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Advertising Influences Food Choices of University Students With ADHD
Journal of Attention Disorders
Abstract
Objective: previous research in adults with ADHD showed high rates of obesity and unhealthy food choices. There is evidence that contextual cues, e.g., advertisements, influence food choices. This study assessed the sensitivity of university students with ADHD to advertised food.
Method: university students (N = 457) with and without ADHD participated in a cafeteria field experiment. Food choices were examined in periods of advertising either healthy or unhealthy sandwiches.
Results: the findings revealed that students with ADHD (1) chose less healthy food items; (2) were more influenced by advertising; (3) showed the same overall healthy food choices as controls when exposed to healthy advertising.
Conclusion: university students with ADHD were more likely to opt for more unhealthy foods at the cafeteria but were also more influenced by advertising. Exposure to healthy food advertisements eliminated ADHD-related unhealthy food choices. As this population has strong association with unhealthy dietary patterns, it is important to continue the research of food cues and the influence on their eating habits.<br/
... A field experiment conducted in a cafeteria involving 457 students with and without ADHD demonstrated students' high sensitivity to advertising. Healthy food advertisements encouraged students to choose healthy foods; unhealthy food advertisements led students to buy sandwiches and other unhealthy foods [18]. ...
... A field experiment conducted in a cafeteria involving 457 students with and without ADHD demonstrated students' high sensitivity to advertising. Healthy food advertisements encouraged students to choose healthy foods; unhealthy food advertisements led students to buy sandwiches and other unhealthy foods [18]. ...
The UN Sustainable Development Goals and the Paris Climate Agreement are pushing the current generation to rethink and transform their behaviors. The importance of the research subject is due to the need for universities to implement the third mission and implement the University 4.0 model in response to emerging challenges of promoting sustainable development of society. The main purpose of the study is to assess the impact of students' dietary choices on students' academic achievements, taking into account environmental aspects. In the course of the study, a methodology based on a qualitative approach was used, including the development of questionnaires and the use of Chi-square statistics. The results obtained indicate that there is no relationship between students' academic performance and factors of rational nutrition. The analysis of the responses made it possible to conclude that there is an urgent need for universities to rethink the strategy and mechanisms for the implementation of the mission. It is necessary to give priority attention to the implementation of policies aimed at the formation of mechanisms for the transformation of students' eating behavior in order to achieve sustainable academic growth, taking into account environmental aspects.
... A field experiment conducted in a cafeteria involving 457 students with and without ADHD demonstrated students' high sensitivity to advertising. Healthy food advertisements encouraged students to choose healthy foods; unhealthy food advertisements led students to buy sandwiches and other unhealthy foods [18]. ...
The UN Sustainable Development Goals and the Paris Climate Agreement are pushing the current generation to rethink and transform their behaviors. The importance of the research subject is due to the need for universities to implement the third mission and implement the University 4.0 model in response to emerging challenges of promoting sustainable development of society. The main purpose of the study is to assess the impact of students' dietary choices on students' academic achievements, taking into account environmental aspects. In the course of the study, a methodology based on a qualitative approach was used, including the development of questionnaires and the use of Chi-square statistics. The results obtained indicate that there is no relationship between students' academic performance and factors of rational nutrition. The analysis of the responses made it possible to conclude that there is an urgent need for universities to rethink the strategy and mechanisms for the implementation of the mission. It is necessary to give priority attention to the implementation of policies aimed at the formation of mechanisms for the transformation of students' eating behavior in order to achieve sustainable academic growth, taking into account environmental aspects.
... This is the reason why half of the respondents consume tinned tomatoes. Accordingly, Kucharczuk et al. (2022) and Hershko et al. (2021) revealed that advertisement of food products influences food choices. Figure 1 depicts consumers' reading habits of labels on tinned tomatoes. ...
Purpose -
With the empirical evidence on the purchase behaviour of tinned tomatoes, food labelling and the safety consciousness of consumers in Ghana were examined.
Design/methodology/approach –
Primary data were obtained from 130 consumers. Descriptive statistics, factor analysis and multinomial probit analysis were applied.
Findings –
Consumers use tinned tomatoes for cooking because of its easy accessibility in nearby shops, guaranteed constant supply, attractive package, it being affordable/cheaper, its better colour, advertisement/promotion, and longer shelf life. There is a low level of food safety consciousness among consumers since only one-fifth read labels on tinned tomatoes very often, and one-fifth do not read labels at all. Consumers frequently check on tinned tomatoes’ most essential information: brand/type, manufacturing and expiry dates, and weight/volume. Age, residential status, contact information, nutritional benefits and affordability influence the choice of retail brand of tinned tomatoes. The health label consumer segment and conventional label consumer segment were identified, with the majority being the former.
Research limitations/implications –
The sample size used for the study could be improved in terms of number and geographical coverage. This is because the study was limited to only one main urbanised area in Ghana. Therefore, it will be worthwhile for a further study to be conducted by comparing urban and rural consumers in Ghana and other countries within Africa, to either validate or reveal a different trajectory of consumer behaviour relevant to marketing, policy and practice.
Originality/value –
Tomato paste (tinned tomatoes) is consumed in almost all homes in Africa, but there are
food scare concerns about tinned tomatoes due to reported cases of adulteration with unhealthy materials such as starch and food colour, leading to negative health implications on consumers. This makes the reading of tinned tomato labels very crucial. Thus, it is of policy relevance to investigate consumers’ reading behaviour of label information on tinned tomatoes in Ghana. However, previous studies on food labelling focussed on food and nutrition labelling and implications of food labelling on consumers’ purchase behaviour, with most of them outside Africa.
... There is a growing concern among public health officials regarding the number of advertisements for risky products e.g., alcohol, gambling, unhealthy food and beverages 16,17 . Numerous studies conducted around the world indicate that exposure to unhealthy energy-dense, nutrition-poor food and beverage advertisements can promote unhealthy eating habits [18][19][20][21][22][23][24] . The marketing of products that are high in fat, sugar and salt to children is particularly concerning, as it increases the potential for diet-related diseases later in life 21 . ...
While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements, which may encourage their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool 360∘ Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 25,349, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th–18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas and those frequented by students. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities.
... There is a growing concern among public health officials regarding the number of advertisements for risky products e.g., alcohol, gambling, unhealthy food and beverages 16,17 . Numerous studies conducted around the world indicate that exposure to unhealthy energy-dense, nutrition-poor food and beverage advertisements can promote unhealthy eating habits [18][19][20][21][22][23][24] . The marketing of products that are high in fat, sugar and salt to children is particularly concerning, as it increases the potential for diet-related diseases later in life 21 . ...
While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements encouraging their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool 360 degree Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 26,645, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th -- 18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405) (e.g., cars and broadband). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas, and those frequented by students and children carrying excess weight. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities.
Background
Partially driven by public concerns about modern food production practices, organic food has gained popularity among consumers. However, the impact of organic food consumption during pregnancy on offspring health is scarcely studied. We aimed to investigate the association between maternal intake of organic food during pregnancy and symptoms of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring at 8 years of age.
