School performance and psychiatric morbidity 6 years after pediatric acute disseminated encephalomyelitis: A nationwide population-based cohort study

Published:October 03, 2019DOI:


      • Increased psychiatric morbidity after pediatric ADEM (HR = 2.4; 95% CI = 1.2‒5.1; p = 0.02).
      • Normal grade point average in secondary school (9–10 grade) after pediatric ADEM (p = 0.86).
      • Clinicians should consider problems with sleep and mood after pediatric ADEM.



      Acute disseminated encephalomyelitis (ADEM) can cause cognitive impairment in children. However, long-term consequences for school performance and psychiatric morbidity have never been characterized. Our aim was to investigate long-term school performance and psychiatric morbidity after pediatric ADEM (<18 years).


      We identified all children with ADEM 2008–2015 in Denmark using hospital diagnostic codes for acquired demyelinating syndromes. We reviewed all medical records to validate ADEM including blinded MRI review. Reference children were the entire pediatric (<18 years) population or randomly sampled sex and age-matched reference children. Outcomes were from nationwide population-based registers on special needs assistance, grade point average, highest completed education, in-hospital psychiatric hospital diagnoses, out-of-hospital psychiatric consultations or psychopharmacological drug prescriptions.


      52 children had ADEM (median onset age: 5.5 years; median age at follow-up end: 13.4 years). Secondary school grade point average was similar among children with ADEM and reference children; however, children with ADEM had increased psychiatric morbidity (hazard ratio = 2.4; 95% confidence interval = 1.2–5.1; p = 0.02), primarily due to increased drug prescriptions for sleep problems and depression.


      Children with prior ADEM have increased sleep problems and possibly also depression; however, school performance is seemingly unaffected. Clinicians should consider problems with sleep and mood at follow-up.



      ADEM (acute disseminated encephalomyelitis), ADS (acquired demyelinating syndrome), MRI (magnetic resonance imaging), ICD-10 (International Classification of Diseases version 10), ON (optic neuritis), NMOSD (neuromyelitis optica spectrum disorder), IPMSSG (International Pediatric MS Study Group)
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