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Halt AH, Hirvonen TT, Koskela J, Kerkelä M, Hurtig T. Attention-deficit/hyperactivity disorder is not associated with overweight in adolescence but is related to unhealthy eating behavior and limited physical activity. Nord J Psychiatry 2023:1-9. [PMID: 37104707 DOI: 10.1080/08039488.2023.2198504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE The aim of the study was to examine the possible relation between adolescent ADHD and high BMI, studying also eating behavior and physical activity. METHODS The data were collected from the Northern Finland Birth Cohort 1986. The follow-up at the age of 16 consisted of a self-assessment form and clinical examination where height and weight were measured and questionnaires on physical activity and eating habits was completed. ADHD diagnosis was based on a diagnostic interview with adolescents and parents according to DSM-IV-TR criteria. The participants were divided into the following study groups: individuals with adolescent ADHD (n = 90), those with only childhood ADHD (n = 40), and community controls (n = 269). RESULTS Results showed no significant differences in BMI, but adolescents with ADHD seemed to have unhealthier eating habits than controls; they ate less often vegetables and breakfast, devoured more often, and consumed more fast food, soft drinks, sweets, and potato crisps daily. Individuals with adolescent ADHD reported light exercise more often but strenuous exercise more seldom than controls. Those with only childhood ADHD did not significantly differ from community controls regarding health behaviors. CONCLUSIONS There was no relation between ADHD and high BMI but adolescents with ADHD had unhealthier eating habits than those without ADHD. It is conceivable that unhealthy eating behaviors in adolescence might be a risk factor for the development of later overweight; however, the longitudinal associations between ADHD, unhealthy eating behaviors and overweight have not been considered in the present study and remain to be examined further.
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Affiliation(s)
- Anu-Helmi Halt
- Research Unit of Clinical Medicine, Psychiatry, University of Oulu, Oulu, Finland
- Department of Psychiatry, Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Clinic of Child Psychiatry, University Hospital of Oulu, FI-90014 University of Oulu, Oulu, Finland
| | - Taru-Tuulia Hirvonen
- Department of Psychiatry, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Jari Koskela
- Department of Psychiatry, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Martta Kerkelä
- Department of Psychiatry, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Tuula Hurtig
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Clinic of Child Psychiatry, University Hospital of Oulu, FI-90014 University of Oulu, Oulu, Finland
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Yilmaz Z, Quattlebaum MJ, Pawar PS, Thornton LM, Bulik CM, Javaras KN, Yao S, Lichtenstein P, Larsson H, Baker JH. Associations Between Attention Deficit Hyperactivity Disorder Symptom Dimensions and Disordered Eating Symptoms in Adolescence: A Population-Based Twin Study. Behav Genet 2023; 53:143-153. [PMID: 36484893 PMCID: PMC10167484 DOI: 10.1007/s10519-022-10128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Abstract
Although bivariate associations between attention-deficit/hyperactivity disorder (ADHD) and eating disorders in adolescent girls and boys have been previously identified, the mechanistic link underlying the symptom-level associations remains unclear. We evaluated shared genetic and environmental influences on ADHD symptoms and disordered eating in 819 female and 756 male twins from the Swedish TCHAD cohort using bivariate models. Common additive genetic and unique environmental effects accounted for majority of ADHD and disordered eating associations in a differential manner. For girls, the strongest genetic correlation was observed for cognitive/inattention problems-bulimia (0.54), with genetic factors accounting for 67% of the phenotypic correlation. For boys, the strongest genetic correlations were observed for conduct problems-bulimia and hyperactivity-bulimia (~ 0.54), accounting for 83% and 95% of the phenotypic correlation, respectively. As per our findings, the risk of comorbidity and shared genetics highlights the need for preventative measures and specialized treatment for ADHD and disordered eating in both sexes.
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Affiliation(s)
- Zeynep Yilmaz
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mary J Quattlebaum
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Pratiksha S Pawar
- Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristin N Javaras
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, USA
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Zhou J, Teng Y, Zhang F, Ru X, Li P, Wang J, Yan S, Zhu P, Tao F, Huang K. Sex-specific association between placental inflammatory cytokine mRNA expression and preschoolers' behavioral development: The Ma'anshan birth cohort study. Brain Behav Immun 2022; 104:110-121. [PMID: 35661681 DOI: 10.1016/j.bbi.2022.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/25/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Placental inflammation may contribute to brain abnormalities and childhood neuropsychiatric disorders, but limited knowledge is available on the association of placental inflammatory cytokine levels and offspring's behavioral development. This study aimed to examine the sex-specific association between placental inflammatory cytokine mRNA expression and preschoolers' behavioral development. METHODS 3474 pregnant women were recruited as the initial study population in the Ma'anshan birth cohort (MABC) study. Placentas (n = 2519) were collected during childbirth, and the mRNA expression of IL-8, IL-1β, CRP, TNF-α, IL-6, IL-10, and IL-4 was assessed. The Child Behavior Checklist 1.5-5 (CBCL 1.5-5) was used to assess children's behavioral development at 4 years old. A T-score ≥ 60 on summary scales or a score ≥ 65 on syndrome scales was regarded as the borderline clinical range. Multiple linear regression models and binary logistic regression models were applied to explore the sex-specific associations between placental inflammatory cytokines mRNA transcript levels and preschoolers' behavioral development. RESULTS Sex-specific associations between placental inflammatory cytokines mRNA expression and preschoolers' behavioral development were observed. There was a positive association between IL-8 and CBCL scores for boys on anxious/depressed problems, aggressive behaviors, externalizing problems and total problems. Logistic regression models showed that high levels of IL-8 were associated with a higher risk of girls' emotionally reactive problems and sleep problems compared to low/medium levels. High TNF-α was correlated with increased sleep problem scores in boys, and medium TNF-α (vs. low levels) was associated with an increased risk of girls' externalizing problems. Medium levels of CRP, IL-1β, and IL-6 were found to be associated with a decreased risk of girls' behavioral problems compared to low/high levels. For anti-inflammatory cytokines, medium IL-10 and IL-4 (vs. low levels) were observed to be associated with a lower risk of internalizing problems in boys and externalizing problems in girls, respectively. High IL-10 was correlated with decreased attention problem scores in boys. CONCLUSION This study indicates that placental inflammatory cytokine mRNA expression of IL-8, CRP, TNF-α, IL-1β, IL-4 and IL-10 may be associated with preschoolers' behavioral development in a sex-specific manner.
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Affiliation(s)
- Jixing Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Yuzhu Teng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Fu Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Xue Ru
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Peixuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Jianqing Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University
| | - Shuangqin Yan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Maternal and Child Health Care Center of Ma'anshan, No 24 Jiashan Road, Ma'anshan 243011, Anhui, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, China.
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Salvat H, Mohammadi MN, Molavi P, Mostafavi SA, Rostami R, Salehinejad MA. Nutrient intake, dietary patterns, and anthropometric variables of children with ADHD in comparison to healthy controls: a case-control study. BMC Pediatr 2022; 22:70. [PMID: 35093041 PMCID: PMC8800296 DOI: 10.1186/s12887-022-03123-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor health behaviors and variables are recently more documented in attention-deficit hyperactivity disorder (ADHD) lifestyle which might be relevant to the pathophysiology of this disorder. The objective of this case-control study was to assess the nutrient intake, dietary patterns, and anthropometric variables in children with ADHD compared to normal peers. METHOD One hundred children diagnosed with ADHD were included and compared to 100 healthy, sex-matched normal children as the control group. Anthropometric indices, macronutrients, and micronutrients were measured and compared in both groups. RESULTS ADHD children were significantly consuming more simple sugars, tea, ready-made meals but less protein, vitamin B1, vitamin B2, vitamin C, zinc and calcium compared to the control group. The body mass index (BMI) and waist circumference of children with ADHD were significantly higher and were related to the severity and type of the disease. CONCLUSION Unhealthy eating behavior is more frequent in children with ADHD, compared to normal children which might warrant lifestyle intervention in this disorder.
