Attention-deficit/hyperactivity disorder in children with a history of febrile seizures: a systematic review and meta-analysis.

There exists a disagreement in the current literature on whether febrile seizures (FS) are associated with adverse neurodevelopmental outcomes such as attention-deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis was thus commenced to determine the association between childhood FS and ADHD and quantitatively measure its magnitude. This review was reported according to the PRISMA and MOOSE guideline. PubMed, Embase, Web of Science, Google Scholar, CINAHL, Scopus, and PsycINFO were systematically searched for observational studies reporting the occurrence of ADHD in patients with childhood FS. Then, unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI) were extracted from studies and pooled. The protocol for this review was registered in PROSPERO (CRD42024541299). Our meta-analysis included 12 studies with a total of 958,082 participants. FS was associated with 1.91 times greater odds of ADHD in the unadjusted analysis (95% CI = 1.32 to 2.76) and 2.68 times greater odds in the adjusted analysis (95% CI = 1.21 to 5.93). Subgroup and meta-regression analyses identified mean baseline age, follow-up duration, study aim, ADHD diagnostic criteria, study design, and region as moderators of the overall effect.

conclusionIn the present meta-analysis, a significant association between childhood FS and later ADHD was observed. To our knowledge, this is the first systematic review and meta-analysis investigating the association between the two disorders. Our findings contradict the common belief that FS are benign, thus suggesting that children with FS may benefit from closer developmental monitoring given the observed association with ADHD. WHAT IS KNOWN: • Febrile seizure (FS) is the most common type of seizure in childhood, affecting 2% to 5% in all infants and children between ages 6 through 60 months. • Several studies and guidelines have determined FS as a universally benign disorder, but in recent years, an increasing amount of literature has challenged this idea. WHAT IS NEW: • Our findings suggest a positive association between FS and ADHD, challenging the widely accepted belief that childhood FS is benign. • Subgroup analyses and meta-regression have identified study aim, ADHD diagnostic criteria, study design, region, mean age, and follow-up duration as factors that modify the overall effect.