Attention Magazine April 2023

Is ADHD related to challenges with eating? This research update reviews two recent studies involving samples of young children as well as young adults.

The first is a cross-sectional study that found links between ADHD and eating disorder symptoms among university students. In particular, the inattentive symptoms of ADHD were related to body dissatisfaction, bulimia, and having a drive for thinness, all difficulties characteristic of eating disorders.

The second study used a longitudinal methodology to examine eating behaviour and ADHD symptoms across time for young children. The findings of this study showed that urges to eat in reaction to external cues at four years of age were predictive of hyperactivity at age six.

Taken together, both studies suggest a potential link between ADHD and eating disorders.

Symptoms of ADHD and eating disorders in university students

This study explored the relationship between symptoms of ADHD and eating disorders in undergraduate university students, as past research has found similarities between these two disorders. Indeed, adolescent females with ADHD were found to be 3.6 times more likely to meet eating disorder criteria, with an even greater likelihood for developing symptoms of bulimia nervosa, a disorder involving recurrent binge-eating and compensatory behaviours to avoid gaining weight (Biederman et al., 2007). As well, research suggests that in addition to predicting the probability of an eating disorder, ADHD symptoms may also predict its severity. ADHD symptoms such as inattention, hyperactivity, impulsivity, and challenges with planning and organizing, may help explain the co-occurrence of ADHD and eating disorders.
The present study involved 133 undergraduate psychology students in Canada between the ages of 18 and 22 years. Approximately 20% of the participants were male and 80% were female. Participants completed a questionnaire measuring the presence and severity of ADHD symptoms, as well as a survey that evaluated the presence and severity of eating disorder symptoms in the areas of bulimia, body dissatisfaction, and drive for thinness. Approximately 6% of the participants reported having an ADHD diagnosis, and about 6% reported a previous eating disorder diagnosis.

Overall results indicated that increased ADHD symptoms were related to worse eating disorder symptoms. In particular, the inattentive symptoms of ADHD were associated with all of the eating disorder areas assessed (drive for thinness, bulimia, body dissatisfaction), whereas hyperactive/impulsive symptoms were only associated with eating disorder symptoms with respect to body dissatisfaction. It is possible that symptoms of inattention (e.g., mind wandering, forgetfulness, challenges staying organized) influence patterns of disordered eating. However, future research that examines changes across time will be necessary to understand the causality of these relationships.

Baraskewich J & Climie E. (2022). The relation between symptoms of ADHD and symptoms of eating disorders in university students. The Journal of General Psychology, 149, 405-419. https://doi.org/10.1080/00221309.2021.1874862

Eating behaviors and ADHD symptoms in schoolchildren

This study used a longitudinal design to examine eating behaviours of children at four years of age and ADHD symptoms two years later. Researchers predicted that children who had an urge to eat in reaction to signals outside of themselves (such as smelling or seeing food) would be more likely to show later ADHD symptoms. It was also expected that children who engaged in emotional eating (that is, eating more than necessary due to negative feelings) would have higher ADHD symptoms two years later. Furthermore, it was predicted that child ADHD symptoms at four years of age would be related to a higher Body Mass Index (BMI) at six years of age.

Nine-hundred and twenty-six mothers in Greece participated in this birth cohort study, which involved completing surveys at different timepoints, including when their children were four and six years of age. When their children were four years old, participants completed a questionnaire assessing the eating style of their child, which included measures of food responsiveness and emotional overeating. Participants also completed questionnaires examining their child’s ADHD symptoms at four and six years of age.

Consistent with the researchers’ prediction, higher food responsiveness at four years of age predicted higher hyperactivity at six years of age. The pattern of results did not differ depending on gender. Higher impulsivity may be a possible mechanism for this association between greater food responsiveness and more hyperactivity. However, more research examining potential mechanisms in depth is needed to understand this relationship. Interestingly, results also showed that more emotional eating at four years of age was associated with lower levels of hyperactivity at six years of age. As well, ADHD symptoms were not related to BMI.

Overall, these findings may be unique to the sample, which involved children at an early age. Future studies with older children may be useful, as well as research measuring contextual factors (home and school supports, for example) that may influence the results found.

Leventakou V, Herle M, Kampouri M, Margetaki K, Vafeiadi M, Kogevinas M, … & Micali N. (2022). The longitudinal association of eating behaviour and ADHD symptoms in school age children: A follow-up study in the RHEA cohort. European Child & Adolescent Psychiatry, 31, 511-517. https://doi.org/10.1007/s00787-021-01720-x

Yuanyuan Jiang, PhD, CPsych, is an assistant professor in the school of counselling, psychotherapy, and spirituality at Saint Paul University, and an adjunct professor in educational psychology at the University of Alberta. She directs the Attention, Behaviour, and Cognitions (ABC) Lab, which focuses on studying how attention, behavior, and cognitions interact to improve assessments and interventions for children with inattentiveness and/or hyperactivity/impulsivity.

Joelle Ciccarelli is a registered dietitian and master’s student in the school of counselling, psychotherapy, and spirituality at Saint Paul University. Her research interests focus on the relationship between neurodiversity, eating pathology, and body relationship with the goal of supporting individuals to care for their bodies in a way that meets their emotional, psychological, and physical needs.