Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder.

Abstract

Investigated prospectively-assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with ADHD-Combined Type (ADHD-C; n=93), ADHD-Inattentive Type (ADHD-I; n=47), and a comparison group (n=88). The sample, initially aged 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD-C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD-I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent-child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology.Keywords attention-deficit hyperactivity disorder (ADHD); girls; eating pathology; bulimia nervosa; body image dissatisfaction It is well known that children with attention-deficit/hyperactivity disorder (ADHD) are at risk for delinquency, academic failure, substance abuse, and depression/anxiety in adolescence (Barkley, 2002;Mannuzza & Klein, 2000). Yet research has not examined relationships between ADHD and adolescent eating pathology, considered in this study to be body dissatisfaction and maladaptive bingeing/purging behaviors symptomatic of bulimia nervosa (BN). In this introduction, we review (a) reasons why such investigation has been limited, (b) theoretical rationale as to why ADHD and eating pathology may be linked, (c) existing research on this question, and (d) the potential for differential predictions regarding the ADHDInattentive (ADHD-I) vs. ADHD-Combined (ADHD-C) types.Address correspondence to Amori Yee Mikami, Department of Psychology, University of Virginia, 102 Gilmer Hall, P.O. Box 400400, Charlottesville, VA 22904-4400; mikami@virginia.edu. NIH Public Access Lack of Research on ADHD and Eating PathologyTwo factors that have limited the investigation of links between ADHD and eating pathology are the strong preponderance of males in the ADHD literature, far exceeding the community male:female ratio of 3:1 (Hinshaw & Blachman, 2005), and the focus on children as opposed to adolescents with ADHD. Eating pathology overwhelmingly affects females-who outnumber males 9:1 in diagnoses of BN and 3:1 in subclinical BN symptoms and body image dissatisfaction (Sweeting & West, 2002)-and post-pubertal adolescents (Stice, Presnell, & Bearman, 2001). A prospective longitudinal sample of girls with ADHD followed into adolescence is required to conduct a sensitive test of risk for eating pathology, yet this type of sample is...

The association between ADHD and eating disorders/pathology in adolescents: A systematic review

“…Of these, seven articles met full criteria for inclusion and one article was identified from the reference lists of the included articles. Thus, eight articles are summarized in the present review [17][18][19][20][21][22][23][24]. Figure 1 depicts the article selection and review process.…”

“…Two studies [22,24] were performed on large populationbased datasets and a third study was based on a large community sample of adolescents [21]. Four studies were comprised of large samples of youth with ADHD ascertained within clinical settings or specialized camps designed for research in children with ADHD [17][18][19][20]. One study was comprised of inpatients hospitalized for eating isorders [23].…”

The Importance of Social Contextual Factors in Peer Relationships of Children with ADHD

“…Results from several investigations suggest that if children with ADHD are rejected by peers, this augments the risk associated with ADHD diagnostic status for depression, anxiety, delinquency, academic failure, eating pathology, and substance abuse in adolescence [24][25][26]. Recent evidence finds that, in addition to ADHD symptoms predicting peer problems, peer rejection may actually exacerbate ADHD symptoms over the course of a year [27•].…”

The neurobiological profile of girls with ADHD

“…Even so, it is clear that ADHD is associated with considerable functional and psychosocial impairment in girls, including an increased risk of internalizing disorders (eating disorders, depression, suicide), especially in adolescence and young adulthood Gershon, 2002;Makris et al, 2008;Mikami et al, 2008]. Longitudinal follow-up of a large cohort of girls with ADHD aged 6-18 years at baseline showed that girls with ADHD were at significantly higher risk for elevated prevalence of antisocial, addictive, mood, and anxiety disorders, including Major Depression, Bipolar Disorder, Tourette syndrome, and Nicotine Dependence [Biederman et al, 2006].…”