Methods
This study was based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). The total study sample included 40,707 mother–child pairs (children born 2002–2009). Organic food consumption during pregnancy was assessed by six questions from a food frequency questionnaire in mid-pregnancy (sum score 0–18). Symptoms of ADHD and ASD in the offspring aged 8 years were measured by ADHD (0–54) and ASD (0–39) symptom scores based on the Parent/Teacher Rating Scale for Disruptive Behaviour disorders and the Social Communication Questionnaire. Associations between maternal intake of organic food during pregnancy and symptoms of ADHD and ASD in the offspring were analyzed using regression models with adjustment for covariates such as maternal anxiety and depression, including sibling analysis.
Results
Mean ADHD and ASD symptom scores in the offspring differed only slightly by maternal intake of organic food. The covariate-adjusted unstandardized regression coefficient (adjusted(Adj)beta) with 95% confidence interval for the ADHD symptom score with one unit increase in organic food sum score was 0.03 (0.01, 0.05). Similarly, Adjbeta for autism symptom score was 0.07 (0.04, 0.10). For ADHD, the adjusted estimates weakened when adjusting for maternal symptoms of ADHD. The sibling analyses showed no significant results with Adjbeta − 0.07 (− 0.15, 0.01) and − 0.001 (− 0.12, 0.12) for ADHD and ASD outcomes, respectively.
Conclusions
We observed weak positive associations between frequent maternal organic food consumption during pregnancy and offspring ADHD and ASD symptom levels at 8 years of age. This trend weakened or disappeared after adjusting for maternal symptoms of ADHD, and in sibling analyses, suggesting that the associations mainly reflect genetic confounding. Our study indicates that consumption of organic food during pregnancy should neither be considered a risk factor nor protective against symptoms of ADHD and ASD in offspring.
The adverse effects of junk foods on the risk of attention deficit hyperactivity disorder (ADHD) symptoms were reported in several studies. In this meta-analysis, the association between junk food consumption and the risk of ADHD was investigated in children and adolescents. A comprehensive systematic search was conducted to find all relevant literature via four databases, including PubMed, Web of Science, Scopus, and Google scholar, up to September 2022. Two independent authors screened all documents based on inclusion criteria. The overall effect sizes and related 95% confidence interval (CI) were pooled with the random effect approach. Subgroup analysis was done to measure potential sources of heterogeneity between studies. The quality of the included studies was evaluated with The Newcastle–Ottawa scale (NOS). Nine observational studies with 58,296 children /adolescents were eligible to be include in the meta-analysis. According to the random effect model, there was a positive relation between the consumption of junk foods and ADHD symptoms (odds ratio (OR): 1.24, 95%CI 1.15–1.34, P < 0.001, I²: 37.4%, P = 0.085). A similar significant positive association was shown in the subgroups analysis by different junk foods (sweetened beverages/soft drinks, sweets/candies, and other types of junk foods). This meta-analysis finding demonstrated that consuming junk foods, especially sweetened beverages/soft drinks, and sweets/candies is associated with ADHD symptoms.
Purpose
Scholars have noted the impact of advertising on unhealthy food consumption. However, a systematic literature review (SLR) on this topic is currently lacking. This study aims to find, analyze and synthesize prior literature to set the stage for future researchers and practitioners. It also uncovers research gaps, suggests potential research questions and presents a conceptual framework for use in future research.
Design/methodology/approach
This paper catalogs and synthesizes topic-related literature by using the time-tested SLR methodology. It identifies and analyzes 99 relevant studies that have addressed the impact of advertising on unhealthy food consumption. Research profiling of the selected studies supported the synthesis of key themes in the extant literature.
Findings
The authors identify three key thematic foci: a) viewer attributes pertaining to excessive unhealthy food consumption, b) advertisement attributes pertaining to excessive unhealthy food consumption and, c) unhealthy food consumption regulation. Within these themes, the authors also identify some subthemes, presenting specific advertising and viewer attributes that contribute to unhealthy food consumption. The authors further develop a conceptual framework based on the stimulus-organism-response (S-O-R) model, summarizing the findings of the study. This could aid future researchers and practitioners in their design of certain strategies.
Research limitations/implications
The study uncovers various gaps in the extant literature and suggests potential areas that can be examined by scholars. From a practical perspective, the study recommends certain actionable strategies for policymakers, helping customers to achieve the long-term goal of obesity reduction.
Practical implications
From the perspective of practice, the study recommends certain actionable strategies for policymakers helping customers achieve the long-term goal of obesity reduction.
Originality/value
The current study makes a novel contribution to the research on advertising and unhealthy food consumption by identifying theme-based research gaps in the existing literature, mapping those with potential research questions and presenting a conceptual framework based on the S-O-R model. Based on the findings, the study also proposes five potential research models examining diverse aspects of advertising and unhealthy food consumption to guide interested scholars and practitioners to shape the future research discourse.
One of the most concerning aspects of attention-deficit/hyperactivity disorder (ADHD) is its association with numerous risk-taking behaviors. Following a discussion of the definition and measures of risk-taking behavior in real life and laboratory, this chapter reviews meta-analyses, registry studies, and large prospective studies that documented links between ADHD and risk-taking behavior in several domains: substance use, sex, driving, gambling, finance, lifestyle, and delinquency. Next, the chapter reviews socio-demographic, clinical, social, personality, cognitive, and biological mechanisms involved in the link between ADHD and risk-taking behavior. Finally, established interventions targeting risk-taking behavior in people with ADHD are reviewed, and potential theory-based interventions are suggested.
Kimliğin bir ifadesi olarak toplumsal bağları güçlendiren yemek kültürü, taşıdığı mitsel ve sembolik anlamlarla bir grubun gelenek ve göreneklerini, tarihini ve inanç sistemini yansıtabilmektedir. Bu çalışmada, Alevi topluluğunda yemek erkânının, mitler ve semboller bağlamında gündelik hayat pratiği ve inanç sistemi ile ilişkisini araştırmak amaçlanmaktadır. Çalışmada, yemek kültürü ve kimlik arasındaki ilişkiyi inceleyebilmek amacıyla öncelikle yemek kültüründe ritüel, mit ve sembollerin işlevleri ele alınmıştır. İkinci bölümde ise söz konusu bu erkân, mit ve semboller ile ortak atalar, soy ve köken arasındaki ilişki değerlendirilmiştir. Son olarak, Alevi geleneğinin yemek erkânında bölgeler arası farklılıkları analiz edebilmek amacıyla literatürdeki çalışmalara yer verilmiştir. Çalışmada, Kocaeli Balören Köyü’nde ikamet eden ya da kendisini Alevi kimliğiyle tanımlayan 18 kişi ile yüz yüze görüşmeler yapılmıştır. Ayrıca, 1 Nisan 2023 tarihinde yapılan Bağlantı Cemi ve 14 Mayıs 2023 tarihinde gerçekleştirilen Gönül Birliği lokması, katılımcı gözlemci olarak incelenmiştir. Araştırma sonuçları, Kocaeli Balören Köyü yöresi Alevilerinin cemlerde, geçiş ve özel gün sofralarında lokma geleneğini sürdürdüğünü göstermiştir. Muharrem, Hızır ve Kasım oruçlarında ve musâhiblik, düşkünlük, görgü, dardan indirme ve bağlantı cemlerindeki erkânlarda kurban edilerek yapılan yemekler (lokmalar) ve bulgur/pirinç pilavı, gözleme, lokum, börek, yufka, poğaça, kıvırma tatlısı, aşure, tulumba tatlısı ve un helvası yapıldığı tespit edilmiştir. Musâhiblik ceminde, musâhibler tarafından yenilen süt, elma, bal ve üzüm yiyeceklerinin kutsal sayıldığı ortaya çıkmıştır. Ayrıca, cemlerde yapılan yemek erkânları aracılığıyla grup kimliğine yönelik sadakatin tesis edildiği ve Balören Köyü’nde ikâmet eden Alevi topluluğuna mensup bireylerin kolektif yükümlülük ve fedakârlık pratiklerinin güçlendirildiği belirlenmiştir.
