Clinical characteristics of attention-deficit/hyperactivity disorder with sarcopenia in children: a case-control study.

BACKGROUND

This study aimed to investigate the characteristics of body composition, core symptoms, functional impairment, and comorbidities in children with attention-deficit hyperactivity disorder (ADHD) and sarcopenia.

METHODS

A case-control study compared children with ADHD and sarcopenia (n = 85) with matched ADHD-only controls (n = 85). Comprehensive evaluations included body composition analysis and standardized behavioral assessments (SNAP-IV, Vanderbilt, WFIRS).

RESULTS

Compared to the control group, the ADHD with sarcopenia group exhibited significantly lower values on total body water, protein, minerals, body fat mass, fat-free mass, bone mineral content, body mass index, fat mass index, and fat-free mass index (False Discovery Rate (FDR) corrected P < 0.05), while exhibiting higher muscle-to-fat ratio. They also demonstrated lower ADHD core symptom severity, decreased comorbidity proportion (including oppositional defiant disorder [ODD]), and impaired family function (FDR corrected P < 0.05). Regression analysis identified hyperactive-impulsive symptom severity (OR 3.97, 95% CI:2.22-7.12) and increased soft lean mass (SLM) (OR 1.13, 95% CI:1.05-1.21) as predictors of comorbid ODD risk.

CONCLUSION

ADHD children with sarcopenia had lower body composition values, milder core symptoms, and fewer comorbidities (including ODD). SLM and hyperactive-impulsive symptoms exhibited positive associations with comorbid ODD risk in children with ADHD.

IMPACT: Children with ADHD and sarcopenia show skeletal muscle wasting alongside declines in fat mass, protein content, and bone mineral content compared with the control group (children with ADHD without sarcopenia). The ADHD-sarcopenia group (participants with both ADHD and sarcopenia) had significantly lower ADHD core symptom scores (inattention and hyperactivity-impulsivity) and a reduced comorbidity proportion. Hyperactivity-impulsivity symptoms and soft lean mass increased the risk of comorbid oppositional defiant disorder in children with ADHD.