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Affiliation(s)
- Habibeh Salvat
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehriar Nader Mohammadi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parviz Molavi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Seyed Ali Mostafavi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
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The longitudinal association of eating behaviour and ADHD symptoms in school age children: a follow-up study in the RHEA cohort. Eur Child Adolesc Psychiatry 2022; 31:511-517. [PMID: 33599859 PMCID: PMC8634555 DOI: 10.1007/s00787-021-01720-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/11/2021] [Indexed: 10/26/2022]
Abstract
Previous evidence suggests a link between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating behaviours; however, the direction of the causal association remains unclear. Building on our previous research, we aimed to examine the longitudinal association between eating behaviours at 4 years, ADHD symptoms at 6 years of age, and the role of body mass index (BMI). We included children from the RHEA mother-child cohort in Greece, followed up at 4 and 6 years (n = 926). Parents completed the Children's Eating Behaviour Questionnaire (CEBQ) to assess children's eating behaviour at 4 years and the ADHD Test (ADHDT) and Child Behaviour Checklist for ages 6-18 (CBCL/6-18) to evaluate ADHD symptoms at 4 and 6 years, respectively, as well as measures of BMI. Longitudinal structural equation modeling (SEM) was carried out to evaluate the associations of all variables between 4 and 6 years. Food responsiveness at 4 years was positively associated with hyperactivity at age 6, whereas emotional overeating was negatively associated with hyperactivity. There was no evidence of an association between eating behaviours of preschoolers and BMI at 6 years, or BMI at 4 years and later ADHD symptoms and vice versa. Findings suggest that food responsiveness is an early marker of ADHD symptoms at 6 years of age. In contrast to our hypothesis there was no significant association between ADHD at age 4 and BMI at age 6.
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Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study. J Clin Med 2020; 9:jcm9072305. [PMID: 32698514 PMCID: PMC7408799 DOI: 10.3390/jcm9072305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = -0.08, p = 0.375) and worse treatment outcome (B = -0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatology.
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Hukkelberg S, Keles S, Ogden T, Hammerstrøm K. The relation between behavioral problems and social competence: A correlational Meta-analysis. BMC Psychiatry 2019; 19:354. [PMID: 31706279 PMCID: PMC6842530 DOI: 10.1186/s12888-019-2343-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have shown that children who display behavioral problems also tend to display low social competence. The relation does however vary according to type of behavior being measured, as well as demographic characteristics of the respondent. The present meta-analysis examined the correlation between different types of behavioral problems and social competence among children aged 3-13, and investigated possible moderators in this relation. METHODS A systematic literature search was conducted for English language studies from January 2008 to January 2018 that reported correlations between three types of behavioral problems (i.e., externalizing behaviors, conduct problems, or aggression) and two types of social competence (i.e., social competence or social skills). The studies included reports from parents and teachers, or both as a dyad. The review included data from 54 independent studies and a total of 46,828 participants. Effect sizes were estimated using a random effects approach and moderator analyses between subsets of categorical variables were tested by the significant Q test. RESULTS Results showed an overall correlation between behavioral problems and social competence of medium effect size (r = -.42, p < .01). Moderation analyses indicated no significant differences for different types of behavioral problems or social competence. However, a significant difference was found with regard to type of respondent; the correlation was significantly higher when both measures were reported by the same respondent (teacher or parent) compared to when measures were reported by parent-teacher as a dyad. CONCLUSIONS Findings summarized and quantified a robust negative correlation between behavioral problems and social competence. The results indicate that intervention programs targeting problem behaviors in children would benefit from reducing behavioral problems and in concert, increase social competence to help children with emerging or present problem behaviors.
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Affiliation(s)
- Silje Hukkelberg
- The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway.
| | - Serap Keles
- 0000 0004 1936 8921grid.5510.1The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway
| | - Terje Ogden
- 0000 0004 1936 8921grid.5510.1The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway
| | - Karianne Hammerstrøm
- grid.458806.7Center for Child and Adolescent Mental Health, Oslo, Eastern and Southern Norway
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Bisset M, Rinehart N, Sciberras E. Body dissatisfaction and weight control behaviour in children with ADHD: a population-based study. Eur Child Adolesc Psychiatry 2019; 28:1507-1516. [PMID: 30888505 DOI: 10.1007/s00787-019-01314-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) is associated with eating disorders (EDs), it is unclear when ED risk emerges in children with ADHD. We compared differences in body dissatisfaction and weight control behaviour in children with/without ADHD aged 12-13 years concurrently, and when aged 8-9 and 10-11 years, to determine when risk emerges. We also examined differences by ADHD medication status at each age. This study uses waves 1-5 from the Longitudinal Study of Australian Children (n = 2323-2972). ADHD (7.7%) was defined at age 12-13 years by both parent- and teacher-reported SDQ Hyperactivity-Inattention scores > 90th percentile, parent-reported ADHD diagnosis and/or ADHD medication treatment. Children reported body dissatisfaction and weight control behaviour at 8-9, 10-11 and 12-13 years. Children with ADHD had greater odds of body dissatisfaction at ages 8-9 and 12-13 years. Comorbidities drove this relationship at 8-9 but not at 12-13 years [adjusted odds ratio (AOR): 1.6; 95 % CI 1.1-2.4; p = 0.01]. At 12-13 years, children with ADHD had greater odds of both trying to lose and gain weight, regardless of BMI status. Comorbidities drove the risk of trying to lose weight in ADHD but not of trying to gain weight (AOR 2.3; 95% CI 1.1-4.6; p = 0.03), which is likely accounted for by ADHD medication treatment. ADHD moderately increases body dissatisfaction risk in children aged 8-9 and 12-13 years. Clinicians should monitor this and weight control behaviour throughout mid-late childhood, particularly in children with comorbid conditions and those taking ADHD medication, to reduce the likelihood of later ED onset.
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Affiliation(s)
- Matthew Bisset
- School of Psychology, Faculty of Health, Deakin Child Study Centre, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia. .,Murdoch Children's Research Institute, Parkville, Australia.
| | - Nicole Rinehart
- School of Psychology, Faculty of Health, Deakin Child Study Centre, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin Child Study Centre, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2019; 10:708. [PMID: 31649563 PMCID: PMC6796791 DOI: 10.3389/fpsyt.2019.00708] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs. Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD. Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD. Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Viktoria Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bisset M, Rinehart N, Sciberras E. DSM-5 eating disorder symptoms in adolescents with and without attention-deficit/hyperactivity disorder: A population-based study. Int J Eat Disord 2019; 52:855-862. [PMID: 30945761 DOI: 10.1002/eat.23080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is associated with increased eating disorder symptoms, yet little research examining this association has taken a diagnostic approach using a population-based sample. This cross-sectional study examined differences in DSM-5 eating disorder symptoms and partial-syndrome diagnoses at 14-15 years of age in adolescents with and without ADHD in a population-based sample. METHOD This study uses data from waves 1, 5 and 6 of the Longitudinal Study of Australian Children (N = 2,672). ADHD (6.9%) was defined at 12-13 years of age by both parent- and teacher-reported hyperactivity-inattention scores ≥90th percentile on the Strengths and Difficulties Questionnaire, parent-reported ADHD diagnosis, and/or ADHD medication treatment. Adolescents reported eating disorder symptoms at 14-15 years of age via the Branched Eating Disorders Test. RESULTS Boys with ADHD had greater odds of regular objective binge eating than boys without ADHD (OR: 9.4; 95% CI: 1.7-52.8; p = .01). Groups did not differ in prevalence of any other eating disorder symptoms or partial-syndrome diagnoses. DISCUSSION Boys with ADHD appear to be at a greater risk of regular binge eating classified by DSM-5 criteria at 14-15 years of age. Overall, the risk for eating disorder symptoms and partial-syndrome diagnoses in adolescents with ADHD does not appear to be high at 14-15 years of age when using DSM-5 criteria with population-based sampling.
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Affiliation(s)
- Matthew Bisset
- Faculty of Health, Deakin Child Study Centre, School of Psychology, Deakin University, Burwood, Victoria, Australia.,Health Services, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicole Rinehart
- Faculty of Health, Deakin Child Study Centre, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Emma Sciberras
- Faculty of Health, Deakin Child Study Centre, School of Psychology, Deakin University, Burwood, Victoria, Australia.,Health Services, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
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11
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Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients. Eat Weight Disord 2018; 23:513-519. [PMID: 28534123 DOI: 10.1007/s40519-017-0395-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics. METHOD The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10). RESULTS Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD. CONCLUSIONS In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.
