up to 20% of children, has been linked to behavioral and emotional problems based on parent- or self-reports. Teachers provide unique insights into school-based challenges, but few studies include their perspective. To address this gap, our study evaluated the association between AD and teacher-reported Strengths and Difficulties Questionnaire (SDQ) scores, a validated tool for assessing emotional and behavioral problems, and examined the concordance between parent and teacher ratings. Data from 11,373 participants in the U.K. Avon Longitudinal Study of Parents and Children birth cohort were analyzed. Longitudinal latent class mixed models identified AD trajectories between 6 months and 7 years old: unaffected/rare (62.9%), early-onset resolving (1.1%), persistent mild (31.4%), moderate-to-severe (0.9%), and worsening (3.7%) AD. SDQ was completed by parents and teachers at age 7 years. In multivariate regression analysis adjusted for sex, gestational age, family socioeconomic factors, and atopic comorbidities, no associations were found between AD trajectories and teacher-reported SDQ scores. However, parent-reported SDQ ratings showed higher emotional problem scores in moderate-to-severe AD (β: 0.47 [95% CI: 0.09-0.85]), persistent mild AD (0.15 [0.07-0.23]), and worsening AD (0.23 [0.04-0.42]) compared to the unaffected/rare group. Total difficulties were also higher in persistent mild AD (β: 0.34, [95% CI: 0.12-0.57]). Parent-teacher concordance measured by intraclass correlation coefficients was low to moderate, ranging from 0.20 (95% CI: 0.17-0.23) for emotional problems to 0.41 (0.38-0.44) for hyperactivity. In sum, AD was associated with worse parent-reported but not teacher-reported SDQ ratings. Low concordance underscores context’s role and same-reporter bias, highlighting the importance of multiple informants in assessing behavioral and emotional outcomes in children with AD. Elle Kim¹, Sarah Radtke², Maria Kaltchenko¹, Joy Wan¹ 1. Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. 2. Department of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Clinical Research: Epidemiology and Observational Research