Girls With ADHD Are at Increased Risk for Eating Disorders and Depression

Marlene Busko

November 08, 2007

November 8, 2007 (Boston) -- Compared with controls, girls with attention-deficit/hyperactivity disorder (ADHD) were more likely to develop an eating disorder or to develop major depression, according to 2 recent studies.

These findings were presented in a symposium at the American Academy of Child and Adolescent Psychiatry 54th Annual Meeting.

Very little information is available about ADHD in girls and women, and these 2 studies showed that girls with ADHD can have eating-disorder problems that are not seen in boys, and they can also have life-threatening depression, Joseph Biederman, MD, from Massachusetts General Hospital, in Boston, who presented the depression study, told Medscape Psychiatry

"People who have certain characteristics with ADHD such as conduct disorders, eating disorders, or depression require very different treatment and follow a more complicated path as they grow into adulthood," he added.

Underrecognized Eating Disorder Risk

"The risk for eating disorders in ADHD, we can say with more confidence now, may be underrecognized," said Craig B. H. Surman, MD, from Massachusetts General Hospital.

He reported that in a large prospective study of adolescent girls with and without ADHD (controls), those with ADHD were 3.6 times more likely to develop an eating disorder, defined as either anorexia or bulimia nervosa (Biederman J et al. J Dev Behav Pediatr. 2007;28:302).

During the study's 5-year follow-up, 16% of the girls with ADHD (20 girls) and 5% of the controls (5 girls) developed an eating disorder.

Compared with the controls, the girls with ADHD were 5.6 times more likely to develop bulimia and 2.7 times more likely to develop anorexia nervosa. They also had significantly higher rates of depression, anxiety disorders, and disruptive behavior.

Treatment for ADHD should be considered in patients with eating disorders, said Dr. Surman, adding the caveat that such treatment can be complicated by the adverse effects of medication.

Fivefold Greater Risk for Depression

Girls with ADHD were 5.4 times more likely to develop major depression than girls without ADHD, in a longitudinal study of 140 girls with ADHD and 122 girls without ADHD (controls) that was presented by Dr. Biederman.

The girls, aged 6 to 18 years, were followed prospectively for 5 years. Compared with the controls, those with ADHD had an earlier onset of major depression, and the depression was associated with greater impairment, such as suicidality, and was more likely to require hospitalization. Major depression developed on average at age 17 years and lasted twice as long in the girls with ADHD vs controls (3 years vs 1.3 years). Dr. Biederman noted that "3 years in the life of a 17-year-old girl is a significant chunk of life."

Prior mania and parental major depression independently predicted depression among the girls with ADHD.

"These findings indicate that major depression emerging in the context of ADHD is an impairing and severe comorbidity worthy of further clinical and scientific interest," said Dr. Biederman.

Dr. Biederman is on the advisory board of and is a consultant for Cephalon, Eli Lilly, Janssen LP, McNeil Pediatrics Division of McNeil-PPC, Novartis Pharmaceuticals, and Shire US. He receives research support from Abbott Laboratories, Bristol-Myers Squibb, Eli Lilly, Janssen LP, McNeil Pediatrics Division of McNeil-PPC, New River Pharmaceuticals, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the National Institute of Mental Health, Otsuka America Pharmaceutical, Pfizer, and Shire US. He is on the speaker's bureau for Cephalon, Eli Lilly, McNeil Pediatrics Division of McNeil-PPC, Novartis Pharmaceuticals, Shire US, and UCB. Dr. Surman is on the advisory board of Shire US and has received advisory board honoraria from the Takeda Pharmaceutical Company. He has received educational honoraria from McNeil Pediatrics Division of McNeil-PPC and Shire US and research support from McNeil Pediatrics Division of McNeil-PPC. He has received speaking honoraria from Cephalon, Janssen LP (Canada), and Shire US and speaker's bureau honoraria from Novartis Pharmaceuticals.

American Academy of Child and Adolescent Psychiatry 54th Annual Meeting: Symposium 25. October 23-28, 2007.

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