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12
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Van Eck K, Morse M, Flory K. The Role of Body Image in the Link Between ADHD and Depression Symptoms Among College Students. J Atten Disord 2018; 22:435-445. [PMID: 25870202 DOI: 10.1177/1087054715580845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Given the link between negative body image and depression symptoms, body image may affect the association between ADHD and depression symptoms. We evaluated the degree to which a variety of body image constructs mediated the association between ADHD and depression symptoms. METHOD Participants were undergraduate psychology students ( N = 627, age: M = 20.23, SD = 1.40, 60% female, 47% European American) who completed an online assessment. RESULTS Results indicated that ADHD symptoms were indirectly associated with increased depression symptoms, and that negative evaluation of physical appearance, overweight preoccupation, and body dissatisfaction mediated the association between ADHD and depression symptoms. ADHD symptoms were also directly associated with increased depression symptoms. CONCLUSION Body image appears to play a role in the association between ADHD and depression symptoms for college students. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Kathryn Van Eck
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kate Flory
- 3 University of South Carolina, Columbia, USA
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13
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Torabi F, Farahani A, Safakish S, Ramezankhani A, Dehghan F. Evaluation of motor proficiency and adiponectin in adolescent students with attention deficit hyperactivity disorder after high-intensity intermittent training. Psychiatry Res 2018; 261:40-44. [PMID: 29276993 DOI: 10.1016/j.psychres.2017.12.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/02/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a chronic condition with frequent comorbidities such as obesity, troubled relationships, low self-esteem, and difficulty in motor proficiency. This study aims to elucidate the effect of high-intensity intermittent training on motor proficiency, adiponectin, and insulin resistance in adolescent students with ADHD disorder. Fifty adolescent students of both genders with ADHD diagnosis participated and assigned into four experimental groups (each group with 15 girls and 10 boys students; two experimental and two control groups). High-intensity intermittent training was performed continuously 3 times a week for 6 weeks in experimental groups. Serum adiponectin level significantly increased in the experimental groups of both genders after 6 weeks intermittent training while insulin resistance levels were markedly decreased. Furthermore, motor proficiency score were significantly improved in the experimental groups of both genders. In addition gender had no significant impact on adiponectin, insulin resistance and motor proficiency rating. The findings of this study suggest that high intensity intermittent training improved physiological systems in ADHD population that leads to reduce risk factors for future development of comorbidities.
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Affiliation(s)
- Farnaz Torabi
- Department of Physical Education and Sport Sciences, Payame Noor University, Tehran, Iran.
| | - Abolfazl Farahani
- Department of Physical Education and Sport Sciences, Payame Noor University, Tehran, Iran
| | - Sepide Safakish
- Department of Physical Education and Sport Sciences, Payame Noor University, Tehran, Iran
| | - Azam Ramezankhani
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Firouzeh Dehghan
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
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14
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Ziobrowski H, Brewerton TD, Duncan AE. Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample. Psychiatry Res 2018; 260:53-59. [PMID: 29172099 DOI: 10.1016/j.psychres.2017.11.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Abstract
The objective of this study was to examine whether previously observed associations of attention-deficit/hyperactivity disorder (ADHD) with eating disorders (EDs) are at least partially attributable to other underlying psychopathology. Data came from 4719 participants aged 18-44 years in the National Comorbidity Survey Replication and the National Survey of American Life. DSM-IV diagnoses were assessed using the World Health Organization Composite International Diagnostic Interview. Multinomial logistic regression assessed associations between DSM-IV lifetime and past-12 month diagnoses of ADHD with EDs in unadjusted models and in models adjusted for demographic variables and other psychopathology. Lifetime ADHD was strongly and significantly associated with lifetime bulimia nervosa (BN), binge eating disorder (BED), and any ED in unadjusted models, but not with anorexia nervosa or subthreshold BED. After adjusting for demographic variables and psychiatric comorbidities, all associations of lifetime ADHD with EDs were substantially attenuated, and only the association of ADHD with BN remained statistically significant. Similar results were found using past-12 month diagnoses. These results suggest that previously observed associations of ADHD with EDs might be due - at least in part - to additional psychiatric disorders that are often comorbid with both ADHD and EDs.
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Affiliation(s)
- Hannah Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alexis E Duncan
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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15
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Kaisari P, Dourish CT, Rotshtein P, Higgs S. Associations Between Core Symptoms of Attention Deficit Hyperactivity Disorder and Both Binge and Restrictive Eating. Front Psychiatry 2018; 9:103. [PMID: 29651258 PMCID: PMC5884932 DOI: 10.3389/fpsyt.2018.00103] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/14/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION It is unclear whether core symptoms of attention deficit hyperactivity disorder (ADHD) relate to specific types of disordered eating and little is known about the mediating mechanisms. We investigated associations between core symptoms of ADHD and binge/disinhibited eating and restrictive eating behavior and assessed whether negative mood and/or deficits in awareness and reliance on internal hunger/satiety cues mediate these relationships. METHODS In two independent studies, we used a dimensional approach to study ADHD and disordered eating. In Study 1, a community-based sample of 237 adults (72.6% female, 18-60 years [M = 26.8, SE = 0.6]) completed an online questionnaire, assessing eating attitudes/behaviors, negative mood, awareness, and reliance on internal hunger/satiety cues and ADHD symptomatology. In Study 2, 142 students (80.3% female, 18-32 years [M = 19.3, SE = 0.1]) were recruited to complete the same questionnaires and complete tasks assessing interoceptive sensitivity and impulsivity in the laboratory. RESULTS In each study, core symptoms of ADHD correlated positively with both binge/disinhibited and restrictive eating and negative mood mediated the relationships. Deficits in awareness and reliance on internal hunger/satiety signals also mediated the association between inattentive symptoms of ADHD and disordered eating, especially binge/disinhibited eating. The results from both studies demonstrated that inattentive symptoms of ADHD were also directly related to binge/disinhibited eating behavior, while accounting for the indirect pathways of association via negative mood and awareness and reliance on internal hunger/satiety signals. CONCLUSION This research provides evidence that core symptoms of ADHD are associated with both binge/disinhibited eating and restrictive eating behavior. Further investigation of the role of inattentive symptoms of ADHD in disordered eating may be helpful in developing novel treatments for both ADHD and binge eating.
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Affiliation(s)
- Panagiota Kaisari
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | | | - Pia Rotshtein
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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16
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Hinshaw SP. Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis. Annu Rev Clin Psychol 2017; 14:291-316. [PMID: 29220204 DOI: 10.1146/annurev-clinpsy-050817-084917] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Controversy abounds regarding the symptom dimensions of attention problems, impulsivity, and hyperactivity, developmentally extreme and impairing levels of which compose the diagnostic category of attention deficit hyperactivity disorder (ADHD). I highlight causal factors, underlying mechanisms, developmental trajectories, and female manifestations of ADHD, integrating the psychobiological underpinnings of this syndrome with contextual factors related to its clinical presentation, impairments, and soaring increases in diagnosed prevalence. Indeed, despite strong heritability, ADHD is expressed via transactional patterns of influence linked to family-, school-, peer-, neighborhood-, and policy-related factors. Moreover, intervention strategies must take into account both pharmacologic and behavioral modalities if the goal is to enhance competencies, rather than symptom reduction per se. A comprehensive understanding of ADHD mandates multiple levels of analysis-spanning genes, neurotransmission, brain pathways, individual skill levels, family socialization, peer relationships, and educational and cultural forces-which must be integrated and synthesized to surpass reductionist accounts, reduce stigma, and maximize the impact of prevention- and intervention-related efforts.
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Affiliation(s)
- Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California 94720-1650, USA; .,Department of Psychiatry, University of California, San Francisco, California 94143, USA
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17
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Capusan AJ, Yao S, Kuja-Halkola R, Bulik CM, Thornton LM, Bendtsen P, Marteinsdottir I, Thorsell A, Larsson H. Genetic and environmental aspects in the association between attention-deficit hyperactivity disorder symptoms and binge-eating behavior in adults: a twin study. Psychol Med 2017; 47:2866-2878. [PMID: 28578734 DOI: 10.1017/s0033291717001416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior research demonstrated that attention-deficit hyperactivity disorder (ADHD) is associated with binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa (BN). The aim of this study was to investigate these associations in an adult twin population, and to determine the extent to which ADHD symptoms and binge-eating behavior share genetic and environmental factors. METHODS We used self-reports of current ADHD symptoms and lifetime binge-eating behavior and associated characteristics from a sample of over 18 000 adult twins aged 20-46 years, from the population-based Swedish Twin Registry. Mixed-effects logistic regression was used to examine the association between ADHD and lifetime binge-eating behavior, BED, and BN. Structural equation modeling was used in 13 773 female twins to determine the relative contribution of genetic and environmental factors to the association between ADHD symptoms and binge-eating behavior in female adult twins. RESULTS ADHD symptoms were significantly associated with lifetime binge-eating behavior, BED, and BN. The heritability estimate for current ADHD symptoms was 0.42 [95% confidence interval (CI) 0.41-0.44], and for lifetime binge-eating behavior 0.65 (95% CI 0.54-0.74). The genetic correlation was estimated as 0.35 (95% CI 0.25-0.46) and the covariance between ADHD and binge-eating behavior was primarily explained by genetic factors (91%). Non-shared environmental factors explained the remaining part of the covariance. CONCLUSIONS The association between adult ADHD symptoms and binge-eating behavior in females is largely explained by shared genetic risk factors.
