Early Childhood ADHD Symptoms May Predict Maladaptive Eating Behaviors

Attention-deficit/hyperactivity disorder (ADHD) symptoms may be associated with obesity-related eating patterns in early childhood, according to study data published in Pediatric Obesity. The investigators abstracted data from the Newborn Epigenetics Study (NEST), a pre-birth cohort founded in 2005 to examine the effect of environmental exposures on development outcomes.

Per NEST protocol, pregnant women (n=2175) were recruited from participating prenatal clinics between April 2005 and June 2011. Researchers conducted follow-up surveys in 2 periods (2011-2013 and 2016-2018). The present cross-sectional study used data from 470 mothers who completed at least 1 survey in both periods. To discriminate between children with and without ADHD symptoms, the researchers examined the attention problems and hyperactivity subscales from the Behavior Assessment System for Children, Second Edition (BASC-2). They also assessed child eating behaviors, including food approaching and food avoidant behaviors, with the Children’s Eating Behavior Questionnaire (CEBQ).

Multivariable linear regression models, performed to assess cross-sectional relationships between ADHD symptoms and eating behaviors, were adjusted for maternal age and education, as well as child age, sex, and body mass index. For a subset of mother-child pairs with data at both follow-up times (n=100), the researchers performed linear change score modeling to assess the prospective association between ADHD symptoms and eating behaviors.

At follow-up, mean child age was 4±1.93 years, and mean maternal age was 33.1±5.8 years. The majority of mothers reported their race/ethnicity as black (51%) or white (42%). According to body mass index cutoffs, 52 (11%) children were overweight, and 87 (19%) were obese at first follow-up. A total of 79 (17%) and 51 (11%) children had “clinically significant” attention problem and hyperactivity scores, respectively.

Attention problem scores were positively associated with desire to drink (ß=0.28; P =.01), slowness in eating (ß=0.17; P =.01), emotional overeating (ß=0.08; P =.01), and food responsiveness (ß=0.19; P =.02). They were also negatively associated with enjoyment of food (ß=−0.20; P =.01). Hyperactivity was positively associated with desire to drink (ß=0.51; P <.001), food responsiveness (ß=0.42; P <.001), slowness in eating (ß=0.18; P =.02), emotional overeating (ß=0.09; P =.01), and satiety responsiveness (ß=0.16; P =.049).

Both attention problems and hyperactivity were positively associated with prospective changes in food responsiveness. Children with attention problems in the first period experienced greater changes in food responses (P =.01), emotional overeating (P <.001), and satiety responsiveness (P <.001) by the second period. Similarly, hyperactivity symptoms were associated with more significant prospective changes in emotional overeating and satiety responsiveness later on (both P =.01). The association between ADHD symptoms and eating behaviors was not bidirectional; problem eating behaviors did not predict hyperactivity or attention problems.

The researchers noted that ADHD symptoms in early childhood may predict more significant changes in eating behaviors over time, and the mechanisms that underlie this relationship warrant further investigation. As study limitations, they noted that data collected in the southeastern United States may not be generalizable to other populations.

“ADHD symptoms may also influence eating behaviors by disturbing sleep patterns,” the investigators concluded. “Sleep is disrupted among children with ADHD and problematic eating may ensue to compensate for low-energy levels resulting from a lack of sleep.”

Reference

Fuemmeler BF, Sheng Y, Schechter JC, et al. Associations between attention deficit hyperactivity disorder symptoms and eating behaviors in early childhood [published online March 2, 2020]. Pediatr Obes. doi:10.1111/ijpo.12631