Comorbidity between ADHD and Obesity: Exploring Shared Mechanisms and Clinical Implications

Cortese, Samuele; Peñalver, Carmen Morcillo

doi:10.3810/pgm.2010.09.2205

Cited by 89 publications

(81 citation statements)

References 61 publications

(62 reference statements)

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“…Although the link between ADHD and pediatric obesity is often explained by dopaminergic dysfunction leading to impairments in reward processing, 18,19 isolating more proximal behavioral and/or neurocognitive skills involved in children's daily functioning is critical. The current study highlights EF as a more proximal selfregulation mechanism that appears to be particularly impaired among children with ADHD and co-occurring weight problems.…”

Section: Discussionmentioning

confidence: 99%

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Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning

et al. 2011

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OBJECTIVE:To explore the link between pediatric obesity and attention deficit/hyperactivity disorder (ADHD) by examining whether executive functioning (EF) and medication status are associated with body mass index (BMI) and weight status in children with ADHD. METHOD: Participants for this study included 80 children (mean age ¼ 10 years, 9 months) with a DSM-IV diagnosis of ADHD, confirmed by a comprehensive clinical diagnostic assessment. Children's EF was measured using three neuropsychological tests, and severity of ADHD symptoms and medication status were obtained from parent report. Children's height and weight were also measured during the visit using a wall-mounted stadiometer and a balance beam scale. RESULTS: Children with ADHD who performed poorly on the neuropsychological battery had greater BMI z-scores, and were more likely to be classified as overweight/obese compared with children with ADHD who performed better on the neuropsychological battery. In addition, children with ADHD who were taking a stimulant medication had significantly lower BMI z-scores compared with children with ADHD who were not taking medication or who were taking a non-stimulant medication. CONCLUSION: EF is more impaired among children with ADHD and co-occurring weight problems, highlighting the importance of self-regulation as a link between pediatric obesity and ADHD.

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Section: Discussionmentioning

confidence: 99%

“…18,19 It is well documented that children with ADHD have impaired capacity to delay gratification and diminished responses to reinforcement schedules. 20,21 Similar reductions in dopaminebinding potential have been observed in adults with obesity.…”

Section: Introductionmentioning

confidence: 99%

Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning

et al. 2011

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“…Attention deficit hyperactivity disorder, the most prevalent behavioral disorder in childhood, is highly comorbid with other externalizing problems and has been linked to obesity in children. [34][35][36][37] Underlying mechanisms linking externalizing problems with pediatric obesity include: impulsive behaviors related to uncontrolled eating, 37 elevated sensitivity to immediate reward 38 and impaired executive functions (neurocognitive skills that are necessary for planning, monitoring and executing goal-directed actions) that might foster dysregulated eating behaviors, such as binge eating, emotional eating or eating in the absence of hunger. 39 Children with externalizing behaviors may also be at greater risk of food addictions.…”

Section: Discussionmentioning

confidence: 99%

Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary cortisol concentrations

Pervanidou

Bastaki

Chouliaras

et al. 2015

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OBJECTIVE: Pediatric obesity commonly co-exists with emotional and behavioral disorders, while disturbed cortisol concentrations have been reported in both obese and chronically stressed individuals with anxiety and/or depression. We investigated the prevalence of internalizing and externalizing problems, reported by both parents and children, in a clinical population of obese children (OC) compared to normal-weight children. We examined the role of cortisol as a potential mediator between obesity and such problems. DESIGN: We compared 110 obese with 31 normal-weight children. The Greek version of the child behavior checklist (CBCL) and the youth self-report (YSR) were used and salivary cortisol was determined serially five times a day. RESULTS: T-scores of internalizing problems (anxiety/depression, social withdrawal, somatic complains) reported by both children (49.3±12.3 vs. 43.2±9.1) and mothers (60.6±11.3 vs. 50.6±10.4) were significantly higher (p=0.03 and p<0.001, respectively) in the obese than in the lean children. Externalizing problems (delinquency, rule-breaking behaviors) reported only by mothers were significantly higher in the OC (57.2 ±10.5 vs. 48.2±13.3, p=0.003). The cortisol area under the curve (AUC) was significantly smaller (p=0.03) in the OC than in the controls; however, a cortisol correlation with internalizing/externalizing symptoms was not observed. CONCLUSIONS: There is a high prevalence of internalizing and externalizing problems in a clinical population of OC. A mediation effect of cortisol in the relation between internalizing/ externalizing problems and obesity could not be supported.

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“…Psychological hypotheses have been offered, including deficient inhibitory control, poor executive functions, and inability to monitor eating behaviors. 2,10,[29][30][31][32] Regarding neurobiological correlates, dysfunction of fronto-striatal dopaminergic pathways has been implicated in ADHD, 30 as well as in obesity 33 ; whereas stimulant therapy may function in the short-term to minimize this dysfunction, its longterm effect may diminish.…”

Section: Discussionmentioning

confidence: 99%

Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Childhood attention-deficit/ hyperactivity disorder has been associated with both childhood and adult obesity, whereas treatment with stimulants has been associated with delayed child growth. No longitudinal studies with details about dates of diagnosis, treatment, and duration of stimulant use have been published. WHAT THIS STUDY ADDS:Using electronic health record data, this was the first study to evaluate the independent associations of attention-deficit/hyperactivity disorder diagnosis, stimulant treatment, age at first stimulant use, and duration of stimulant use on longitudinal BMI trajectories throughout childhood and adolescence.abstract BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with childhood and adult obesity, and stimulant use with delayed childhood growth, but the independent influences are unclear. No longitudinal studies have examined associations of ADHD diagnosis and stimulant use on BMI trajectories throughout childhood and adolescence. METHODS:We used longitudinal electronic health record data from the Geisinger Health System on 163 820 children ages 3 to 18 years in Pennsylvania. Random effects linear regression models were used to model BMI trajectories with increasing age in relation to ADHD diagnosis, age at first stimulant use, and stimulant use duration, while controlling for confounding variables.RESULTS: Mean (SD) age at first BMI was 8.9 (5.0) years, and children provided a mean (SD) of 3.2 (2.4) annual BMI measurements. On average, BMI trajectories showed a curvilinear relation with age. There were consistent associations of unmedicated ADHD with higher BMIs during childhood compared with those without ADHD or stimulants. Younger age at first stimulant use and longer duration of stimulant use were each associated with slower BMI growth earlier in childhood but a more rapid rebound to higher BMIs in late adolescence. CONCLUSIONS:The study provides the first longitudinal evidence that ADHD during childhood not treated with stimulants was associated with higher childhood BMIs. In contrast, ADHD treated with stimulants was associated with slower early BMI growth but a rebound later in adolescence to levels above children without a history of ADHD or stimulant use. The findings have important clinical and neurobiological implications. Pediatrics 2014;133:668-676

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Comorbidity between ADHD and Obesity: Exploring Shared Mechanisms and Clinical Implications

Cited by 89 publications

References 61 publications

Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning

Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning

Internalizing and externalizing problems in obese children and adolescents: associations with daily salivary cortisol concentrations

Attention Deficit Disorder, Stimulant Use, and Childhood Body Mass Index Trajectory

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