Impulsivity and Binge-Eating in Children: Connecting the Dots

Published in Summer 2016 and Brain Wise - Winter 2016
In recent years, pediatric psychiatrist Shauna P. Reinblatt began seeing a trend in her clinics: More children with attention deficit and hyperactivity disorder (ADHD) are also obese, even though their constant activity and the stimulants used to treat ADHD typically cause these children to lose weight. So, Reinblatt wondered, could impulsive behaviors be triggering binge eating?
Her search for studies on the topic turned up few. There are data linking ADHD and adult binge eating—the most common eating disorder in adults—but there is scant information on children with that problem, which Reinblatt prefers to describe as loss of control eating syndrome (LOC-ES).
Binge eating, she explains, is harder to define and standardize in children of different ages because of growth spurts, which can naturally boost appetites. LOC-ES “means these kids are eating considerably more than their peers and are unable to control what or how much is being consumed,” says Reinblatt, who founded the Johns Hopkins Child Psychiatry Overeating Clinic for children and teens.
Reinblatt speculated about possible shared mechanisms in these children, such as impulse control deficits that are at play in both ADHD and LOC-ES. A recent study she led validates that hunch.
In the study of 79 children ages 8 to 14 whose body mass index was over the fifth percentile, the odds of LOC-ES were increased 12 times for children with ADHD. In addition, children with LOCES had much greater impulse control deficits during performance-based neuropsychological tests and on parent reports than children without LOC-ES.
Though the study’s findings suggest a link between ADHD and disinhibited eating, Reinblatt cautions that the roots of any underlying connection remain obscure, and longitudinal studies are needed. Children with ADHD who also have LOC-ES might have a more severe form of ADHD marked by more episodes of impulsive behavior. Alternatively, she says, children with both ADHD and LOC-ES could share an underlying risk factor, such as genetic predisposition to impulsivity.
Associated symptoms, such as negative feelings and secrecy, also may play a role in this wider definition of binge eating, says Reinblatt. During her treatment sessions with parents and children, for example, a parent might report that the child regularly sneaks food. “We need to find out if these kids feel guilty or embarrassed about eating,” she says.
Ultimately, Reinblatt hopes to identify any underlying mechanism connecting ADHD and loss of control eating “to figure out what’s going on in these cases and better understand when to use stimulants,
cognitive behavioral therapy or other treatments.” In the meantime, she adds, clinicians who see children with ADHD should be mindful that they may be binging.