Introduction:
Adults with attention-deficit/hyperactivity disorder (ADHD) have unhealthy eating habits, associated with overweight/obesity. We explored whether they present with different food-related benefit/risk perceptions, compared to those without ADHD.
Methods:
One hundred five university students with (n = 36) and without (n = 69) ADHD, aged 22-30, participated in the study. They rated the level of frequency and likelihood of food consumption, as well as the perceived attractiveness, convenience, and risk of 32 healthy and unhealthy food items.
Results:
The findings revealed significantly lower healthy/unhealthy food frequency consumption ratios for the ADHD group compared with the non-ADHD one but no differences in the ratios of estimated likelihood of food consumption and perceptions (attractiveness, convenience, and risk).
Conclusion:
The results of this study demonstrated a discrepancy between the eating behavior (more unhealthy eating patterns in adults with ADHD compared with controls) and their food-related perceptions (same perceptions regarding the benefit and risk of foods in both groups).
Our relationship with the marketing of food occurs spontaneously, often unconsciously and although we think we have control, the choices we make are not happening in a vacuum. The chapter examines the role of food marketing highlighting the need for a change towards facilitating a sustainability transition. It elaborates on what food marketing should be delivering to the consumer in responding to the planetary emergency from a social and individual perspective. Food marketing should be supporting ethical and sustainable products with transparency about the food production process while aiming at achieving population health and wellness.
Purpose of Review
There is abundant evidence that food marketing influences children’s and adults’ food preferences and consumption. As such, exposure to unhealthy food marketing is a widely acknowledged risk factor contributing to the development of overweight and obesity. Less is known about the effects of healthy food promotion on people’s dietary behavior. This narrative review describes research from the past 5 years focused on the effects of healthy food marketing on children’s and adults’ food preferences and dietary intake. Our aim is to gain insight into the potential effects and mechanistic underpinnings of healthy food promotion, thereby building on existing knowledge on underlying mechanisms of the effectiveness of unhealthy food marketing.
Recent Findings
Only a small number of studies directly examined the effects of healthy food promotion on children’s and adults’ dietary behavior. Most studies targeted children’s fruit and/or vegetable intake and used a variety of marketing techniques, ranging from television adverts to social media influencer marketing. Six out of ten studies found a positive effect of healthy food promotion, indicating that healthy food marketing has the potential to influence dietary behavior.
Summary
Food marketing is highly effective in stimulating and reinforcing food consumption, in particular for energy-dense foods. Further investigation and experimentation into the efficiency and effectiveness of healthy food promotion are needed to determine how marketing techniques could be used to improve dietary behavior. The healthy food promotion model provides a framework for future research in this area.
Objective:
This study examined the mediation roles of multiple lifestyle factors in school-aged children. Structural equation modeling (SEM) tested how lifestyle factors play mechanism roles one another in the impact of ADHD to seek theoretical and intervention insights.
Method:
An online survey assessed children's lifestyle factors including diet, physical activity, screen time, sleep difficulties, and having ADHD diagnosis. A multi-country sample from English speaking nations included 309 caregivers. Multiple regression and SEM were planned to identify significant correlates and mediators of ADHD in explaining lifestyle differences.
Results:
Preliminary multiple regression showed only sleep quality was significantly different between children with and without ADHD. Significant triple mediation effects suggested diet, physical activity, and screen time mediated the ADHD impact on sleep quality.
Conclusion:
Researchers and practitioners may incorporate the findings to develop intervention models for children with ADHD attending to the mediational roles of lifestyle factors to improve sleep quality.
Objectives:
Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis.
Methods:
A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD.
Results:
Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis.
Conclusions:
Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.
Background:
Literature has suggested that ADHD may be associated with increased risk of obesity. If so, this would have important clinical implications.
Objective:
To clarify the size of the association between ADHD and obesity and to evaluate key moderators of the association including medication, gender, age, and psychiatric comorbidity.
Method:
Two preliminary studies are presented to supply critical additional data for the meta-analysis: a two-year longitudinal study of an ADHD case-control sample of 313 children aged 7-11, and a national survey study of 45,309 families in the United States using the 2012 National Survey of Children's Health. Formal meta-analysis was then conducted. The identification procedure yielded 43 studies, reporting 225 comparisons or effect sizes, studying 703,937 participants An overall effect size was estimated with a random effects model (after pooling within study using a modified fixed effects model). Effect size was then examined in relation to medication, gender, age, and psychiatric comorbidity.
Results:
The new study of children revealed no reliable association of ADHD and body mass index at any age or time point. In the national survey, ADHD was associated with obesity only in adolescent girls but not in children or boys; this effect was statistically accounted for by covarying of depression and conduct disorder. In the meta-analysis, the composite effect size was OR=1.22 (95% CI=1.11-1.34); 22 studies provided effects with medication controlled, yielding a composite effect size of OR=1.30 (95% CI=1.12-1.50). Pooled across age the association without covariates was reliable in females (OR=1.19 [1.01-1.41]) but not males (OR=1.10 [0.95-1.23]) although males and females did not statistically differ. Pooled across gender, the association was significantly larger in adults (>18years) (OR=1.37 [1.19-1.58]) than in youth (OR=1.13 [1.00-1.27]), p=.04.
Conclusions:
ADHD has a small overall association with obesity, but this effect is moderate in adults. The effect is likely to be of no clinical significance in children, possible clinical significance in adolescent girls with comorbid disorders, and of clinical relevance by adulthood.