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Affiliation(s)
- A J Capusan
- Department of Psychiatry and Department of Clinical and Experimental Medicine,Linköping University,Sweden
| | - S Yao
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - R Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - C M Bulik
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - L M Thornton
- Department of Psychiatry,University of North Carolina at Chapel Hill,Chapel Hill,USA
| | - P Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences,Linköping University,Motala,Sweden
| | - I Marteinsdottir
- Department of Clinical and Experimental Medicine,Center for Social and Affective Neuroscience (CSAN), Linköping University,Linköping,Sweden
| | - A Thorsell
- Department of Clinical and Experimental Medicine,Center for Social and Affective Neuroscience (CSAN), Linköping University,Linköping,Sweden
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
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18
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Abstract
PURPOSE OF REVIEW Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy. RECENT FINDINGS We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date. SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers' impressions about youth with ADHD.
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Affiliation(s)
- Amori Yee Mikami
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Sophie Smit
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Adri Khalis
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
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19
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Yilmaz Z, Javaras KN, Baker JH, Thornton LM, Lichtenstein P, Bulik CM, Larsson H. Association Between Childhood to Adolescent Attention Deficit/Hyperactivity Disorder Symptom Trajectories and Late Adolescent Disordered Eating. J Adolesc Health 2017; 61:140-146. [PMID: 28734322 PMCID: PMC5726271 DOI: 10.1016/j.jadohealth.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE Disordered eating is more prevalent among adolescents with attention deficit/hyperactivity disorder. Both inattention and hyperactivity/impulsivity symptoms show strong associations with disordered eating, but few investigations of these associations have been longitudinal. Thus, we examined the effect of childhood to adolescent inattention and hyperactivity/impulsivity symptom trajectories on late adolescent disordered eating. METHODS We used growth mixture modeling to identify distinct inattention and hyperactivity/impulsivity symptom trajectories (called "classes") across three time points (ages 8-9, 13-14, and 16-17 years) in the Swedish Twin study of CHild and Adolescent Development. The resulting classes were used to predict Eating Disorder Inventory-2 Bulimia, Drive for Thinness, and Body Dissatisfaction subscales at age 16-17 years, with adjustment for sex and body mass index at age 16-17 years. RESULTS The combined inattention and hyperactivity/impulsivity symptom trajectory classes included: a "low symptom" class characterized by low inattention and hyperactivity/impulsivity throughout childhood/adolescence; a "predominantly inattention" class characterized by elevated inattention, but not hyperactivity/impulsivity, throughout childhood/adolescence; a "predominantly hyp/imp" class characterized by elevated hyperactivity/impulsivity, but not inattention, throughout childhood/adolescence; and a "both inattention and hyp/imp" class characterized by elevated inattention and hyperactivity/impulsivity throughout childhood/adolescence. After adjusting for sex and body mass index or sex and anxiety/depression symptoms, the "both inattention and hyp/imp" (vs. "low symptom") class predicted significantly higher Eating Disorder Inventory-2 subscale scores during late adolescence. CONCLUSIONS Increased vigilance for disordered eating among children who have both inattention and hyperactivity/impulsivity symptoms throughout childhood and adolescence could aid in early identification of eating disorders.
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Affiliation(s)
- Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.
| | - Kristin N Javaras
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina; Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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20
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Bravender T. Attention-Deficit/Hyperactivity Disorder and Disordered Eating. J Adolesc Health 2017; 61:125-126. [PMID: 28734319 DOI: 10.1016/j.jadohealth.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Terrill Bravender
- Division of Adolescent Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan
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21
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Tong L, Shi H, Li X. Associations among ADHD, Abnormal Eating and Overweight in a non-clinical sample of Asian children. Sci Rep 2017; 7:2844. [PMID: 28588278 PMCID: PMC5460237 DOI: 10.1038/s41598-017-03074-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/24/2017] [Indexed: 11/30/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been found to be comorbid with obesity in adults, but the association in children is uncertain. Because the underlying mechanism of comorbidity in children has not been researched sufficiently, this study aims to explore the associations among ADHD, abnormal eating, and body mass index (BMI), as well as the mediating effect of depression in children. We conducted a cross-sectional study of 785 primary students in China. The parent-report version of ADHD Rating Scale-IV (ADHDRS-IV), the Child Eating Behaviour Questionnaire (CEBQ) and the Children’s Eating Attitude Test (ChEAT) were used to identify ADHD symptoms and abnormal eating. The Child Behavior Checklist (CBCL) was applied to assess depression. Structural Equation Modeling was carried out to clarify the associations between ADHD symptoms, depression, abnormal eating, and overweight of students. We found that ADHD positively contributed to emotional eating and Bulimia Nervosa symptoms. However, neither emotional eating nor Bulimia Nervosa symptoms was related to BMI in children. We also found that ADHD significantly contributed to depression, and depression directly predicted emotional eating. In conclusion, ADHD increased the risk of abnormal eating in children, while no significant relationship existed between ADHD and BMI. Comorbid depression raised the risk of emotional eating, rather than Bulimia Nervosa symptoms.
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Affiliation(s)
- Lian Tong
- Department of Maternal, Child and Adolescent health, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Chinese Ministry of Education, Shanghai, China.
| | - Huijing Shi
- Department of Maternal, Child and Adolescent health, School of Public Health, Fudan University/Key Laboratory of Public Health Safety, Chinese Ministry of Education, Shanghai, China
| | - Xiaoru Li
- Department of Psychology, School of Social Development and Public Policy, Fudan University, Shanghai, China
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22
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Attention Deficit Hyperactivity Disorder (ADHD) and disordered eating behaviour: A systematic review and a framework for future research. Clin Psychol Rev 2017; 53:109-121. [DOI: 10.1016/j.cpr.2017.03.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/19/2022]
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23
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Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord 2016; 49:1045-1057. [PMID: 27859581 DOI: 10.1002/eat.22643] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There has been interest in whether people with Attention-Deficit/Hyperactivity Disorder (ADHD) are at higher risk of developing an Eating Disorder (ED). The aim of this study was estimate the size of this association with a meta-analysis of studies. METHODS We retrieved studies following PRISMA guidelines from a broad range of databases. RESULTS Twelve studies fitted our primary aim in investigating ED in ADHD populations (ADHD = 4,013/Controls = 29,404), and five exploring ADHD in ED populations (ED = 1,044/Controls = 11,292). The pooled odds ratio of diagnosing any ED in ADHD was increased significantly, 3.82 (95% CI:2.34-6.24). A similar level of risk was found across all ED syndromes [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI: 3.56-9.16) and Binge Eating Disorder = 4.13 (95% CI:3-5.67)]. The risk was significantly higher if ADHD was diagnosed using a clinical interview [5.89 (95% CI:4.32-8.04)] rather than a self-report instrument [2.23 (95% CI:1.23-4.03)]. The pooled odds ratio of diagnosing ADHD in participants with ED was significantly increased, 2.57 (95% CI:1.30-5.11). Subgroup analysis of cohorts with binge eating only yielded a risk of 5.77 (95% CI:2.35-14.18). None of the variables examined in meta-regression procedures explained the variance in effect size between studies. DISCUSSION People with ADHD have a higher risk of comorbidity with an ED and people with an ED also have higher levels of comorbidity with ADHD. Future studies should address if patients with this comorbidity have a different prognosis, course and treatment response when compared to patients with either disorder alone. RESUMEN OBJETIVO Ha habido interés en saber si la gente con Trastorno por Déficit de Atención e Hiperactividad (TDAH) están en mayor riesgo de desarrollar un Trastorno de la Conducta Alimentaria (TCA). El objetivo de este estudio fue estimar el tamaño de esta asociación con un meta-análisis de los estudios. Métodos: Recuperamos estudios de una amplia gama base de datos, que siguen los lineamientos PRISMA. Resultados: Doce estudios encajaron con nuestro objetivo primario de investigar los TCA en poblaciones con TDAH (TDAH = 4,013/Controles = 29,404), y 5 exploraron TDAH en poblaciones con TCA (TCA = 1,044/Controles = 11,292). El odds ratio (OR) agrupado de diagnosticar cualquier TCA en el TDAH se incrementó significativamente, 3.82 (95% CI:2.34-6.24). Un nivel de riesgo similar fue encontrado en todos los síndromes de TCA [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI:3.56-9.16) y Trastorno por Atracón = 4.13 (95% CI: 3-5.67)]. El riesgo fue significativamente mayor si el TDAH fue diagnosticado utilizando una entrevista clínica [5.89 (95% CI:4.32-8.04)] en lugar de un instrumento de auto-reporte [2.23 (95% CI:1.23-4.03)]. El odds ratio (OR) agrupado de diagnosticar TDAH en participantes con TCA fue significativamente incrementado, 2.57 (95% CI:1.30-5.11). El análisis de los subgrupos de cohort con atracones solamente produjo un riesgo de 5.77 (95% CI:2.35-14.18). Ninguna de las variables examinadas en los procedimientos de meta-regresión explicaron la varianza en el tamaño del efecto entre los estudios. Discusión: La gente con TDAH tiene un mayor riesgo de comorbilidad con un TCA y la gente con un TCA también tiene niveles altos de comorbilidad con TDAH. Los estudios futuros deberán abordar si los pacientes con esta comorbilidad tienen diferente pronóstico, curso y respuesta a tratamiento cuando son comparados con pacientes que solamente tienen uno de los trastornos. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016) © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1045-1057).
