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

doi:10.1186/s40337-022-00674-y

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

J Eat Disord. 2022 Nov 1;10(1):152. doi: 10.1186/s40337-022-00674-y.

Authors

Aaron R Keshen^{1

2}, Anja Hilbert³, Victoria Taylor⁴, Anastasia L Harris⁴, Nami Trappenberg⁴, Joseph Sadek⁵, Guido K W Frank⁶, Stuart B Murray⁷

Affiliations

¹ Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada. aaron.keshen@nshealth.ca.
² Department of Psychiatry, Dalhousie University, Halifax, NS, Canada. aaron.keshen@nshealth.ca.
³ Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
⁴ Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada.
⁵ Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
⁶ Department of Psychiatry, University of California, San Diego, CA, USA.
⁷ Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.

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.

Associated data

ClinicalTrials.gov/NCT05592119