Understanding the neurobiological substrates that encode learning about food-associated cues and how those signals are modulated is of great clinical importance especially in light of the worldwide obesity problem. Inappropriate or maladaptive responses to food-associated cues can promote over consumption, leading to excessive energy intake and weight gain. Chronic exposure to foods rich in fat and sugar alters the reinforcing value of foods and weakens inhibitory neural control, triggering learned, but maladaptive, associations between environmental cues and food rewards. Thus, responses to food-associated cues can promote cravings and food-seeking by activating mesocorticolimbic dopamine neurocircuitry, and exert physiological effects including salivation. These responses may be analogous to the cravings experienced by abstaining drug addicts that can trigger relapse into drug self-administration. Preventing cue-triggered eating may therefore reduce the over consumption seen in obesity and binge eating disorder. In this review we discuss recent research examining how cues associated with palatable foods can promote reward-based feeding behaviors and the potential involvement of appetite-regulating peptides including leptin, ghrelin, orexin and melanin concentrating hormone. These peptide signals interface with mesolimbic dopaminergic regions including the ventral tegmental area to modulate reactivity to cues associated with palatable foods. Thus, a novel target for anti-obesity therapeutics is to reduce non-homeostatic, reward driven eating behavior, which can be triggered by environmental cues associated with highly palatable, fat and sugar rich foods. This article is protected by copyright. All rights reserved.
Impulsivity and inattention related to attention deficit hyperactivity disorder (ADHD) may increase food intake and, consequently, weight gain. However, findings on the association between obesity/overweight and ADHD are mixed. The authors conducted a meta-analysis to estimate this association.
A broad range of databases was searched through Aug. 31, 2014. Unpublished studies were also obtained. Study quality was rated with the Newcastle-Ottawa Scale. Random-effects models were used.
Forty-two studies that included a total of 728,136 individuals (48,161 ADHD subjects; 679,975 comparison subjects) were retained. A significant association between obesity and ADHD was found for both children (odds ratio=1.20, 95% CI=1.05-1.37) and adults (odds ratio=1.55, 95% CI=1.32-1.81). The pooled prevalence of obesity was increased by about 70% in adults with ADHD (28.2%, 95% CI=22.8-34.4) compared with those without ADHD (16.4%, 95% CI=13.4-19.9), and by about 40% in children with ADHD (10.3%, 95% CI=7.9-13.3) compared with those without ADHD (7.4%, 95% CI=5.4-10.1). The significant association between ADHD and obesity remained when limited to studies 1) reporting odds ratios adjusted for possible confounding factors; 2) diagnosing ADHD by direct interview; and 3) using directly measured height and weight. Gender, study setting, study country, and study quality did not moderate the association between obesity and ADHD. ADHD was also significantly associated with overweight. Individuals medicated for ADHD were not at higher risk of obesity.
This study provides meta-analytic evidence for a significant association between ADHD and obesity/overweight. Further research should address possible underlying mechanisms and the long-term effects of ADHD treatments on weight in individuals with both ADHD and obesity.
Background and objective:
Overdiagnosis and underdiagnosis of attention-deficit/hyperactivity disorder (ADHD) are widely debated, fueled by variations in prevalence estimates across countries, time, and broadening diagnostic criteria. We conducted a meta-analysis to: establish a benchmark pooled prevalence for ADHD; examine whether estimates have increased with publication of different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM); and explore the effect of study features on prevalence.
Methods:
Medline, PsycINFO, CINAHL, Embase, and Web of Science were searched for studies with point prevalence estimates of ADHD. We included studies of children that used the diagnostic criteria from DSM-III, DSM-III-R and DSM-IV in any language. Data were extracted on sampling procedure, sample characteristics, assessors, measures, and whether full or partial criteria were met.
Results:
The 175 eligible studies included 179 ADHD prevalence estimates with an overall pooled estimate of 7.2% (95% confidence interval: 6.7 to 7.8), and no statistically significant difference between DSM editions. In multivariable analyses, prevalence estimates for ADHD were lower when using the revised third edition of the DSM compared with the fourth edition (P = .03) and when studies were conducted in Europe compared with North America (P = .04). Few studies used population sampling with random selection. Most were from single towns or regions, thus limiting generalizability.
Conclusions:
Our review provides a benchmark prevalence estimate for ADHD. If population estimates of ADHD diagnoses exceed our estimate, then overdiagnosis may have occurred for some children. If fewer, then underdiagnosis may have occurred.
The prevalence of metabolic syndrome has been increasing in Korea and has been associated with dietary habits. The aim of our study was to identify the relationship between dietary patterns and the prevalence of metabolic syndrome. Using a validated food frequency questionnaire, we employed a cross-sectional design to assess the dietary intake of 1257 Korean adults aged 31 to 70 years. To determine the participants' dietary patterns, we considered 37 predefined food groups in principal components analysis. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III. The abdominal obesity criterion was modified using Asian guidelines. Prevalence ratios and 95% confidence intervals for the metabolic syndrome were calculated across the quartiles of dietary pattern scores using log binomial regression models. The covariates used in the model were age, sex, total energy intake, tobacco intake, alcohol consumption, and physical activity. The prevalence of metabolic syndrome was 19.8% in men and 14.1% in women. The PCA identified three distinct dietary patterns: the 'traditional' pattern, the 'meat' pattern, and the 'snack' pattern. There was an association of increasing waist circumference and body mass index with increasing score in the meat dietary pattern. The multivariate-adjusted prevalence ratio of metabolic syndrome for the highest quartile of the meat pattern in comparison with the lowest quartile was 1.47 (95% CI: 1.00-2.15, p for trend = 0.016). A positive association between the prevalence of metabolic syndrome and the dietary pattern score was found only for men with the meat dietary pattern (2.15, 95% CI: 1.10-4.21, p for trend = 0.005). The traditional pattern and the snack pattern were not associated with an increased prevalence of metabolic syndrome. The meat dietary pattern was associated with a higher prevalence of metabolic syndrome in Korean male adults.
Previous studies have identified significant variability in attention-deficit / hyperactivity disorder (ADHD) prevalence estimates worldwide, largely explained by methodological procedures. However, increasing rates of ADHD diagnosis and treatment throughout the past few decades have fuelled concerns about whether the true prevalence of the disorder has increased over time.
We updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies.
We identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates.
Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.
The current paper describes an endeavor to develop policy and procedure for
standardizing and regulating the diagnosis of learning disability (LD) both in
applicants to higher education institutions and in currently enrolled students, and
for regulating the provision of test accommodations.
This endeavor, conducted by The National Institute for Testing and Evaluation
(NITE) in cooperation with the Council of Higher Education in Israel, included:
(1) development, validation and norming of MATAL: a computer-based test
battery for the diagnosis of LD; (2) development of a statistical decision rule for
determining diagnosis based on test results; (3) development of guidelines for the
provision of test accommodations; (4) establishment of diagnostic centers within
institutions of higher education; and (5) establishment of a professional network
of all parties involved in the diagnosis and support of students with LD in
institutions of higher education.
Over 10,000 applicants to higher education institutions and students were
diagnosed by MATAL in the past five years.
Background
The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen.
Methods
Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice.