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Affiliation(s)
- Bruno Palazzo Nazar
- Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London
| | - Camila Bernardes
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Gemma Peachey
- South London and the Maudsley National Health Trust (SLaM - NHS), London
| | | | - Paulo Mattos
- Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London.,South London and the Maudsley National Health Trust (SLaM - NHS), London
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Steadman KM, Knouse LE. Is the Relationship Between ADHD Symptoms and Binge Eating Mediated by Impulsivity? J Atten Disord 2016; 20:907-912. [PMID: 24804686 DOI: 10.1177/1087054714530779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals with ADHD may be at risk of developing binge eating disorder (BED). Impulsivity correlates with both BED and ADHD; however, more research is needed to explore whether impulsivity plays an underlying role in the observed relationship between ADHD and BED. METHOD Questionnaires were used to assess ADHD and BED symptoms. Multiple questionnaires and a behavioral task were used to assess impulsivity in undiagnosed undergraduate participants (n = 50). RESULTS Expected correlations were found among ADHD symptoms, BED tendencies, and measures of impulsivity with the exception of impulsivity on the behavioral task and BED symptoms; however, none of the measures of impulsivity were found to be significant mediators between ADHD and BED symptoms. CONCLUSION Although impulsivity may play an important role in the interrelationship of ADHD and binge eating, other factors may also be critical in the development of this comorbidity. Investigation of this research question in clinical samples is needed.
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Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clin Psychol Rev 2016; 50:22-36. [PMID: 27693587 DOI: 10.1016/j.cpr.2016.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and eating disorders are common and concerning mental health disorders. There is both empirical and theoretical support for an association between ADHD and eating disorders or disordered eating. This systematic review aims to summarize the extant literature on the comorbidity of ADHD and eating disorders across the lifespan, including the influences of sex, age, eating disorder diagnosis, and potential mediators. A total of 37 peer-reviewed studies on diagnosed ADHD and eating disturbances were identified through key research databases. Twenty-six studies supported a strong empirical association between ADHD and eating disorders or disordered eating. The systematic review findings suggest that children with ADHD are at risk for disordered eating, while adolescents, emerging adults, and adults are at risk for both eating disorders and disordered eating. Methodological considerations, future research, and clinical implications are discussed.
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Affiliation(s)
- Rivka L Levin
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jennine S Rawana
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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26
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Nazar BP, de Sousa Pinna CM, Suwwan R, Duchesne M, Freitas SR, Sergeant J, Mattos P. ADHD Rate in Obese Women With Binge Eating and Bulimic Behaviors From a Weight-Loss Clinic. J Atten Disord 2016; 20:610-6. [PMID: 22930790 DOI: 10.1177/1087054712455503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Few studies have demonstrated a possible association between ADHD and obesity in adults. The aim of this study was to investigate the prevalence of ADHD in a sample of obese women seeking treatment, and its relations with binge eating and bulimic behaviors. METHOD We performed a cross-sectional study in a clinical sample of one hundred fifty-five women, with a mean age of 38.9 (+10.7) years and a mean body mass index (BMI) of 39.2 (+5.29). Participants were evaluated with semistructured interviews and completed self-report psychiatric rating scales. RESULTS The rate of ADHD in the sample was of 28.3%. The presence of ADHD was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptomatology. CONCLUSION Similar to previous studies, a higher than expected rate of ADHD was observed among obese women. ADHD in obese individuals may be a risk factor for greater severity of disordered eating patterns.
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Affiliation(s)
- Bruno Palazzo Nazar
- Federal University of Rio de Janeiro, Brazil State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | | | | | - Monica Duchesne
- State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil
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27
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Leventakou V, Micali N, Georgiou V, Sarri K, Koutra K, Koinaki S, Vassilaki M, Kogevinas M, Chatzi L. Is there an association between eating behaviour and attention-deficit/hyperactivity disorder symptoms in preschool children? J Child Psychol Psychiatry 2016; 57:676-84. [PMID: 26706046 DOI: 10.1111/jcpp.12504] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is some evidence that aberrant eating behaviours and obesity co-occur with attention-deficit/hyperactivity disorder (ADHD) symptoms. The present study is the first that aims to investigate the association between eating behaviours and ADHD symptoms in early childhood in a population-based cohort. METHODS We included 471 preschool children from the Rhea mother-child cohort in Crete, Greece. Parents completed the Children's Eating Behaviour Questionnaire to assess children's eating behaviour and the 36-item ADHD test (ADHDT) to evaluate ADHD symptoms at 4 years of age. Multivariable linear regression models were used to examine the association of eating behaviours with ADHD symptoms. RESULTS Regarding children's food approach eating behaviours, we observed a positive association between food responsiveness and total ADHD index, as well as impulsivity, inattention and hyperactivity subscale, separately. Similarly, there was a significant positive association between emotional overeating and ADHD symptoms. With regard to children's food avoidant behaviours, food fussiness was found to be significantly associated with the impulsivity subscale. A dose-response association between the food approach behaviours and ADHD symptoms was also observed. Children on the medium and highest tertile of the food responsiveness subscale had increased scores on the ADHD total scale, as compared to those on the lowest tertile. As regards emotional overeating, children in the highest tertile of the scale had higher scores on ADHD total and hyperactivity. CONCLUSIONS Our findings provide evidence that food approach eating behaviours such as food responsiveness and emotional overeating are associated with the increased ADHD symptoms in preschool children. Future studies to better understand this overlap will enhance potential interventions.
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Affiliation(s)
- Vasiliki Leventakou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Nadia Micali
- Brain and Behavioural Sciences Unit, UCL, Institute of Child Health, London, UK.,Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA.,Mindich Child Health and Development Institute, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Vaggelis Georgiou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Sarri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Stella Koinaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Maria Vassilaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Aguirre Castaneda RL, Kumar S, Voigt RG, Leibson CL, Barbaresi WJ, Weaver AL, Killian JM, Katusic SK. Childhood Attention-Deficit/Hyperactivity Disorder, Sex, and Obesity: A Longitudinal Population-Based Study. Mayo Clin Proc 2016; 91:352-61. [PMID: 26853710 PMCID: PMC5264451 DOI: 10.1016/j.mayocp.2015.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/12/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess obesity rates during childhood and young adulthood in patients with attention-deficit/hyperactivity disorder (ADHD) and age- and sex-matched controls derived from a population-based birth cohort because cross-sectional studies suggest an association between ADHD and obesity. PATIENTS AND METHODS Study subjects included patients with childhood ADHD (n=336) and age- and sex-matched non-ADHD controls (n=665) from a 1976 to 1982 birth cohort (N=5718). Height, weight, and stimulant treatment measurements were abstracted retrospectively from medical records documenting care provided from January 1, 1976, through August 31, 2010. The association between ADHD and obesity in patients with ADHD relative to controls was estimated using Cox models. RESULTS Patients with attention-deficit/hyperactivity disorder were 1.23 (95% CI, 1.00-1.50; P<.05) times more likely to be obese during the follow-up period than were non-ADHD controls. This association was not statistically significant in either sex (female participants: hazard ratio [HR], 1.49; 95% CI, 0.98-2.27; P=.06; male participants HR, 1.17, 95% CI, 0.92-1.48; P=.20). Patients with ADHD who were not obese as of the date ADHD research diagnostic criteria were met were 1.56 (95% CI, 1.14-2.13; P<.01) times more likely to be obese during the subsequent follow-up than were controls. This association was statistically significant in female study subjects (HR, 2.02; 95% CI, 1.13-3.60; P=.02), but not in male participants (HR, 1.41; 95% CI, 0.97-2.05; P=.07). A higher proportion of patients with ADHD were obese after the age of 20 years compared with non-ADHD controls (34.4% vs 25.1%; P=.01); this difference was observed only in female patients (41.6% vs 19.2%). There were no differences in obesity rates between stimulant-treated and nontreated patients with ADHD. CONCLUSION Childhood ADHD is associated with obesity during childhood and young adulthood in females. Treatment with stimulant medications is not associated with the development of obesity up to young adulthood.
