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

Background: Attention-Deficit/Hyperactivity Disorder (ADHD), one of the most common neurodevelopmental conditions of childhood, is associated with high rates of mood and behavioral disorders. Preliminary evidence suggests that ADHD may also be associated with eating disorders (ED) or eating pathology (EP). This systematic review synthesizes the extant published literature on this association among youth ages 12-21 years. Methods: Literature searches were performed using Medline, Ovid/Psych Info, Google Scholar, and via manual inspection of bibliographies. Cross-sectional, case-control, and prospective studies published in English with sample sizes larger than 50, participant ages 12-21 years, and assessed ADHD and ED or EP, were considered for review. Case reports, feeding, and drug studies were excluded. Results: Preliminary searches yielded 337 articles; eight articles met inclusion/exclusion criteria. Two studies documented an association between ADHD and ED, and three studies found an association between ADHD and EP. Youth with ADHD were nearly 3 to 6 times more likely to develop an ED than youth without ADHD, and were also more likely to have higher rates of EP, body dissatisfaction, and desire to lose weight/ drive for thinness. Impulsivity was predictive of EP, and ADHD youth with co-occurring mood/behavioral disorders and punitive parental relationships were at higher risk. Conclusions: Five of eight studies documented an association between ADHD and ED or EP in adolescents. Future research is needed to confirm and refine further these findings. The findings have clinical implications, including the inclusion of ED/EP in screening and anticipatory guidance efforts. Evaluating whether medical management of ADHD may be efficacious in preventing and/or treating ED/EP is also warranted.