Results
The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by manipulations (no main or interaction effects). Employees preferred shelf displays including a larger healthy snack assortment located at top shelves. Employees also felt more freedom in choice when healthy snacks were displayed at top shelves compared to lower shelves.
Conclusions
Overall, results suggest that increasing the prominence of healthy snacks by enlarging their availability, while permitting access to unhealthy snacks, is a promising strategy to promote sales. These results point to the importance of nudging strategies to encourage healthier snack patterns.
This study was conducted to assess the relation of major dietary patterns identified by factor analysis to attention-deficit/hyperactivity disorder (ADHD) in a group of Iranian school-age children.
This cross-sectional study was conducted in 375 school-age children in Tehran, Iran. We assessed usual dietary intakes by a semiquantitative food-frequency questionnaire. The presence of ADHD was diagnosed using the questionnaire of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Major dietary patterns were identified by factor analysis.
The prevalence of ADHD was 9.7% in this population. We identified four major dietary patterns: "healthy," "Western," "sweet," and "fast food." After controlling for potential confounders, children in the top quintile of the sweet dietary pattern score had greater odds for having ADHD compared with those in the lowest quintile (odds ratio 3.95, 95% confidence interval 1.16-15.31, P for trend = 0.03). Greater adherence to the fast-food dietary pattern was significantly associated with a higher risk of having ADHD (odds ratio 3.21, 95% confidence interval 1.05-10.90, P for trend = 0.03). No overall significant associations were seen between the healthy or Western dietary pattern and ADHD.
We found significant independent associations between the sweet and fast-food dietary patterns and the prevalence of ADHD. Prospective studies are required to confirm these findings.
Although quite overlooked, increasing evidence points to a significant association between attention-deficit/hyperactivity disorder (ADHD) and obesity. Here, we present an updated systematic review and a critical discussion of studies on the relationship between ADHD and obesity, with a particular emphasis on the possible behavioral, neurobiological, and genetics underlying mechanisms. Available empirically based studies indicate that the prevalence of ADHD in clinical samples of patients seeking treatment for their obesity is higher than that in the general population. Moreover, although still limited, current evidence shows that individuals with ADHD have higher-than-average body mass index z-scores and/or significantly higher obesity rates compared with subjects without ADHD. Three mechanisms underlying the association between ADHD and obesity have been proposed: (1) obesity and/or factors associated with it (such as sleep-disordered breathing and deficits in arousal/alertness) manifest as ADHD-like symptoms; (2) ADHD and obesity share common genetics and neurobiological dysfunctions, involving the dopaminergic and, possibly, other systems (e.g., brain-derived neurotropic factor, melanocortin-4-receptor); and (3) impulsivity and inattention of ADHD contribute to weight gain via dysregulated eating patterns. With regards to the possible clinical implications, we suggest that it is noteworthy to screen for ADHD in patients with obesity and to look for abnormal eating behaviors as possible contributing factors of obesity in patients with ADHD. If further studies confirm a causal relationship between ADHD and obesity, appropriate treatment of ADHD may improve eating patterns and, as a consequence, weight status of individuals with both obesity and ADHD.
This paper argues for the importance of diagnosing ADHD in adults, while acknowledging the many attendant difficulties. The paper presents results from two studies implementing the Adult ADHD Self Report Screen (ASRS) in Hebrew. The Hebrew version of the ASRS as approved by the World Health Organization is appended to this paper. The first of the two studies used a paper and pencil version of the ASRS (ASRS_PP) and the second used a computer administered version (ASRS_C). A subset of the participants in the two studies was given both versions. The Hebrew ASRS had excellent test-retest reliability. It had good internal consistency in both forms. Support for the validity of the Hebrew ASRS is given by the significantly higher scores of adults with ADHD versus those without, on both versions of the ASRS and on all of its subscales. The sensitivity of the raw sum of all 18 items was significantly higher than that of the 6-item screen suggested by the authors of the ASRS. The sensitivity and specificity of the ASRS in Hebrew should be further examined in future studies including clinically referred participants. The benefit of using the ASRS as part of the diagnostic process for adult ADHD is discussed.
To examine the relationship between dietary patterns and ADHD in a population-based cohort of adolescents.
The Raine Study is a prospective study following 2,868 live births. At the 14-year follow-up, the authors collected detailed adolescent dietary data, allowing for the determination of major dietary patterns using factor analysis. ADHD diagnoses were recorded according to International Classification of Deiseases, 9th Revision coding conventions. Logistic regression was used to assess the relationship between scores for major dietary pattern and ADHD diagnoses.
Data were available for 1,799 adolescents, and a total of 115 adolescents had an ADHD diagnosis. Two major dietary patterns were identified: "Western" and "Healthy." A higher score for the Western dietary pattern was associated with ADHD diagnosis (odds ratio=2.21, 95% confidence interval=1.18, 4.13) after adjusting for known confounding factors from pregnancy to 14 years. ADHD diagnosis was not associated with the "Healthy" dietary pattern.
A Western-style diet may be associated with ADHD.
Attention-deficit hyperactivity disorder (ADHD) is a prevalent and debilitating disorder diagnosed on the basis of persistent and developmentally-inappropriate levels of overactivity, inattention and impulsivity. The etiology and pathophysiology of ADHD is incompletely understood. There is evidence of a genetic basis for ADHD but it is likely to involve many genes of small individual effect. Differences in the dimensions of the frontal lobes, caudate nucleus, and cerebellar vermis have been demonstrated. Neuropsychological testing has revealed a number of well documented differences between children with and without ADHD. These occur in two main domains: executive function and motivation although neither of these is specific to ADHD. In view of the recent advances in the neurobiology of reinforcement, we concentrate in this review on altered reinforcement mechanisms. Among the motivational differences, many pieces of evidence indicate that an altered response to reinforcement may play a central role in the symptoms of ADHD. In particular, sensitivity to delay of reinforcement appears to be a reliable finding. We review neurobiological mechanisms of reinforcement and discuss how these may be altered in ADHD, with particular focus on the neurotransmitter dopamine and its actions at the cellular and systems level. We describe how dopamine cell firing activity is normally associated with reinforcing events, and transfers to earlier time-points in the behavioural sequence as reinforcement becomes more predictable. We discuss how a failure of this transfer may give rise to many symptoms of ADHD, and propose that methylphenidate might act to compensate for the proposed dopamine transfer deficit.
To ascertain whether ADHD symptoms, and associated problems, are negatively related to subjective well-being.
The Satisfaction With Life Scale (SWLS) was completed by 369 university students, along with the Reasoning & Rehabilitation (R&R) ADHD Training Evaluation (RATE), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Scale for current ADHD symptoms, and the Depression Anxiety Stress Scales (DASS).
The SWLS was negatively correlated with all the other measures, and the strongest correlations were with the Total RATE score. A multiple regression analysis showed that the variables in the study accounted for 22% and 25% of the variance of the SWLS among males and females, respectively. Among males poor social functioning was the best predictor of dissatisfaction with life, whereas among females it was poor emotional control.
