Original Article
International Journal of Obesity (2007) 31, 340–346. doi:10.1038/sj.ijo.0803400; published online 30 May 2006
Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents
S Cortese1,2, P Isnard1,3, M L Frelut4,5, G Michel1,6, L Quantin3, A Guedeney3, B Falissard1,7, E Acquaviva1,7, B Dalla Bernardina2 and M C Mouren1,8
- 1AP-HP, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris, France
- 2Servizio di Neuropsichiatria Infantile, Dipartimento Materno Infantile e di Biologia-Genetica, Università degli Studi di Verona, Verona, Italy
- 3AP-HP, Service de Psychiatrie infanto-juvenile, Hôpital Bichat-Claude Bernard, Paris, France
- 4AP-HP, Service d'endocrinologie pédiatrique, Hôpital Saint Vincent de Paul, Paris, France
- 5Centre thérapeutique Pédiatrique, Croix Rouge Française, Margency, France
- 6UPRES 2114, Université François Rabelais, Tours, France
- 7INSERM U669 PSIGIAM (Paris Sud Innovation Group In Adolescent Mental Health Methodology); Université Paris XI, Paris, France
- 8INSERM U675 'Analyse phénotypique, développementale et génétique des comportements addictifs', Faculté Xavier Bichat, Paris, France
Correspondence: Dr P Isnard, AP-HP, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, 48 Bd Sérurier, Paris 75019, France. E-mail: pascale-isnard@bch.aphp.fr
Received 19 October 2005; Revised 28 March 2006; Accepted 25 April 2006; Published online 30 May 2006.
Abstract
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.
Keywords:
ADHD, bulimic behaviors, eating disorders, children-adolescents
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