ADHD

ADHD

ADHD is a neurodevelopmental condition meaning the nervous system, including the brain has developed and so functions differently to that of most people. It is a naturally occurring form of neurodiversity and can impact feeding and eating experiences.

There are three presentations of ADHD:

• Primarily Hyperactive/Impulsive (ADHD-HI)
• Primarily Inattentive (ADHD-I)
• Combined- both Impulsive/Hyperactive & Inattentive (ADHD-C)

Most people with ADHD are combined-type which means they have enough symptoms of both Hyperactive/Impulsive and Inattentive presentations. For the primarily with Hyperactive/Impulsive presentations, it is a misconception that people must have physical hyperactivity- it can be verbal or internal hyperactivity.

Common eating challenges seen in ADHD: 

People with ADHD (which can also co-occur with autism) are more likely to face eating challenges that can have a significant impact on individuals and their families including:

• Loss of appetite due to stimulant medication
• Hyperfocus on areas of interest or difficulties transitioning from one task to another impacting regularity of eating
• Inattentivess setting up a Restrict-Binge cycle
• Difficulty focusing on one task for an extended period impacting the ability to finish a meal or snack
• Reduced interoception or interoceptive confusion affecting the ability to notice and respond to signals of hunger, thirst and fullness or issues with body mistrust negatively impacting body image
• Preference for immediate rewards resulting in loss of control with eating (estimated to be 12 x higher in ADHD children)
• Difficulties identifying, differentiating and expressing feelings and emotional states resulting in emotional and/or impulsive eating
• Sensitivity to certain textures, smells, tastes, temperature or visual aspects of food, resulting in strong food dislikes and food selectivity
• Seeking sensory input resulting in strong preferences for certain textures e.g. crunchy, salty or spicy foods, carbonated beverages limiting food variety impacting nutritional adequacy
• Strong preference for ‘same foods’ eaten for prolonged periods to provide a sense of safety and regulation through consistency and predictability e.g. A particular brand or type of processed ‘beige’ foods such as nuggets, crackers, potato crisps, white bread, noodles
• Sensory processing differences related to the eating environment (at the table, school or a restaurant) e.g. lighting, crowded/busy/noisy/confined eating areas, visual clutter, hard uncomfortable chairs, social interaction pressures and extreme sensitivity to chewing sounds, making it difficult to eat with others
• Dysregulation and overwhelm due to neurotypical expectations at mealtimes such as must sit down, use cutlery, not stimming, not using fidgets or headphones
• Sensory processing differences making food shopping or preparing food challenging
• Executive functioning differences impacting the ability to plan meals, food shop, follow recipes, prepare food and clean up
• Demand avoidance where eating or responding to hunger feels like a ‘demand’
• Gastrointestinal issues such as abdominal pain, constipation, diarrhoea or bloating or IBS leading to food restriction or avoidance  
• Chronic poor sleep (in up to 50% of ADHers) impacting energy levels, sensory regulation, executive functioning and gut symptoms

How our dietitians can help with eating challenges in ADHD: 

• Providing a safe, non-judgemental, neurodiversity-affirming space to talk openly and share concerns about food and eating challenges
• Providing neurodiversity-affirming psychoeducation on potential sensory, social, and executive functioning differences that can impact food intake
• For children and adolescents, providing a thorough assessment of weight and growth
• Providing individualised strategies to restore appropriate growth trajectory in children and adolescents. This may include taste testing of medical nutrition supplements and scripts to purchase them at a reduced price if required
• Conducting a nutritional analysis of current food intake and blood tests to provide a personalised vitamin and mineral supplementation plan to correct or prevent deficiencies. This may include liquids, chewables, powders, sprays, tablets, or drops depending on personal preference while considering sensory sensitivities
• Reviewing impact of medications (type and timing) on food intake and educating on interactions with food or supplements if relevant
• Providing strategies to expand the diet that are aligned with the individual’s goals g. restore weight and growth, improve energy levels, sleep and concentration, eat socially
• Identifying individual’s unique food sensory profile and providing practical advice to successfully expand on ‘safe’ foods to meet nutrition requirements
• Exploring and supporting sensory needs around food and mealtimes to manage anxiety and dysregulation to help build safety, trust, confidence, and a positive relationship with food
• Creating a structured and predictable mealtime routine and environment to set up for success
• Understanding and challenging neurotypical expectations around eating and food
• If appropriate, providing strategies to improve interoceptive awareness of hunger, thirst and fullness cues
• Providing in-session meal support with the optional support of our Dietwise dogs Ella and Reggie
• Providing practical low-spoon (quick and easy) tips, guides and hacks for meal planning, food shopping, cooking, food storage and clean-up
• Reducing overwhelm and confusion by helping navigate the plethora of conflicting nutrition information and myth-busting informed by the latest research
• Advocating for support, accommodations and autonomy around food and eating at kindergarten, school, university, the workplace, family or friends
• Referring to and collaborating with other members of the interdisciplinary team where required such as a GP, Paediatrician, Occupational Therapist, Speech Pathologist, Psychologist and Psychiatrist

As every ADHD presentation is different, no one approach will suit everyone. Our dietitians approach their work with compassionate curiosity and embrace creative and collaborative problem-solving. We also understand the importance of working in a way that encourages the development of a positive neurodivergent identity for the individual and the family.

A special note on ADHD, eating disorders and neurodiversity-affirming care 

ADHDers are at increased risk of developing an eating disorder due a multitude of factors such as loss of appetite from stimulants, hyperfocus, differences in impulse control, time processing, executive functioning, interoception and sensory processing. Together, these can result in emotional dysregulation and overwhelm/burrnout, decision paralysis around food, lowered capacity to shop and prepare food and irregular eating +/- bingeing.

“When a flower doesn’t bloom, you fix the environment i which it grows, not the flower.”  – Alexander Den Heijer

In terms of treatment, our experience is that compliance and behavioural-based ED interventions such as CBT-E and FBT are not neurodiversity-affirming and may not be a good fit for some people with ADHD. In these cases, we challenge neuronormative beliefs, assumptions, norms, goals and expectations related to food, eating and body to prevent trauma and minimise harm. We prioritise self-determination and autonomy, and use a client-centred, strengths-based approach, adapting nutrition care accordingly. In addition, our Dietitians work alongside our clients with compassionate curiosity and respect neurodivergent ways of being, versus seeking to eradicate or cure it to support a positive neurodivergent identity.