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Affiliation(s)
- Roxana L Aguirre Castaneda
- Division of Pediatric Endocrinology and Metabolism, University of Illinois College of Medicine at Peoria, Peoria
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
| | - Robert G Voigt
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | | | - William J Barbaresi
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jill M Killian
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Ptacek R, Stefano GB, Weissenberger S, Akotia D, Raboch J, Papezova H, Domkarova L, Stepankova T, Goetz M. Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced. Neuropsychiatr Dis Treat 2016; 12:571-9. [PMID: 27042070 PMCID: PMC4780667 DOI: 10.2147/ndt.s68763] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity-impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.
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Affiliation(s)
- Radek Ptacek
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; Department of Psychology, University of New York in Prague, Prague, Czech Republic
| | - George B Stefano
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; MitoGenetics Research Institute, MitoGenetics, LLC, Farmingdale, NY, USA
| | - Simon Weissenberger
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Devang Akotia
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Jiri Raboch
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Hana Papezova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Lucie Domkarova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Tereza Stepankova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Michal Goetz
- Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
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30
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Schoenfelder EN, Kollins SH. Topical Review: ADHD and Health-Risk Behaviors: Toward Prevention and Health Promotion. J Pediatr Psychol 2015; 41:735-40. [PMID: 26717959 DOI: 10.1093/jpepsy/jsv162] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
Across the lifespan, attention deficit/hyperactivity disorder (ADHD) is associated with increased health risk behaviors including substance abuse, binge eating and obesity, and unsafe sexual behavior. These risks are directly linked to the neurocognitive deficits associated with ADHD, and are also mediated by the cascade of psychosocial impairments and stressors caused by ADHD across development. However, little is known about optimal approaches to improve health outcomes in this high-risk population. This topical review provides an overview of health risks associated with ADHD and the limited existing research relevant to health promotion for children and adolescents with ADHD. Future research questions and implications for clinicians are also addressed-especially how psychologists and medical practitioners may improve child health through early screenings, increasing medication adherence, and treating psychosocial impairments.
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31
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Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav 2015; 152:456-65. [DOI: 10.1016/j.physbeh.2015.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Abstract
Attention deficit/hyperactivity disorder (ADHD) is a disorder characterized by impulsivity, hyperactivity, and inattention. Binge-eating behavior is often impulsive and is the hallmark of the two eating disorders, binge-eating disorder (BED) and bulimia nervosa (BN), both of which are associated with significant health impairment. Bingeing behavior is also seen in the binge purge subtype of anorexia nervosa. Individuals with AN of the binge purge subtypes, BN and BED, have been found to exhibit impulsive behaviors that are often not limited to binge eating alone. There is preliminary evidence linking ADHD to BN and to BED in both adults and children. The neurobiological mechanisms behind these associations are only beginning to emerge; however, they suggest that impulse control deficits may play a role in these eating disorders. Additionally, although they may not meet full criteria for one of these eating disorders, some adults and children with ADHD present with dysregulated, impulsive eating disorder behaviors and there is a growing association between ADHD, obesity, and binge-eating behavior in both children and adults. The relationship between ADHD and binge eating is novel, supported by growing evidence and worthy of further research. We will review the underlying neurobiological underpinnings, neuroimaging data, and possible psychopharmacological treatment options, which target both ADHD and binge-eating behaviors as well as future research and treatment directions.
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33
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Bleck J, DeBate R, Levin BL, Baldwin J. Underlying Mechanisms and Trajectory of Comorbid ADHD and Eating Disorders: Proposing an Innovative Systems Framework for Informing Research. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9593-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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34
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) and conditions involving excessive eating (eg, obesity, binge/loss of control eating) are increasingly prevalent within pediatric populations, and correlational and some longitudinal studies have suggested inter-relationships between these disorders. In addition, a number of common neural correlates are emerging across conditions, eg, functional abnormalities within circuits subserving reward processing and executive functioning. To explore this potential cross-condition overlap in neurobehavioral underpinnings, we selectively review relevant functional neuroimaging literature, specifically focusing on studies probing (i) reward processing, (ii) response inhibition, and (iii) emotional processing and regulation, and we outline 3 specific shared neurobehavioral circuits. Based on our review, we also identify gaps within the literature that would benefit from further research.
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Abstract
PURPOSE OF REVIEW This article provides an overview of current controversies in attention-deficit/hyperactivity disorder (ADHD) research, with an emphasis on recent findings that are directly relevant to clinical practice. RECENT FINDINGS Over the past few years, a number of studies have added key evidence to ongoing debates about the epidemiology, nosology, and treatment of ADHD. Although the causes of the rising prevalence of ADHD in the USA are still not fully understood, recent research suggests that environmental factors and changes to the diagnostic criteria may have played a role. In addition, there continues to be controversy surrounding the clinical diagnosis of ADHD and newly recognized, related conditions such as sluggish cognitive tempo. Recent studies have also challenged previous assumptions about the long-term effects of stimulant treatment on growth, academic achievement, and substance use. Moreover, although most complementary and alternative therapies for ADHD appear to be ineffective, there is emerging evidence supporting the value of fatty acid supplementation. Although these findings are promising, more research is needed on all fronts. SUMMARY Although research has shed light on unanswered questions about the epidemiology, nosology, and treatment of ADHD, much is still not known. An understanding of the most important current controversies in ADHD research may aid pediatricians in clinical decision making and allow them to counsel patients more effectively.
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36
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Prevalence and comorbidity of eating disorders among a community sample of adolescents: 2-year follow-up. Psychiatry Res 2015; 227:52-7. [PMID: 25771751 DOI: 10.1016/j.psychres.2015.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/03/2015] [Accepted: 02/23/2015] [Indexed: 11/21/2022]
Abstract
The previous literature about comorbidity between eating disorders (ED) and other DSM-IV psychiatric disorders in adolescence has employed cross-sectional studies with clinical samples, where the comorbid disorders were diagnosed retrospectively. The present study aims to overcome these limitations by the analysis of comorbidity in a community population during 2-year follow-up. A semi-structured interview was applied to a teenager sample. Firstly, a cross-sectional and non-randomized study on psychiatric morbidity was conducted with 993 teenagers between the ages of 12 and 16 from five schools. Secondly, 326 students between 14 and 17 years old of one school were reassessed 2 years later in order to detect ED new cases and find associations with previous psychiatric disorders. The ED prevalence was 3.6%. Cross-sectional analysis revealed that 62.9% of individuals with an ED had comorbid disorders: anxiety disorders (51.4%), Attention Deficit Hyperactivity Disorder (31.4%), oppositional defiant disorder (11.4%), and obsessive compulsive disorder (8.6%). Prospective longitudinal analysis showed an ED incidence rate of 2.76% over the course of 2 years. 22.2% of new cases had received previous psychiatric diagnoses, of which all were anxiety disorders. Thus, ED exhibited a high comorbidity rate among adolescent populations and anxiety disorders were the most common comorbid diagnosis.
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Mikami AY, Normand S. The Importance of Social Contextual Factors in Peer Relationships of Children with ADHD. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015. [DOI: 10.1007/s40474-014-0036-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Sonneville KR, Calzo JP, Horton NJ, Field AE, Crosby RD, Solmi F, Micali N. Childhood hyperactivity/inattention and eating disturbances predict binge eating in adolescence. Psychol Med 2015; 45:2511-20. [PMID: 26098685 PMCID: PMC4655585 DOI: 10.1017/s0033291715000148] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identifying childhood predictors of binge eating and understanding risk mechanisms could help improve prevention and detection efforts. The aim of this study was to examine whether features of attention-deficit/hyperactivity disorder (ADHD), as well as childhood eating disturbances, predicted binge eating later in adolescence. METHOD We studied specific risk factors for the development of binge eating during mid-adolescence among 7120 males and females from the Avon Longitudinal Study of Parents and Children (ALSPAC), a cohort study of children in the UK, using data from multiple informants to develop structural equation models. Repeated assessment of eating disturbances during childhood (mid-childhood overeating, late-childhood overeating and early-adolescent strong desire for food), as well as teacher- and parent-reported hyperactivity/inattention during mid- and late childhood, were considered as possible predictors of mid-adolescent binge eating. RESULTS Prevalence of binge eating during mid-adolescence in our sample was 11.6%. The final model of predictors of binge eating during mid-adolescence included direct effects of late-childhood overeating [standardized estimate 0.145, 95% confidence interval (CI) 0.038–0.259, p = 0.009] and early-adolescent strong desire for food (standardized estimate 0.088, 95% CI −0.002 to 0.169, p = 0.05). Hyperactivity/inattention during late childhood indirectly predicted binge eating during mid-adolescence (standardized estimate 0.085, 95% CI 0.007–0.128, p = 0.03) via late-childhood overeating and early-adolescent strong desire for food. CONCLUSIONS Our findings indicate that early ADHD symptoms, in addition to an overeating phenotype, contribute to risk for adolescent binge eating. These findings lend support to the potential role of hyperactivity/inattention in the development of overeating and binge eating.
