Effect of stimulant medication on loss of control eating in youth with attention deficit/hyperactivity disorder: a prospective, observational case series study protocol

Aaron R Keshen, Anja Hilbert, Victoria Taylor, Anastasia L Harris, Nami Trappenberg, Joseph Sadek, Guido K W Frank, Stuart B Murray, Aaron R Keshen, Anja Hilbert, Victoria Taylor, Anastasia L Harris, Nami Trappenberg, Joseph Sadek, Guido K W Frank, Stuart B Murray

Abstract

Background: Loss of control eating (LOC-E) in youth predicts the later development of full-syndrome binge-eating disorder (BED), and therefore, could be a relevant target for prevention treatments. To develop these treatments, it is important to understand the underlying disease processes and mechanisms. Based on the putative role of neurocognitive impairments in the pathogenesis of LOC-E, treatments that modulate these neurocognitive factors warrant further exploration. For instance, stimulants are an effective treatment for impulsivity in youth with attention deficit/hyperactivity disorder (ADHD) and have been shown to improve symptoms of BED in adults. Notably, stimulants have not been examined as a treatment for LOC-E in youth. To explore this gap, we aim to measure change in LOC-E episodes and secondary outcomes in youth with comorbid ADHD and LOC-E who are being started on stimulants.

Methods: We will collect prospective observational data on forty 8-to-13-year-old youth diagnosed with comorbid ADHD and LOC-E who are initiating a stimulant for ADHD. Prior to stimulant initiation, participants will complete baseline measures including LOC-E episode frequency in the last 3 months (primary outcome), and secondary outcomes including disordered eating cognitions, emotions and behaviors, ADHD symptom severity, parental LOC-E, impulsivity and reward sensitivity, and anxiety/mood severity. Outcome measurements will be gathered again at 3-months after initiating the stimulant. Within-patient standardized effect sizes with 95% confidence intervals will be calculated from baseline to 3-month follow-up for all outcomes.

Discussion: Many individuals with LOC-E or binge eating do not fully remit over the course of psychotherapy. Whereas psychotherapy may address psychological and sociocultural domains associated with LOC-E, some individuals with neurocognitive impairments (e.g., ADHD) and neurobiological deficits (e.g., low intrasynaptic dopamine or norepinephrine) may benefit from adjunctive treatment that targets those factors. This will be the first study to provide pilot data for future studies that could examine both the effect of stimulants on LOC-E in youth and underlying mechanisms.

Trial registration: Trial registration number: NCT05592119.

Keywords: Attention deficit/hyperactivity disorder; Binge eating; Children; Eating disorders; Loss of control eating; Stimulants.

Conflict of interest statement

ARK has been a member of scientific advisory boards, participated in speaker events and received educational grant support from Takeda Inc. and Otsuka/Lundbeck. AH has received research grants on eating disorders and obesity from the German Federal Ministry of Education and Research, German Research Foundation, and Roland Ernst Foundation for Healthcare; royalties for books on the treatment of obesity and eating disorders with Hogrefe and Kohlhammer; honoraria for workshops and lectures on obesity and eating disorders and their treatment; honoraria as editor of the International Journal of Eating Disorders and the journal Psychotherapeut; honoraria as a reviewer from Mercator Research Center Ruhr, Oxford University Press, and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers, Zweites Deutsches Fernsehen, and Takeda.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Timeline of Study Procedures. CPT Continuous Performance Test. CBBEQ Children’s Brief Binge-Eating Questionnaire. ChEDE Eating Disorder Examination – Child Version. ChEDE-Q8 Eating Disorder Examination Questionnaire adapted for children, short form. CEBQ Child Eating Behavior Questionnaire. LOCES Loss of Control Over Eating Scale. RCADS-25 Revised Child Anxiety and Depression Scale – Short Version. VADPRS Vanderblit ADHD Diagnostic Parent Rating Scale. BIS/BAS Parent-Report Behavioral Inhibition System/Behavioral Activation System Scales

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