Eating Behavior Profiles and Associated Factors in Children with ADHD: A Multidimensional and Multi-Informant...

Attention-deficit/hyperactivity disorder (ADHD) has been associated with atypical eating behaviors and weight-related outcomes in childhood; however, relationships between specific ADHD symptom dimensions and distinct eating behavior patterns across informants remain insufficiently characterized. This study compared eating behaviors between children with ADHD and typically developing peers and examined symptom-specific correlates of food-approach and food-avoidance behaviors.

This cross-sectional case-control study included 70 medication-naïve children with ADHD and 60 typically developing controls aged 7-9 years. Eating behaviors were assessed using the Children's Eating Behaviour Questionnaire, while ADHD symptoms were evaluated using parent- and teacher-reported measures. Group comparisons, correlation analyses, multivariable regression models, and an exploratory indirect effect analysis were conducted.

Children with ADHD exhibited higher food responsiveness, emotional overeating, enjoyment of food, emotional undereating, and overall food-approach scores than controls. In multivariable analysis, teacher-rated impulsivity emerged as the only statistically significant independent correlate of food-approach behaviors after simultaneous adjustment for all prespecified predictors. Exploratory indirect effect analysis showed a significant indirect association between teacher-rated impulsivity and BMI z-score through emotional overeating.

Eating behaviors in children with ADHD appear heterogeneous, with food-approach and food-avoidance patterns showing distinct associations with symptom dimensions across informants. Emotional overeating may represent a potential behavioral pathway linking impulsivity-related symptoms to relative body weight. These cross-sectional findings warrant confirmation in longitudinal studies.