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Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) have prominent social impairment, which is commonly manifested in unskilled behaviors in social situations and difficulties in being accepted and befriended by peers. This social impairment often remains after administration of medication and behavioral contingency management treatments that address the core symptoms of ADHD. This article reviews traditional social skills training (SST) approaches to remediating social impairment, and presents the evidence for their efficacy and significant limitations to their efficacy. The article introduces potential reasons why the efficacy of traditional SST may be limited, and concludes with some promising alternative SST approaches.
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Affiliation(s)
- Amori Yee Mikami
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Colombia V6T 1Z4, Canada.
| | - Mary Jia
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Colombia V6T 1Z4, Canada
| | - Jennifer Jiwon Na
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Colombia V6T 1Z4, Canada
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40
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Swanson EN, Owens EB, Hinshaw SP. Pathways to self-harmful behaviors in young women with and without ADHD: a longitudinal examination of mediating factors. J Child Psychol Psychiatry 2014; 55:505-15. [PMID: 25436256 PMCID: PMC4251707 DOI: 10.1111/jcpp.12193] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rates of suicide attempts and nonsuicidal self-injury [(NSSI); e.g., cutting, burning] peak in adolescence and early adulthood; females and individuals with psychiatric symptoms and diagnoses appear to beat particular risk. Hinshaw et al. [Journal of Consulting and Clinical Psychology, (2012), 80, 1041] reported that young women with histories of childhood ADHD diagnoses reported higher rates of suicide attempts and NSSI than nondiagnosed, comparison women. METHODS Via analyses of an ongoing longitudinal investigation, our aims are to examine, with respect to both aspects of self-harmful behavior, (a) ADHD subtype differences and effects of diagnostic persistence (vs. transient and nondiagnosed classifications) and (b) potential mediating effects of impulsivity and comorbid psychopathology, ascertained during adolescence. RESULTS Young adult women with a childhood diagnosis of ADHD-Combined type were at highest risk for suicide attempts as well as the most varied and severe forms of NSSI compared with those with ADHD-Inattentive type and those in the comparison group; participants with a persistent ADHD diagnosis were at higher risk than those with a transient diagnosis or those never meeting criteria for ADHD. Mediator analyses revealed that, during adolescence, an objective measure of impulsivity plus comorbid externalizing symptoms were simultaneous, partial mediators of the childhood ADHD-young adult NSSI linkage.Adolescent internalizing symptoms emerged as a partial mediator of the childhood ADHD-young adult suicide attempt linkage. CONCLUSIONs: ADHD in females, especially when featuring childhood impulsivity and especially with persistent symptomatology, carries high risk for self-harm. Psychiatric comorbidity and response inhibition are important mediators of this clinically important longitudinal association. We discuss limitations and implications for prevention and intervention.
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41
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Nazar BP, Suwwan R, de Sousa Pinna CM, Duchesne M, Freitas SR, Sergeant J, Mattos P. Influence of attention-deficit/hyperactivity disorder on binge eating behaviors and psychiatric comorbidity profile of obese women. Compr Psychiatry 2014; 55:572-8. [PMID: 24246603 DOI: 10.1016/j.comppsych.2013.09.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Previous studies have reported higher prevalence rates of attention-deficit/hyperactivity disorder (ADHD) both in eating disorders (ED) and in obese patients. We compared the psychiatric comorbidity profile of obese ADHD women with non-ADHD obese women and how ADHD symptoms impact in binge eating behaviors. DESIGN Cross-sectional study of a clinical sample. SUBJECTS 171 adult women were evaluated at a specialized clinic in obesity and ED. MEASUREMENTS Participants complete a semi-structured interview and psychopathology rating scales. A hierarchical regression model was employed to predict binge eating behavior. RESULTS Obese ADHD patients had a larger number of psychiatric comorbidities (p<0.001), especially Substance Abuse Disorders, and higher scores on psychopathology rating scales (p<0.05). The highest prediction for binge eating in the regression model was the presence of depressive symptoms, followed by ADHD inattention symptoms and trait-impulsivity. CONCLUSION ADHD should be routinely evaluated in obese since it is related with more severe psychopathology. Depressive symptoms can predict the presence of binge eating in obese patients.
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Affiliation(s)
- Bruno Palazzo Nazar
- Attention-Deficit Study Group (GEDA), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Post-Graduate Program in Psychiatry and Mental Health, Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Group of Obesity and Eating Disorders (GOTA), State Intitute of Diabetes and Endocrinology (IEDE), Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Raphael Suwwan
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brasil
| | - Camilla Moreira de Sousa Pinna
- Attention-Deficit Study Group (GEDA), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Post-Graduate Program in Psychiatry and Mental Health, Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Group of Obesity and Eating Disorders (GOTA), State Intitute of Diabetes and Endocrinology (IEDE), Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Monica Duchesne
- Group of Obesity and Eating Disorders (GOTA), State Intitute of Diabetes and Endocrinology (IEDE), Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Silvia Regina Freitas
- Group of Obesity and Eating Disorders (GOTA), State Intitute of Diabetes and Endocrinology (IEDE), Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Joseph Sergeant
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, Amsterdam, The Netherlands
| | - Paulo Mattos
- Attention-Deficit Study Group (GEDA), Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Viborg N, Wångby-Lundh M, Lundh LG. Reciprocal prospective associations between disordered eating and other psychological problems in a community sample of Swedish adolescent girls. Eat Behav 2014; 15:159-63. [PMID: 24411769 DOI: 10.1016/j.eatbeh.2013.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/26/2013] [Accepted: 11/20/2013] [Indexed: 11/29/2022]
Abstract
Disordered eating and its associations with psychological difficulties and body satisfaction were prospectively studied in a community sample of 13-15 year old adolescent girls (N=428). General psychological difficulties (including hyperactivity-inattention) and lower levels of body satisfaction at T1 were found to predict disordered eating at follow-up one year later (T2). Furthermore, reciprocal associations were found between disordered eating and psychological difficulties (but not body dissatisfaction) so that disordered eating at T1 predicted general psychological difficulties (including hyperactivity-inattention) at T2. The results support the notion of a vicious interplay between disordered eating and other subclinical psychological problems, which may represent a potential mechanism for the development of clinically significant eating disorders. It is suggested that it could be important to identify these kinds of bidirectional processes at an early stage, in order to prevent further developments of clinical forms of psychopathology.
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Affiliation(s)
- Njördur Viborg
- Department of Psychology, Lund University, Box 213, SE-221 00 Lund, Sweden.
| | | | - Lars-Gunnar Lundh
- Department of Psychology, Lund University, Box 213, SE-221 00 Lund, Sweden.
