Article

Advertising Influences Food Choices of University Students With ADHD

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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/

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... 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 . ...
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... 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 . ...
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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.
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Chapter
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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.
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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)
Article
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.
Article
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.
Article
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.
Article
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
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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
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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