# Adolescent eating behaviours: associations with autistic and ADHD traits in childhood and the mediating role of anxiety

## TL;DR

The study finds that autistic and ADHD traits in childhood are linked to specific eating behaviors in adolescence, with anxiety playing a key role in some cases.

## Contribution

The study identifies anxiety as a mediator in the link between autistic traits and emotional/restrained eating behaviors in adolescence.

## Key findings

- Higher childhood autistic traits are associated with emotional/restrained and externally driven eating behaviors in adolescence.
- Anxiety partially mediates the link between autistic traits and emotional/restrained eating behaviors.
- Inattention traits are linked to externally driven eating behaviors in adolescence.

## Abstract

Autistic individuals and individuals with ADHD are more likely to experience eating disorders, yet the reasons for this are not well understood. We investigated whether childhood neurodivergent (i.e. autistic and ADHD) traits are associated with patterns of emotional/restrained eating and externally driven eating behaviours in adolescence, whether these associations differed by sex and if they are mediated by anxiety.

We tested the association between parent‐reported childhood (age 7 years) autistic and ADHD (i.e. hyperactivity/impulsivity, inattention) traits and self‐reported adolescent (age 13) eating behaviours in a large population‐representative prospective cohort (N = 7,572; Avon Longitudinal Study of Parents and Children). We performed multi‐group longitudinal analysis stratified by sex to understand whether sex moderates' associations between neurodevelopmental traits and adolescent eating behaviours. Mediation models tested the extent to which observed associations were driven by mid‐childhood (age 10) anxiety symptoms. All analyses were adjusted for child sex, child ethnicity, maternal education levels and maternal age at birth.

Individuals who had higher childhood autistic traits were more likely to report emotional/restrained (b = 0.59, 95% CI [0.29, 0.88], p < .001, B = 0.07) and externally driven (b = 0.17, 95% CI [0.05, 0.28], p < .01, B = 0.06) eating behaviours during adolescence. Additionally, individuals with higher childhood inattention traits were more likely to report externally driven eating behaviours (b = 0.10, 95% CI [0.03, 0.19], p = .02, B = 0.05). No sex differences were identified in the associations. Mediation models suggested a significant indirect effect of anxiety for the association between autistic traits and emotional/restrained eating (b = 0.08, bootstrapped 95% CIs [0.02, 0.13]).

Autistic and ADHD traits in childhood may share some eating behaviour phenotypes in adolescence (externally driven eating), whereas others are specific to autism (emotional/restrained eating). We present evidence for the role of anxiety in underpinning the association between autistic traits and emotional/restrained eating behaviours, suggesting an important potential intervention target.