Associations between adult ADHD core symptoms, cognitive flexibility, and emotional eating: a case-control study

Attention-deficit/hyperactivity disorder (ADHD) in adults often co-occurs with eating disorders (EDs), potentially through shared difficulties in emotional regulation, and executive functions. This study explored the associations between cognitive flexibility as a component of executive functions, core adult ADHD symptom dimensions and emotional eating-related eating behaviorsin adults with ADHD and healthy controls, within the framework of executive functions.

This case-control study included 76 adults with ADHD and 69 healthy controls. Participants completed the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS), Emotional Eating Questionnaire (EEQ), Hospital Anxiety and Depression Scale, Cognitive Control and Flexibility Questionnaire (CCFQ), and Berg's Card Sorting Test. Group differences were tested with t-tests, correlations with Spearman's ρ, and hierarchical regression (Approval No: I11-798-23).

The ADHD group had significantly higher EEQ scores (t = 5.39, p =0.001). The ADHD group also showed lower CCFQ total score (t (125) = -5.52, p <0.001). EEQ scores were positively correlated with SR-WRAADDS Attention Deficit (ρ =0.331, p =0.003), and CCFQ Cognitive Control over Emotion (ρ = -0.256, p =0.02). Regression analysis identified attention deficit as the only significant predictor of the EEQ total scorein the ADHD group.

Our findings suggest that impairments in executive functioning-including cognitive flexibility, attentional regulation, and emotion-related control mechanisms-may play a more central role in the relationship between ADHD and emotional eating-related eating behaviors. Longitudinal studies are warrented to further elucidate these mechanisms.