Both ADHD symptoms and associated problems are significantly related to poorer satisfaction with life.
A self-report screening scale of adult attention-deficit/hyperactivity disorder (ADHD), the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed in conjunction with revision of the WHO Composite International Diagnostic Interview (CIDI). The current report presents data on concordance of the ASRS and of a short-form ASRS screener with blind clinical diagnoses in a community sample.
The ASRS includes 18 questions about frequency of recent DSM-IV Criterion A symptoms of adult ADHD. The ASRS screener consists of six out of these 18 questions that were selected based on stepwise logistic regression to optimize concordance with the clinical classification. ASRS responses were compared to blind clinical ratings of DSM-IV adult ADHD in a sample of 154 respondents who previously participated in the US National Comorbidity Survey Replication (NCS-R), oversampling those who reported childhood ADHD and adult persistence.
Each ASRS symptom measure was significantly related to the comparable clinical symptom rating, but varied substantially in concordance (Cohen's kappa in the range 0.16-0.81). Optimal scoring to predict clinical syndrome classifications was to sum unweighted dichotomous responses across all 18 ASRS questions. However, because of the wide variation in symptom-level concordance, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS in sensitivity (68.7% v. 56.3%), specificity (99.5% v. 98.3%), total classification accuracy (97.9% v. 96.2%), and kappa (0.76 v. 0.58).
Clinical calibration in larger samples might show that a weighted version of the 18-question ASRS outperforms the six-question ASRS screener. Until that time, however, the unweighted screener should be preferred to the full ASRS, both in community surveys and in clinical outreach and case-finding initiatives.
Background and objectives:
Nutritional and dietary habits may affect children's behaviors and learning. The etiology of attention-deficit/hyperactivity disorder (ADHD), a common neurodevelopmental disorder in children, may be associated with unhealthy diets or nutrients deficiencies. The purpose of this study was to examine whether children with ADHD exhibited different dietary habits or nutrient profiles from healthy control subjects.
Methods and study design:
We recruited 42 patients with ADHD (mean age: 8.1 years) and 36 healthy children as the control group (mean age: 9.8 years). We adopted the ADHD Rating Scale and the Swanson, Nolan, and Pelham Version IV Scale to interview both the ADHD patients and the control subjects and then evaluated participants' dietary intake with a food frequency questionnaire. Logistic regression models were utilized to produce a composite dietary/nutrient score, while receiver operating characteristic (ROC) was adopted to differentiate between the two participant groups.
Results:
Compared to the control children, children with ADHD demonstrated a higher intake proportion of refined grains (p=0.026) and a lower proportion of dairy (p=0.013), calcium (p=0.043), and vitamin B-2 (p=0.024). We observed that the composite score of dietary and nutrient could significantly distinguish patients with ADHD from healthy controls (p<0.001). The composite dietary/nutrient score demonstrated a significant correlation with the severity of ADHD clinical symptoms (p<0.05).
Conclusions:
ADHD children and healthy controls have different dietary patterns and that dietary and nutrient factors may play a role in the pathophysiology of ADHD. Clinicians should consider dietary habits and specific nutrients in the routine assessment of children with ADHD.
This study aimed to examine whether adult attention deficit hyperactivity disorder (ADHD) in students is associated with overeating or with unhealthy food choices. Sixty university students with and without ADHD, aged 20 to 30 years, completed the Food Frequency Questionnaire and reported their height and weight. Students with ADHD had a higher body mass index compared with students without ADHD. Although participants in both groups consumed similar amounts of servings, calories, and nutrients, students with ADHD reported lower healthy/unhealthy food consumption ratio. These findings suggest that ADHD in students is not associated with general overeating, but with a biased proportion of unhealthy versus healthy food consumption.
Objective
There has been interest in whether people with Attention-Deficit/Hyperactivity Disorder (ADHD) are at higher risk of developing an Eating Disorder (ED). The aim of this study was estimate the size of this association with a meta-analysis of studies. Methods
We retrieved studies following PRISMA guidelines from a broad range of databases. ResultsTwelve studies fitted our primary aim in investigating ED in ADHD populations (ADHD=4,013/Controls= 29,404), and five exploring ADHD in ED populations (ED=1,044/Controls= 11,292). The pooled odds ratio of diagnosing any ED in ADHD was increased significantly, 3.82 (95% CI:2.34-6.24). A similar level of risk was found across all ED syndromes [Anorexia Nervosa=4.28 (95% CI:2.24-8.16); Bulimia Nervosa= 5.71 (95% CI: 3.56-9.16) and Binge Eating Disorder=4.13 (95% CI:3-5.67)]. The risk was significantly higher if ADHD was diagnosed using a clinical interview [5.89 (95% CI:4.32-8.04)] rather than a self-report instrument [2.23 (95% CI:1.23-4.03)]. The pooled odds ratio of diagnosing ADHD in participants with ED was significantly increased, 2.57 (95% CI:1.30-5.11). Subgroup analysis of cohorts with binge eating only yielded a risk of 5.77 (95% CI:2.35-14.18). None of the variables examined in meta-regression procedures explained the variance in effect size between studies. DiscussionPeople with ADHD have a higher risk of comorbidity with an ED and people with an ED also have higher levels of comorbidity with ADHD. Future studies should address if patients with this comorbidity have a different prognosis, course and treatment response when compared to patients with either disorder alone. Resumen ObjetivoHa habido interes en saber si la gente con Trastorno por Deficit de Atencion e Hiperactividad (TDAH) estan en mayor riesgo de desarrollar un Trastorno de la Conducta Alimentaria (TCA). El objetivo de este estudio fue estimar el tamano de esta asociacion con un meta-analisis de los estudios. Metodos: Recuperamos estudios de una amplia gama base de datos, que siguen los lineamientos PRISMA. Resultados: Doce estudios encajaron con nuestro objetivo primario de investigar los TCA en poblaciones con TDAH (TDAH=4,013/Controles=29,404), y 5 exploraron TDAH en poblaciones con TCA (TCA= 1,044/Controles=11,292). El odds ratio (OR) agrupado de diagnosticar cualquier TCA en el TDAH se incremento significativamente, 3.82 (95% CI:2.34-6.24). Un nivel de riesgo similar fue encontrado en todos los sindromes de TCA [Anorexia Nervosa=4.28 (95% CI:2.24-8.16); Bulimia Nervosa=5.71 (95% CI:3.56-9.16) y Trastorno por Atracon=4.13 (95% CI: 3-5.67)]. El riesgo fue significativamente mayor si el TDAH fue diagnosticado utilizando una entrevista clinica [5.89 (95% CI:4.32-8.04)] en lugar de un instrumento de auto-reporte [2.23 (95% CI:1.23-4.03)]. El odds ratio (OR) agrupado de diagnosticar TDAH en participantes con TCA fue significativamente incrementado, 2.57 (95% CI:1.30-5.11). El analisis de los subgrupos de cohort con atracones solamente produjo un riesgo de 5.77 (95% CI:2.35-14.18). Ninguna de las variables examinadas en los procedimientos de meta-regresion explicaron la varianza en el tamano del efecto entre los estudios. Discusion: La gente con TDAH tiene un mayor riesgo de comorbilidad con un TCA y la gente con un TCA tambien tiene niveles altos de comorbilidad con TDAH. Los estudios futuros deberan abordar si los pacientes con esta comorbilidad tienen diferente pronostico, curso y respuesta a tratamiento cuando son comparados con pacientes que solamente tienen uno de los trastornos. (c) 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016) (c) 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1045-1057)
For many years, attention-deficit hyperactivity disorder (ADHD) was thought to be a childhood-onset disorder that has a limited effect on adult psychopathology. However, the symptoms and impairments that define ADHD often affect the adult population, with similar responses to drugs such as methylphenidate, dexamphetamine, and atomoxetine, and psychosocial interventions, to those seen in children and adolescents. As a result, awareness of ADHD in adults has rapidly increased and new clinical practice has emerged across the world. Despite this progress, treatment of adult ADHD in Europe and many other regions of the world is not yet common practice, and diagnostic services are often unavailable or restricted to a few specialist centres. This situation is remarkable given the strong evidence base for safe and effective treatments. Here we address some of the key conceptual issues surrounding the diagnosis of ADHD relevant to practising health-care professionals working with adult populations. We conclude that ADHD should be recognised in the same way as other common adult mental health disorders, and that failure to recognise and treat ADHD is detrimental to the wellbeing of many patients seeking help for common mental health problems.
