The Whole Is Greater Than the Sum of Its Parts: Co-Morbid ADHD and Autism Spectrum Disorder Is Associated With Greater Risk for Maladaptive Eating Behaviors in Children and Adolescents

Objective: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are linked to disordered eating in youths. Although ADHD and ASD often occur together, little is known about disordered eating among children and adolescents with both conditions. This study explored the relationships between ADHD, ASD, and co-occurring ADHD-ASD with maladaptive eating behaviors in U.S. children and adolescents, including whether these associations differed by age, sex, and race/ethnicity. Method: Children and adolescents (N = 64,691) from the 2022–23 U.S. National Survey of Children's Health were divided into subgroups based on parent-reported ADHD and ASD: ADHD only, ASD only, comorbid ADHD-ASD, and neither condition. Multiple logistic regression models examined associations between diagnostic group status and eight binary maladaptive eating behaviors, adjusting for age, sex, race/ethnicity, household income, adult education, and weight status. Interaction terms evaluated moderation effects, with stratified analyses performed for significant interactions. The false discovery rate was controlled using the Benjamini–Hochberg procedure. Results: Compared to youth with neither condition, both ADHD and ASD were independently linked to higher odds of various maladaptive eating behaviors, including food avoidance (e.g., restrictive eating) and food approach (e.g., emotional overeating) behaviors (AORs = 1.70–4.50). Children and adolescents with both ADHD and ASD showed the most significant and consistent increases across behaviors (AORs = 3.18–5.85). These associations differed by age and race/ethnicity but not by sex, generally with stronger associations observed among children and White participants. Discussion: These findings support early detection, thorough assessment of both restrictive and binge-type behaviors, and targeted prevention efforts for neurodivergent youth.