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Byrd HM, Curtin C, Anderson SE. Attention-deficit/hyperactivity disorder and obesity in US males and females, age 8-15 years: National Health and Nutrition Examination Survey 2001-2004. Pediatr Obes 2013; 8:445-53. [PMID: 23325553 PMCID: PMC3638065 DOI: 10.1111/j.2047-6310.2012.00124.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/27/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Youth with ADHD may be at increased risk for obesity. Medications used to treat ADHD can affect weight. Few studies have investigated possible gender differences in associations between ADHD and obesity. WHAT THIS STUDY ADDS Nationally representative of US youth aged 8-15 years. Height and weight were measured, and ADHD assessed by structured diagnostic interview and parent report. Associations between ADHD and obesity are reported for males and females to enable gender comparisons. OBJECTIVE To investigate how associations between attention-deficit/hyperactivity disorder (ADHD) and obesity differ by gender and medication use in a nationally representative sample of US youth in which height and weight were measured. METHODS Youth age 8-15 (n = 3050) studied in the National Health and Nutrition Examination Survey 2001-2004. Obesity was defined as ≥95th percentile of US body mass index-for-age reference. ADHD was determined by asking parents if child had been diagnosed and using the Diagnostic Interview Schedule for Children IV. Gender-stratified multivariable logistic regression was used to estimate odds of obesity for youth with ADHD (medicated and unmedicated) relative to youth without ADHD. RESULTS Males with ADHD who were medicated had lower odds of obesity compared to males without ADHD (adjusted odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.23-0.78). Unmedicated males with ADHD were as likely as males without ADHD to be obese (adjusted OR = 1.02, 95% CI = 0.43-2.42). The odds of obesity for females taking medication for ADHD did not differ statistically from those of females without ADHD (adjusted OR = 1.21, 95% CI = 0.52-2.81). Females with ADHD not taking medication had odds of obesity 1.54 times those of females without ADHD; however, the 95% CI (0.79-2.98) was wide and not statistically significant at α = 0.05. CONCLUSIONS Associations between ADHD and obesity are influenced by treatment of ADHD with medication and may differ by gender. Youth with ADHD who are not treated with medication are as or more likely than youth without ADHD to be obese.
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Affiliation(s)
- H.C. Michelle Byrd
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Carol Curtin
- University of Massachusetts Medical School/EK Shriver Center, 200 Trapelo Road, Waltham, Massachusetts, USA
| | - Sarah E. Anderson
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
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Bleck J, DeBate RD. Exploring the co-morbidity of attention-deficit/hyperactivity disorder with eating disorders and disordered eating behaviors in a nationally representative community-based sample. Eat Behav 2013; 14:390-3. [PMID: 23910787 DOI: 10.1016/j.eatbeh.2013.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/01/2013] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
Abstract
Emerging evidence signifies the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) with clinical and sub-threshold disordered eating behaviors. However, many existing studies have assessed this co-occurrence among inpatient or intensive outpatient populations. The purpose of this study was to examine the co-occurrence of ADHD with clinical eating disorders and disordered eating behaviors in a nationally representative sample via a secondary data analysis of data from the National Longitudinal Study of Adolescent Health (n = 4,862; 2,243 males; 2,619 females). Results reveal that females have higher rates of co-occurrence of ADHD and diagnosed eating disorders than males (1.05% vs. 0.20%, p < .01). When controlling for age and race, ADHD predicted diagnosed eating disorders in females (incidence rate ratio (IRR): 2.06; 95% CI: 1.09-3.88; p < .05), but did not predict diagnosed eating disorders in males. With regard to disordered eating behaviors, when controlling for age, gender, and race, ADHD significantly predicted disordered eating behaviors (OR: 1.82; 95% CI: 1.21-2.74). When stratifying by type of disordered eating behavior, ADHD predicted binging and/or purging behavior (OR: 2.86; 95% CI: 1.78-4.61), but not restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention efforts in addition to tertiary prevention via patient-specific treatment plans.
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Affiliation(s)
- Jennifer Bleck
- University of South Florida, Department of Community and Family Health, College of Public Health, Tampa, FL 33612-3805, USA.
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Seitz J, Kahraman-Lanzerath B, Legenbauer T, Sarrar L, Herpertz S, Salbach-Andrae H, Konrad K, Herpertz-Dahlmann B. The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa. PLoS One 2013; 8:e63891. [PMID: 23700439 PMCID: PMC3659086 DOI: 10.1371/journal.pone.0063891] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/08/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Little is known about the contribution of impulsivity, inattention and comorbid attention deficit/hyperactivity disorder (ADHD) in the development and maintenance of bulimia nervosa (BN). In particular, their specific contribution to disordered eating symptoms and whether they have additive effects to the general psychopathological burden remains unclear. Methods Fifty-seven female patients seeking treatment for BN and 40 healthy controls completed diagnostic questionnaires and interviews that investigated: a) ADHD, b) impulsivity, c) eating disorders and d) general psychopathology. Attentional processes and impulsivity were assessed by a comprehensive computer-based neuropsychological battery. Results Twenty-one percent of patients with BN met the clinical cut-off for previous childhood ADHD compared to 2.5% of healthy controls. Adult ADHD according to DSM IV was also more prevalent in patients with BN, with an odds ratio of 4.2. Patients with BN and previous childhood ADHD were more impulsive and inattentive than patients with BN alone. These patients also displayed more severely disordered eating patterns and more general psychopathological symptoms compared with those without ADHD. Severity of eating disorder symptoms was better explained by inattentiveness than by either impulsivity or hyperactivity. Discussion Our data suggest an elevated rate of former childhood and current ADHD-symptoms in treatment-seeking patients with BN. Stronger impulsivity and inattention associated with more severe neuropsychological deficits and eating disorder symptoms indicate an additive risk that is clinically relevant for these patients. Thus, clinicians should identify comorbid patients who might profit from additional ADHD-specific treatments.
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Affiliation(s)
- Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, Aachen, Germany.
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Eating problems and overlap with ADHD and autism spectrum disorders in a nationwide twin study of 9- and 12-year-old children. ScientificWorldJournal 2013; 2013:315429. [PMID: 23690743 PMCID: PMC3654255 DOI: 10.1155/2013/315429] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 03/27/2013] [Indexed: 11/28/2022] Open
Abstract
Aim. To establish the prevalence of restrictive eating problems, the overlap and association with attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorders (ASD) and to estimate the heritability of eating problems in a general population sample of twins aged 9 and 12. Methods. Parents of all Swedish 9- and 12-year-old twin pairs born between 1993 and 1998 (n = 12,366) were interviewed regarding symptoms of ADHD, ASD, and eating problems (EAT-P). Intraclass correlations and structural equation modelling were used for evaluating the influence of genetic and environmental factors. Cross-twin, cross-trait correlations were used to indicate a possible overlap between conditions. Results. The prevalence of eating problems was 0.6% in the study population and was significantly higher in children with ADHD and/or ASD. Among children with eating problems, 40% were screened positive for ADHD and/or ASD. Social interaction problems were strongly associated with EAT-P in girls, and impulsivity and activity problems with EAT-P in boys. The cross-twin, cross-trait correlations suggested low correlations between EAT-P and ADHD or EAT-P and ASD. Genetic effects accounted for 44% of the variation in liability for eating problems. Conclusions. In the group with eating problems, there was a clear overrepresentation of individuals with ADHD and/or ASD symptoms.
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Pauli-Pott U, Becker K, Albayrak Ö, Hebebrand J, Pott W. Links between psychopathological symptoms and disordered eating behaviors in overweight/obese youths. Int J Eat Disord 2013; 46:156-63. [PMID: 22987501 DOI: 10.1002/eat.22055] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Among overweight and obese youths, rates of depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are elevated. We analyze whether these emotional and behavioral problems are associated with specifically disordered eating pattern. METHOD Participants in the study were 128 overweight and obese children/adolescents (BMI: m = 29.3, s = 4.5; BMI-SDS: m = 2.5, s = 0.4) between 8 and 15 years. Structured psychiatric assessments were conducted adopting a multimethod, multiinformant approach. RESULTS Children/adolescents with ODD symptoms showed increased eating in response to external cues and binge eating. ADHD symptoms were not associated with disordered eating behaviors. Children/adolescents with symptoms of depression and anxiety showed emotional and binge eating. In particular, overweight girls with symptoms of depression showed restrained eating. DISCUSSION Our results point to specific eating problems in overweight/obese children with ODD and depression/anxiety symptoms. The findings could help to tailor interventions to optimally meet the specific needs of overweight children with emotional and behavioral problems.
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Babinski DE, Sibley MH, Ross JM, Pelham WE. The effects of single versus mixed gender treatment for adolescent girls with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 42:243-50. [PMID: 23330787 PMCID: PMC3587658 DOI: 10.1080/15374416.2012.756814] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the social behavior of adolescents with attention deficit hyperactivity disorder (ADHD) in single and mixed gender treatment settings. We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent for 10 girls (M age = 13.17, 80% Hispanic) and 11 boys (M age = 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female vs. male) × Setting (single vs. mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Several Gender × Setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD and whether gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD.
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Affiliation(s)
- Dara E Babinski
- Department of Clinical and Health Psychology, University of Florida, Miami, FL 33186, USA.
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Curtin C, Pagoto SL, Mick E. The association between ADHD and eating disorders/pathology in adolescents: A systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojepi.2013.34028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol 2012; 80:1041-1051. [PMID: 22889337 PMCID: PMC3543865 DOI: 10.1037/a0029451] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status. METHOD Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior. RESULTS Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ). CONCLUSIONS Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.
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