The Study On The Executive Functions And Quality Of Life In Obese Children With ADHD

ObjectivesIt has been indicated that obesity is a new described comorbidity of Attention deficit hyperactivity disorder(ADHD).As is known,the deficit of executive functions(EF)is popular in children with ADHD as well as in obese children.The dysfunction of EF would contribute greatly to poor cognitive functions,lower academic performance and health related quality of life.Presently,there is no any research on the topic of EF and quality of life in children with both ADHD and obesity conditions.Are the impairments of EF and quality of life more serious in children with ADHD comorbided obesity than those with single disease of ADHD?And,it is unknown whether psychopharmacological treatment can improve the EF and quality of life,and change BMI.With these information,this comorbidity would be evaluated systematically,and could be treated more efficiently.Therefore,the current study aimed at comparing EF and quality of children with ADHD and obesity with the controls,including ADHD children,obese children and normal controls.We hypothesized that the ADHD+Obesity group would perform worse than the other control groups,and psychostimulant can improve EF and quality of life.MethodsIn part 1,four group of children were recruited,including children with both ADHD and obesity(n=42),children who had been diagnosed with ADHD without obesity(n=49),children with obesity(n=45),normal controls(n=53).The Connners rating scale-Parent version,SNAP-IV-Parents and teachers version,Vanderbilt ADHD diagnostic rating scale-Parent version were used to assess the ADHD symptoms.Wisconsin Card Sorting Test(WCST),Stroop test and digit span were used to assess the executive functions.Pediatric Quality of Life Inventory(PedsQL V.4.0TM)(parent and child reports)(PedsQL)was used to evaluate the quality of life of 4 groups.In part 2,Osmotic Release Oral System Methylphenidate(Concerta)was prescribed to the children with both condition of ADHD and obesity,and with ADHD.Six months later,EF and quality of life were re-assessed.The results of EF and quality of life on endpoint were compared with those on baseline.The change of BMI-P was evaluated,and the possible factors influencing BMI was analysed.Data were entered into Excel software and analyzed in the SPSS(version 13.0)software package.Differing gender and pubertal developmental stages were analyzed by chi-square analysis.One way ANOVA was employed to analyze the differences among 4 groups.Differences below P<0.05 were considered to be significant.ResultsExecutive functions:There are statistical differences of the results of WCST,Stroop test and digit span test among ADHD+OB group,ADHD group,obesity group and normal control group.The results in children with both ADHD and obesity were the lowest,indicating that EFs in this group were impaired most serious.When adjusted for IQ,this difference was unchanged.For PedsQL,the total scores of parents reporting in four groups were 70.3±13.0,76.5±11.3,78.9±16.3 and 85.6±7.5,respectively.The total scores of child reporting in four groups were 74.6±14.1,78.1±12.8,81.4±11.4 and 88.5±7.4,respectively.A significant difference was found between groups(P<0.001)by one way ANOVA.After psychopharmacological treatment,all EFs were improved to normal level except of the backward digit span test in children with both conditons of ADHD and obeisty.The quality of life was improved after treatment except for physical function.The BMI percentile was greatly decreased in children with ADHD comorbided obesity.ConclusionsThe deficits of executive functions of children with both ADHD and obesity were severe,compared with ADHD children and obese ones.The quality of life is poor in the comorbidity group.Treatment with psychostimulant could improve the EFs and quality of life in children with both condtions of ADHD and obesity.The possible factors accounting for the decreased BMI-P were improved EFs and ADHD symptoms,and loss of appetite of the medication.