High rates of overweight, obesity and chronic disease are partly attributable to an increased prevalence of poor dietary choices, which are in part due to the modern environment being conducive to the development of habitual unhealthy food and beverage choices. Nudging aims to influence habitual behaviors by altering the presentation of options to consumers. This systematic literature review investigated nudging interventions, as attributed by the original authors, and their effectiveness for influencing healthier choices. Eight bibliographic databases from the disciplines of psychology, business and health were searched. Included studies were available in the English language and as full-text peer reviewed publication. Studies used nudging or choice architecture interventions that influenced adult food and beverage choices. The number of papers reporting nudging interventions (as attributed by the authors) was low, with only thirteen articles included in the review (comprising 26 primary studies). All studies fall into ‘salience’ and ‘priming’ – type nudging interventions, which were tested across different adult populations and settings – including laboratories, canteens, cafeterias and restaurants. According to the NHMRC levels of evidence only two interventions were of a high level of evidence, and the majority of articles received average or poor quality ratings, as per the Scottish Intercollegiate Guidelines. Combined ‘salience’ and ‘priming’ nudges showed consistent positive influence on healthier food and beverage choices. This review had limited ability to determine effectiveness of nudging due to various populations and settings tested and the use and reporting of incomparable outcome measures. This is the first review to synthesize nudging interventions, finding minimal uptake of nudging in the academic literature, and mixed effectiveness of nudging for influencing healthier food and beverage choices. This review is registered with PROSPERO - CRD42013005056.
Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder with a prevalence of 1·4-3·0%. It is more common in boys than girls. Comorbidity with childhood-onset neurodevelopmental disorders and psychiatric disorders is substantial. ADHD is highly heritable and multifactorial; multiple genes and non-inherited factors contribute to the disorder. Prenatal and perinatal factors have been implicated as risks, but definite causes remain unknown. Most guidelines recommend a stepwise approach to treatment, beginning with non-drug interventions and then moving to pharmacological treatment in those most severely affected. Randomised controlled trials show short-term benefits of stimulant medication and atomoxetine. Meta-analyses of blinded trials of non-drug treatments have not yet proven the efficacy of such interventions. Longitudinal studies of ADHD show heightened risk of multiple mental health and social difficulties as well as premature mortality in adult life.
Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD
Most of our research on eating behavior has no impact on health or public policy. Part is due to the nontranslational way we often conduct our studies; part is due to us not having a useful framework that organizes our conclusions. This paper's first purpose is to offer an organizing framework that shows how nearly all effective interventions on food choice either make healthy choices more convenient (physically or cognitively), more attractive (comparatively or absolutely), or more normal (perceived or actual). This paper's second purpose is to introduce the notion of activism research—an approach to designing and executing studies in a way that makes consumer psychology research more actionable, useful, effective, and scalable. Together these two tools could help expand both the relevance and reach, and impact of what we do.
Whereas the adverse impact of attention-deficit/hyperactivity disorder (ADHD) on emotional and psychosocial well-being has been well investigated, its impact on physical health has not. The main aim of this study was to assess the impact of ADHD on lifestyle behaviors and measures of adverse health risk indicators. Subjects were 100 untreated adults with ADHD and 100 adults without ADHD of similar age and sex. Unhealthy lifestyle indicators included assessments of bad health habits, frequency of visits to healthcare providers, and follow through with recommended prophylactic tests. Assessments of adverse health risk indicators included measurements of cardiovascular and metabolic parameters, weight, body mass index, and waist circumference. No differences were identified in health habits between subjects with and without ADHD, but robust differences were found in a wide range of adverse health risk indicators. ADHD is associated with an adverse impact in health risk indicators well known to be associated with high morbidity and mortality.
Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and can be associated with obesity. The aim of this study was to reveal the connection between ADHD symptoms, food habits and obesity.
We examined 12 350 children (6010 boys, 6340 girls) from 27 elementary schools in Cheonan, the Republic of Korea. The study subjects were 5- to 13-year-old children (9.4 ± 1.7 years). Parents completed the DuPaul ADHD Rating Scale. Food habits were measured by a questionnaire adapted from the Korea Youth Risk Behavior Web-based Survey and a validated mini-dietary assessment tool. The full set of hypothesized associations was tested using covariance structural modelling.
The prevalence of ADHD was 7.6% and that of obesity was 4.5% in our study population. The data was well fit by the model. ADHD was associated with body mass index (BMI; standardized β = 0.086, P < 0.001). Bulimic dietary behaviours was related to BMI (standardized β = 0.548, P < 0.001). Socio-economic status was associated with BMI (standardized β = -0.017, P = 0.027).
Our analysis suggested that ADHD was a risk factor for obesity through dietary behavioural change and socio-economic status.
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
Background:
It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and preferences for other foods. Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces. Older girls find whole fruits messy and unattractive to eat.
Purpose:
To determine the effect of offering pre-sliced fruit in schools on selection and intake.
Design:
Three of six schools were assigned randomly to serve apples in slices. Three control schools served apples whole. Selection, consumption, and waste of apples were measured prior to and during treatment.
Setting/participants:
Cafeterias in six public middle schools in Wayne County NY in 2011. Participants included all students who purchased lunch on days when data were collected.
Intervention:
Treatment schools were provided with a standard commercial fruit slicer, and cafeteria staff members were instructed to use it when students requested apples. Trained researchers recorded how much of each apple was consumed and how much was wasted in both control and treatment schools.
