BACKGROUND. No study has investigated the association between enterovirus 71 central nervous system infection and symptoms related to attention-deficit/ hyperactivity disorder. In this study we evaluated attention-deficit/ hyperactivity disorder-related symptoms and internalizing problems as long-term sequelae resulting from entero- virus 71 central nervous system infection in children. METHODS. We enrolled 86 children 4 to 16 years old with virus-culture-confirmed enterovirus 71 infection and central nervous system involvement diagnosed 3 to 7 years before the study and 172 control subjects, matched for age, gender, and parents' education levels. Their mothers and teachers were asked to report on possible attention-deficit/hyperactivity disorder-related symptoms, and their mothers were asked to report on possible internalizing problems. All of the children previously infected with enterovirus 71 received intelligence tests. RESULTS. Forty-two (49%) of the children previously infected with enterovirus 71 had had viral meningitis;35 (41%) had severe central nervous system involvement, such as encephalitis, poliomyelitis-like syndrome, or encephalomyelitis;and 9 (10%) had cardiopulmonary failure and central nervous system involvement. The children previously infected with enterovirus 71 had higher scores than matched control subjects on teacher- and mother-rated scales of inattention, hyperactivity-impulsiv- ity, oppositional symptoms, and attention-deficit/ hyperactivity disorder index. The rate of elevated attention-deficit/ hyperactivity disorder-related symptoms among children with enterovirus 71 central nervous system infection was 20%, whereas that rate among matched control subjects was only 3%. They also had more internalizing problems. Their verbal and performance IQs, as well as verbal comprehension indices, were significantly inversely correlated with symptoms of inattention, hyperactivity-impulsivity, and attention-deficit/hyperactivity disorder index scores. CONCLUSIONS. Enterovirus 71 central nervous system infection may affect long-term regulation of attention and emotion and cause hyperactivity- impulsivity in children.
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