Attention-deficit/hyperactivity disorder in hearing loss: A systematic review

Abstract

This systematic review primarily aimed to evaluate the frequency of clinically diagnosed attention-deficit/hyperactivity disorder (ADHD) and its association with hearing loss (HL) in children and adolescents. Secondary aims were to synthesize evidence on ADHD-related symptoms identified by rating scales, general attention problems, differential diagnosis, and rehabilitation outcomes. PubMed and Web of Science Core Collection were searched from inception through April 2024 in accordance with PRISMA 2020. English-language original studies addressing HL and ADHD or attention-related outcomes were eligible, and reference lists were screened manually. Fourteen studies were included from 352 identified records. Two reviewers independently appraised methodological quality using design-specific Joanna Briggs Institute (JBI) critical appraisal checklists. Clinically diagnosed ADHD, rating-scale symptoms, general attention outcomes, and rates from selected clinical samples were analyzed separately. One retrospective cohort study reported higher crude ADHD rates in children with HL (12.1% vs. 3.6%), but the association was not significant after adjustment (OR = 0.9, 95% CI: 0.4-1.9; p = 0.70). A nationwide population-based study reported severe ADHD in 0.65% of adolescents with HL and 0.29% of those without HL (adjusted OR = 1.70, 95% CI: 1.29-2.20). Rating-scale and general-attention findings varied across studies. Limited and heterogeneous evidence suggests that children with coexisting HL and ADHD may benefit from individualized auditory rehabilitation. Current evidence suggests that ADHD diagnoses or ADHD-related behaviors may be reported more frequently in some groups of children with HL. However, clinical diagnoses, symptom scores, and general attention measures are not equivalent outcomes. Methodological heterogeneity, comorbidities, language ability, fatigue, and residual confounding limit certainty, and the available evidence does not establish that HL independently causes ADHD.