Main outcome measures:
Daily apple sales, percentage of an apple serving consumed per student, and percentage of an apple serving wasted per student.
Results:
Data were analyzed in 2012. Schools that used fruit slicers to pre-slice fruit increased average daily apple sales by 71% compared to control schools (p<0.01). The percentage of students who selected apples and ate more than half increased by 73% (p=0.02) at schools that served pre-sliced fruit, and the percentage that wasted half or more decreased by 48% (p=0.03).
Conclusions:
Sliced fruit is more appealing to children than whole fruit because it is easier and tidier to eat. This study applies the principle of convenience from behavioral economics and provides an example of a scalable, low-cost environmental change that promotes healthy eating and decreases waste.
Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention-disorganization and/or hyperactivity-impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes.
ADHD is associated with altered reinforcement sensitivity, despite a number of inconsistent findings. This review focuses on the overlap and differences between seven neurobiologically valid models and lists 15 predictions assessing reinforcement sensitivity in ADHD. When comparing the models it becomes clear that there are great differences in the level of explanation. For example, some models try to explain a single core deficit in terms lower-level reinforcement systems, such as the dopamine transfer to reward back in time. Other models explain multiple deficits, by describing higher-level systems, such as impaired bottom-up prefrontal activation. When reviewing the available experimental evidence in support of the predictions, most experimental studies have been focusing on behavioral changes in the face of reward and response cost over no-reward, and on delay discounting. There is currently a lack in studies that focus on explaining underlying cognitive or neural mechanisms of altered reinforcement sensitivity in ADHD. Additionally, there is a lack in studies that try to understand what subgroup of children with ADHD shows alterations in reinforcement sensitivity. The scarcity in studies testing the neurobiological predictions is explained partly by a lack in knowledge how to test some of these predictions in humans. Nevertheless, we believe that these predictions can serve as a useful guide to the systematic evaluation of altered reinforcement sensitivity in ADHD.
In the context of food, convenience is generally associated with less healthy foods. Given the reality of present-biased preferences, if convenience was associated with healthier foods and less healthy foods were less convenient, people would likely consume healthier foods. This study examines the application of this principle in a school lunchroom where healthier foods were made more convenient relative to less healthy foods.
One of two lunch lines in a cafeteria was arranged so as to display only healthier foods and flavored milk. Trained field researchers collected purchase and consumption data before and after the conversion. Mean comparisons were used to identify differences in selection and consumption of healthier foods, less healthy foods and chocolate milk.
Sales of healthier foods increased by 18% and grams of less healthy foods consumed decreased by nearly 28%. Also, healthier foods' share of total consumption increased from 33 to 36%. Lastly, we find that students increased their consumption of flavored milk, but flavored milk's share of total consumption did not increase.
In a school lunchroom, a convenience line that offered only healthier food options nudged students to consume fewer unhealthy foods. This result has key implications for encouraging healthy behavior in public schools nation wide, cafeterias and other food establishments.
Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ(2) = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.
Following negative reinforcement and affect-regulation models of dysfunctional appetitive motivation, this study examined the effect of negative mood on objective and subjective cognitive indices of motivation for food; i.e., attentional bias for food cues and self-reported hunger/urge to eat, respectively. The study extended previous research on the effect of mood on food motivation by using (i) an experimental mood manipulation, (ii) an established index of attentional bias from the visual-probe task and (iii) pictorial food cues, which have greater ecological validity than word stimuli. Young female adults (n=80) were randomly allocated to a neutral or negative mood induction procedure. Attentional biases were assessed at two cue exposure durations (500 and 2000ms). Results showed that negative mood increased both attentional bias for food cues and subjective appetite. Attentional bias and subjective appetite were positively inter-correlated, suggesting a common mechanism, i.e. activation of the food-reward system. Attentional bias was also associated with trait eating style, such as external and restrained eating. Thus, current mood and trait eating style each influenced motivation for food (as reflected by subjective appetite and attentional bias). Findings relate to models of cognitive mechanisms underlying normal and dysfunctional appetitive motivation and eating behaviour.
In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder.
To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis.
We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications.
The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1-3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Meta-regression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample.
Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM-IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.
The past 30 years have seen dramatic changes in the food and physical activity environments, both of which contribute to the changes in human behavior that could explain obesity. This paper reviews documented changes in the food environment, changes in the physical activity environment and the mechanisms through which people respond to these environments, often without conscious awareness or control. The most important environmental changes have been increases in food accessibility, food salience and decreases in the cost of food. The increases in food marketing and advertising create food cues that artificially stimulate people to feel hungry. The existence of a metabolic pathway that allows excess energy to be stored as fat suggests that people were designed to overeat. Many internal mechanisms favor neurophysiologic responses to food cues that result in overconsumption. External cues, such as food abundance, food variety and food novelty, cause people to override internal signals of satiety. Other factors, such as conditioning and priming, tie food to other desirable outcomes, and thus increase the frequency that hunger is stimulated by environmental cues. People's natural response to the environmental cues are colored by framing, and judgments are flawed and biased depending on how information is presented. People lack insight into how the food environment affects them, and subsequently are unable to change the factors that are responsible for excessive energy consumption. Understanding the causal pathway for overconsumption will be necessary to interrupt the mechanisms that lead to obesity.
Self-reported effects of stress on eating behaviour and food were assessed in a brief questionnaire in 212 students. Snacking behaviour was reportedly increased by stress in the majority of respondents (73%) regardless of gender or dieting status. The overall increase in snacking during stress was reflected by reports of increased intake of "snack-type" foods in all respondents, regardless of dieting status. In contrast, intake of "meal-type" foods (fruit and vegetables, meat and fish) was reported to decrease during stressful periods. The majority of the respondents reported an effect of stress on overall amount eaten, but while snacking, roughly equal numbers reporting decreased intake (42%) and increased intake (38%). The direction of change in intake could be predicted in part by dieting status, with dieters being more likely to report stress hyperphagia and nondieters being more likely to report stress hypophagia.
Building on findings related to physiological and psychological motivations of food preference, this research develops a framework to examine preferences toward comfort foods. Study 1 used a North American survey of 411 people to determine favored comfort foods, and Study 2 quantified the preferences for these foods across gender and across age groups using a stratified sample of 1005 additional people. Consistent with hypotheses, the findings showed different comfort food preferences across gender and across age. Males preferred warm, hearty, meal-related comfort foods (such as steak, casseroles, and soup), while females instead preferred comfort foods that were more snack related (such as chocolate and ice cream). In addition, younger people preferred more snack-related comfort foods compared to those over 55 years of age. Associations with guilty feelings underscored how these different preferences between males and females may extend to areas of application.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
Attention deficit hyperactivity disorder. The Lancet
- A Thapar
- M Cooper
Thapar, A., & Cooper, M. (2016). Attention deficit hyperactivity
disorder. The Lancet, 387, 1240-1250. doi:10.1016/S0140-6736(15)00238-X