Eating Problems and Overlap with ADHD and Autism Spectrum Disorders in a Nationwide Twin Study of 9- and 12-Year-Old Children

Maria Råstam,Peik Gustafsson,Henrik Anckarsäter,Armin Tajnia,Sebastian Lundström,Christopher Gillberg,Paul Lichtenstein,Jakob Täljemark,Nóra Kerekes

doi:10.1155/2013/315429

Abstract

Aim. To establish the prevalence of restrictive eating problems, the overlap and association with attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorders (ASD) and to estimate the heritability of eating problems in a general population sample of twins aged 9 and 12. Methods. Parents of all Swedish 9- and 12-year-old twin pairs born between 1993 and 1998 (n = 12,366) were interviewed regarding symptoms of ADHD, ASD, and eating problems (EAT-P). Intraclass correlations and structural equation modelling were used for evaluating the influence of genetic and environmental factors. Cross-twin, cross-trait correlations were used to indicate a possible overlap between conditions. Results. The prevalence of eating problems was 0.6% in the study population and was significantly higher in children with ADHD and/or ASD. Among children with eating problems, 40% were screened positive for ADHD and/or ASD. Social interaction problems were strongly associated with EAT-P in girls, and impulsivity and activity problems with EAT-P in boys. The cross-twin, cross-trait correlations suggested low correlations between EAT-P and ADHD or EAT-P and ASD. Genetic effects accounted for 44% of the variation in liability for eating problems. Conclusions. In the group with eating problems, there was a clear overrepresentation of individuals with ADHD and/or ASD symptoms.

Highlights

In typically developing younger children, the prevalence of the clinical eating disorders is low [1, 2], with one large-scale study reporting a prevalence of 0.15% for DSM-IV eating disorders in 11- to 12-year olds [3]
Of the 12,304 children included in the present study, 903 were screened positive for attention-deficit/hyperactivity disorder (ADHD) only, 89 were screen positive for autism spectrum disorders (ASD) only, and 288 children were screened positive for both ASD and ADHD
The prevalence of eating problems (EAT-P) was significantly higher in the group of children with ADHD and/or ASD compared to the group of children with no ADHD and no ASD (P < 0.001)

Summary

Introduction

In typically developing younger children, the prevalence of the clinical eating disorders is low [1, 2], with one large-scale study reporting a prevalence of 0.15% for DSM-IV eating disorders in 11- to 12-year olds [3]. A recent surveillance study [4] based on close to 2500 Canadian paediatricians’ reports on “any disordered eating behavior sufficient to cause a disruption, weight gain, or actual loss of weight” found 161 children from 5 to 12 years of age. Non-specific risk factor increases the risk of developing an eating disorder by about five times [5]. It has been suggested that subclinical variants of eating disorders start at an earlier age than was the case in the twentieth century and that the prevalence of early dieting/restrictive eating is increasing [6]. While eating problems in childhood may be a risk factor for the development of eating disorders in adolescence and young adulthood [7,8,9], a comprehensive review on risk factors for eating disorders stressed a need for larger-scale studies [10]

Methods

Results

Conclusion