Show-Me State Times

More than 6 million children in America have been diagnosed with attention deficit hyperactivity disorder (ADHD). A new study co-led by the University of Missouri has uncovered a significant correlation: Unmedicated youth with ADHD not only have higher rates of obesity but also tend to exceed screen time recommendations and fall short of meeting crucial sleep guidelines.

Crystal Lim, an associate professor in the College of Health Sciences at Mizzou, along with other researchers, analyzed data from a nationally representative survey that included tens of thousands of youths aged 11-17. Parents were asked about their children's daily sleep, screen time, and exercise across three groups: those without ADHD, those with ADHD on medication, and those with ADHD not on medication.

The research concluded that while sleeping more and limiting screen time are beneficial for all children, these behaviors are particularly helpful for unmedicated youth with ADHD due to their higher prevalence of obesity. Lim noted that common stimulant medications for treating ADHD, such as Adderall, may suppress appetite as a side effect. However, she emphasized that not all ADHD medications are stimulants and that medication is just one part of the solution.

“If some families are not as interested in medication, identifying sleep as a key health behavior to target for improvement can help reduce the obesity risk,” Lim said. “As a clinical psychologist, I regularly meet with families and give them evidence-based strategies for creating long-lasting, healthy behavioral changes.”

Lim's research aims to address both increasing awareness of ADHD and pediatric obesity. Since childhood obesity rates have surged in the United States since 1990 — especially in rural and underserved areas — Lim has focused on encouraging healthy lifestyle behaviors among children. In 2022, she examined childhood obesity prevention programs in rural schools to emphasize the importance of both nutrition and exercise.

After working in an obesity clinic in Mississippi — where she was drawn to Mizzou because of interdisciplinary collaboration opportunities within the College of Health Sciences — Lim highlighted her collaborative work at Mizzou. “Getting to collaborate with psychologists, medical providers, therapists and researchers at Mizzou has been great because my work is at the intersection of all of it,” she said.

Looking ahead, Lim hopes her research will encourage children and families to adopt healthy behaviors into their daily lives. “My goal is to offer strategies for how we can modify our evidence-based treatments as clinical psychologists in practical ways,” she said.

With summer here, Lim offers several tips for families considering how the end of the school year might impact their child's routines regarding sleep, screen time, and exercise:

1. Set a nighttime routine for consistently going to bed at the same time.

2. Consider cutting off internet access at a certain time.

3. Avoid having TVs or other screens in bedrooms.

4. Avoid large meals right before bed.

5. Encourage physical activity during the day through activities such as swimming or sports.

6. Create a cool, dark environment to promote sleep.

7. Use screen time as a reward after chores or physical activities are completed.

"Understanding health behaviors that modify the risk for obesity in ADHD" was published recently.

Editor's note: Lim collaborated on the study with Delanie Roberts from Children’s Hospital Los Angeles; Dustin Sarver and Benjamin Walker from University of Mississippi Medical Center; and Annah Cash from Virginia Polytechnic Institute and State University.