The connection between ADHD and Eating Disorders
A 2024 report from the Butterfly Foundation highlights that rising rates of eating disorders (ED) in Australia means that 1.1 million Australians currently live with EDs, a 21% increase since 2012. As ADHD (Attention Deficit Hyperactivity Disorder) children may be up to three times more vulnerable to developing ED’s than non-ADHD children due to differences in impulsivity and executive functioning, the Eating Disorders Neurodiversity Australia (EDNA) report on ED’s and Neurodivergence recommends incorporating ADHD investigation in ED intervention processes such as paediatric care for young people with EDs. Neurodivergence, like ADHD, has been defined as inherent differences in neurocognitive functioning that significantly varies from what society generally understands as typical.
Consequently, at BodyMatters our ED-informed pediatricians Dr Carina Burgess and Dr Samantha Hattle understand how important it is to consider ADHD as part of their broader comprehensive ED work with children. Dr. Burgess highlights that “we don’t just focus on ADHD, but rather all the physical and neurodevelopmental conditions can co-occur with EDs” because this allows our allied healthcare team of pediatricians, psychologists, and dieticians to work with neurodivergent young people experiencing EDs more effectively. This approach aligns with EDNA’s evidence-based recommendation for neurodiversity-affirming ED intervention that incorporates knowledge around ADHD differences into treatment to ensure it remains person-centered and effective.
Given the association between ADHD and EDs, the early age of ED onset, and the significant positive impact neurodiversity-affirming ED informed treatment may have on improving wellbeing and recovery intervention it seems important to clarify how our clinicians approach investigating ADHD in young people with EDs . Through this review, families engaged in support around potential ADHD in their children with EDs may have increased clarification around what these processes may look like.
What is the difference between a psychologist’s ADHD assessment and a paediatrician investigating ADHD in working with EDs?
In assessing ADHD a psychologist will often undertake a clinical interview with parents, gather information from educators, and administer cognitive tests to investigate for impacts to processing speed or working memory and/or other cognitive considerations that may require exploration before making and ADHD diagnosis. This information helps the psychologist determine whether potential ADHD symptoms meet ADHD diagnostic criteria or if they may be alternatively explained by other neurodivergence, such as autism, learning difficulties or other mental health concerns such as an ED.
In comparison, Paediatricians are medical specialists and have a comprehensive and broader understanding of of how the body functions. When assessing for ADHD a paeditrician does so through a medical lense- and so whilst a psychologist may determine ADHD on tba basis of a psychological assessment, a paediatrician will consider additional factors that a psychologist will not. ADHD assessment is further complicated when working with EDs because EDs such as anorexia are known to also cause impacts on cognitive processes, to working memory and processing speed due to starvation syndrome, ED-derived decreases in mood, and ED-derived increases in anxiety impairing cognitive function. Therefore it may be critical when working with young people experiencing EDs and potential ADHD to incorporate an ED-informed paediatrician in the ADHD investigation process to both support in ruling out alternate mental and physical health explanations for identified ADHD symptoms, and to ensure that all the information that is necessary for providing neurodiversity-affirming ED treatment is obtainws.
Can both paediatricians and psychologists prescribe ADHD medication?
Only paediatricians and psychiatrists can prescribe ADHD medication such as ritalin or vyvanse. This prescribing privilege is part of why it is so crucial for the paediatric assessment to assess all psychological and physical health factors, as they can influence the appropriate dosage of ADHD medication when appropriate or even clarify that it may be inappropriate or unsafe to prescribe at all.
Dr. Burgess highlights that “complex ADHD”, where ADHD is accompanied by additional mental or physical health concerns, is “much more common than simple ADHD”. Fellow ED informed pediatrician Dr. Hattle emphasises that this means treatment is “very individualised” rendering it critical for the medical assessment to include: multiple blood tests, an assessment of diet concerns, analysis of sleep patterns, identification of physiological deficiencies. By exploring all possible physical health and mental health factors, such as trauma, that may potentially contribute to ADHD symptoms such as reduced concentration or distractibility, this individualized person-centered treatment clarifies anything if medication is necessary, as well as any factors that may complicate the prescription of ADHD medication.
Further considerations underpinning the consideration of prescribing is medical history, mental health history, and the pre-existing medications that someone may already be consuming. It is common for people to undertake a consultation with a paediatrician with the hope that a pharmacological intervention will be prescribed immediately, particularly if a psychological assessment has suggested that ADHD is present. However there are many additional considerations an ED-informed paediatrician may need to address to confirm a prescription will be helpful.
What other considerations are there in prescribing ADHD medications with EDs?
The 2022 Australian Evidence-Based Clinical Practice Guideline for ADHD reported that medication and non-pharmacological intervention, such as cognitive-behavioural therapy, work with ADHD in different ways. According to the research, ADHD medication seems to be most effective at treating core ADHD symptoms such as working memory and processing speed, whilst non-pharmacological approaches fosters improvement in overall functioning. A further complication to emphasising one treatment approach over the other in a vacuum is the fact that comorbid physical and mental health concerns identified in the ADHD investigation process may complicate how appropriate certain treatment options are.
In conclusion, engaging with an ED-informed pediatrician equipped to support you in understanding the best neurodivergence-affirming options available may be helpful in supporting children with a dual-diagnosis of ADHD and an ED. As BodyMatters currently provides ADHD testing services and paediatric services, please contact us if you would like to organise an appointment with one of our pediatricians or a psychological assessment. You can contact our wonderful team via our website or by phoning 02 9908 2833