Overweight and obesity in children with Attention-Deficit/Hyperactivity Disorder

Holtkamp, Kristian; Konrad, Kerstin; Müller, Bodo; Heussen, Nicole; Herpertz, Sabine C.; Herpertz‐Dahlmann, Beate; Hebebrand, Johannes

doi:10.1038/sj.ijo.0802623

Cited by 195 publications

(170 citation statements)

References 27 publications

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“…6 As it is often assumed that a low level of physical activity is involved in the etiology of obesity, one might think that ADHD (or at least the hyperkinetic component of this disorder) may be underrepresented in obese patients. 7 However, preliminary evidence surprisingly suggests a potential relationship between ADHD and obesity in clinical samples of obese adults and children seeking treatment. In a group of 215 adult patients treated for obesity, Altfas 8 found that 27.4% had ADHD (diagnosed according to DSM-IV criteria) and 33.5% presented with 'subthreshold' ADHD symptoms (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of ADHD was particularly significant in patients with the highest degree of obesity: 42.6% of extremely obese subjects were diagnosed with ADHD. Holtkamp et al 7 reported that the mean body mass index (BMI)-standard deviation score of a clinical sample of ADHD boys was significantly higher than the age-adapted reference values. In their sample, significantly more subjects than expected had a BMI X90th percentile (19.6%) and X97th percentile (7.2%).…”

Section: Introductionmentioning

confidence: 99%

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Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

et al. 2006

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Objective: Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents. Design: Cross-sectional study. Subjects: Ninety-nine severely obese adolescents aged 12-17 years. Measurements: Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages. Results: Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms. Conclusion: Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

et al. 2006

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“…This is the more surprising in light of mounting evidence for a significant comorbidity between obesity and ADHD [4,24]. We assume that especially for ADHD, relying on the information of a child or an adolescent leads to an underestimation of the prevalence.…”

Section: Discussionmentioning

confidence: 98%

Psychiatric disorders and symptom severity in referred versus non-referred overweight children and adolescents

Vlierberghe

Braet

Goossens

et al. 2008

Eur Child Adolesc Psychiatry

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Background: This study aimed firstly to investigate whether youngsters referred for overweight treatment differ from non-referred overweight youngsters on the prevalence of psychiatric disorders and psychological symptoms. Secondly, the potentially moderating role of age, gender, socio-economic status and degree of overweight in the association of referral status and mental disorder in overweight youth was explored. Methods: Participants were 155 overweight youngsters enrolled in an obesity treatment programme (mean age = 13.76; mean BMI = 33.99) and 73 non-referred overweight youngsters (mean age = 13.74; mean BMI = 27.35). The Structured Clinical Interview for DSM-IV-Childhood version and the Child version of the Eating Disorder Examination were administered and participants filled out the Children’s Depression Inventory, the Spence Children’s Anxiety Scale and the Youth Self Report. Parents were asked to complete the Child Behavior Checklist. Results: In the referred group 37.50% and in the non-referred group 23.29% of the participants met criteria for at least one mental disorder. In both groups, anxiety disorders were most prominent. Overall, a higher prevalence of mental disorders was found in the referred group. Referred youth displayed significantly more ‘full blown’ eating disorders and binge eating than non-referred youngsters and exhibited a significantly greater severity of self- and parent-reported internalizing symptoms. Referral was also associated with a significantly higher degree of overweight and significantly lower SES. After controlling for these pre-existing differences in degree of overweight and SES, only the greater severity of parent-reported internalizing symptoms in referred youth remained significant. Older age was generally predictive for the presence of mental disorders and in the non-referred group SES was positively associated with psychiatric disorder. Conclusions: A substantial proportion of overweight youngsters suffer from mental disorders. Referral status and age are associated with the presence of psychopathology. However, differences between referred and non-referred youngsters are not as pronounced as expected on the basis of earlier research in the field

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“…Overweight and obesity seem to be more prevalent among persons with mental disorder 29 and children with ADHD symptoms. 30,31 ADHD has been mainly linked to dysfunction in dopaminergic and serotonergic systems in genetic studies 32 and recently some evidence points to dysfunctions in the same systems among overweight and obese women. 33,34 Thus, genetic predisposition could account for both overweight and ADHD symptoms.…”

Section: Possible Mechanismsmentioning

confidence: 99%

Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts

et al. 2007

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Objectives: We examine whether pregnancy weight (pre-pregnancy body mass index (BMI) and/or weight gain) is related to core symptoms of attention deficit hyperactivity disorder (ADHD) in school-age offspring. Design: Follow-up of prospective pregnancy cohorts from Sweden, Denmark and Finland within the Nordic Network on ADHD. Methods: Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as 'severe' and two as 'present' (approximately 10% of children scored in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms. Results: Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms (below recommendations: odds ratio (OR): 0.96; 95% confidence interval (CI): 0.81, 1.14; above recommendations: OR: 0.98; 95% CI: 0.82, 1.16). To examine various patterns of pre-pregnancy BMI and weight gain, we used latent class analysis and found significant associations between classes that included pre-pregnancy overweight or obesity and a high ADHD symptom score in offspring, ORs ranged between 1.37 (95% CI: 1.07, 1.75) and 1.89 (95% CI: 1.13, 3.15) adjusted for gestational age, birth weight, weight gain, pregnancy smoking, maternal age, maternal education, child gender, family structure and cohort country of origin. Children of women who were both overweight and gained a large amount of weight during gestation had a 2-fold risk of ADHD symptoms (OR: 2.10, 95% CI: 1.19, 3.72) compared to normal-weight women. Conclusions: We show for the first time that pre-pregnancy BMI is associated with ADHD symptoms in children. Our results are of public health significance if the associations are causal and will then add ADHD symptoms in offspring to the list of deleterious outcomes related to overweight and obesity in the prenatal period.

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Overweight and obesity in children with Attention-Deficit/Hyperactivity Disorder

Cited by 195 publications

References 27 publications

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Psychiatric disorders and symptom severity in referred versus non-referred overweight children and adolescents

Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts

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