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Background Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for problematic gaming. Although impulsivity has been linked to problematic gaming, it is unclear whether different impulsivity facets show distinct associations with heterogeneous DSM-5 Internet Gaming Disorder (IGD) symptom domains. Methods In this cross-sectional study, 45 male adolescents with ADHD (ages 12–17) presenting with excessive gaming concerns were recruited from two child and adolescent psychiatry outpatient clinics in Turkiye (December 2025–January 2026). ADHD diagnoses and comorbidity screening were confirmed with the K-SADS-PL-DSM-5-T semi-structured interview; comorbid psychiatric disorders expected to meaningfully affect impulsivity or gaming-symptom reporting were excluded. Impulsivity was assessed using the Barratt Impulsiveness Scale-11-SF (BIS-11-SF) (attentional, motor, non-planning) and IGD symptoms using the IGDS-27 (nine DSM-5 criteria). Spearman correlations were computed between impulsivity indices and IGD total/domain scores, with uncertainty quantified using 5,000-sample bias-corrected and accelerated (BCa) bootstrap 95% confidence intervals (CIs). Selected exploratory comparisons of dependent overlapping correlations were also conducted. Age, ADHD pharmacotherapy status, and parental psychiatric history were examined in sensitivity analyses. Results Most participants reported gaming > 4 h/day on weekdays (73.3%) and weekends (75.6%). IGDS-27 total score was positively associated with non-planning impulsivity (ρ = 0.56, 95% CI [0.30, 0.74]), attentional impulsivity (ρ = 0.52, 95% CI [0.23, 0.74]), and motor impulsivity (ρ = 0.45, 95% CI [0.16, 0.69]). In a multivariable linear regression including all three impulsivity facets simultaneously, only non-planning impulsivity remained independently associated with IGD symptom severity (B = 4.15, 95% CI [1.63, 6.67], p = .002; model R² = 0.45). Selected exploratory comparisons suggested stronger associations of non-planning impulsivity with problems and deception than with preoccupation or escape. Age was not significantly correlated with impulsivity or IGD severity, and sensitivity analyses did not indicate differences by ADHD pharmacotherapy status or parental psychiatric history. Conclusions In this clinical sample of male adolescents with ADHD, IGD symptom severity was positively associated with all three impulsivity facets in bivariate analyses, while non-planning impulsivity retained an independent association in multivariable analysis after accounting for shared variance among facets. Facet-symptom level associations were exploratory and should be interpreted cautiously. Trial registration Not applicable.

Food addiction (FA) has been proposed as a behavioral factor contributing to obesity in adolescents, particularly among those experiencing psychological difficulties. Mindful eating may represent a protective characteristic, but its statistical relationship with psychological difficulties and FA in adolescents with obesity remains unclear. Forty-eight adolescents with obesity (ages 11–18; 54.2% female) were recruited from a pediatric outpatient clinic in Türkiye. FA symptoms were assessed using the Yale Food Addiction Scale for Children (YFAS-C), mindful eating with the Mindful Eating Questionnaire (MEQ), and psychological difficulties via parent reports on the Strengths and Difficulties Questionnaire (SDQ). SDQ total difficulties score was positively correlated with YFAS-C symptom scores (r = .45, p = .001) and negatively correlated with MEQ scores (r = –.38, p = .01). MEQ scores were negatively correlated with YFAS-C scores (r = –.64, p < .001). A statistical mediation analysis indicated that mindful eating functioned as a hypothesized mediator, with the data showing an associational pattern consistent with a mediation model. Psychological difficulties were associated with FA both directly (B = 0.068, p = .047) and indirectly through mindful eating (B = 0.058, 95% CI [0.014, 0.109]). The observed pattern suggests that mindful eating may be involved in the statistical relationship between psychological difficulties and FA symptoms, but causal mediation cannot be inferred from cross-sectional data. Mindful eating may represent a potential target for future intervention research. Longitudinal and experimental studies are required to determine temporal ordering and clarify causal pathways.

Background Ethical decision-making in child and adolescent psychiatry (CAP) is inherently complex, shaped by developmental vulnerability, evolving autonomy, and competing responsibilities to patients, families, and the legal system. Clinicians often face moral dilemmas when navigating adolescent confidentiality, parental authority, and mandatory reporting duties, especially in high-stakes or culturally sensitive contexts. As large language models (LLMs) enter clinical settings, their potential to support ethical reasoning remains underexplored, particularly outside Western paradigms. This study qualitatively investigates how different LLMs provide ethical, legal, and emotional guidance to clinicians facing ethically challenging scenarios in CAP, situated within Turkiye’s sociocultural and legal landscape. Method A scenario-based qualitative design was employed. Three expert-developed case vignettes reflecting ethically charged dilemmas, such as adolescent autonomy, parental conflict, and confidentiality, were submitted to the three LLMs (ChatGPT 4.0, Gemini 2.5 Flash, and GROK 3). Responses were analyzed using content and thematic analysis to identify key patterns of ethical-legal reasoning, alongside discourse analysis to examine tone, empathy, and cultural sensitivity. Two researchers, with backgrounds in CAP and medical ethics, conducted independent coding and reached consensus through a reflexive, interdisciplinary approach. Results All LLMs addressed core ethical principles (autonomy, non-maleficence, beneficence, and justice) and referenced Turkish legal frameworks such as the Child Protection Law, Patient Rights Regulation, and mandatory reporting obligations, situating their guidance within the national regulatory context. They also differed in their engagement with sociocultural sensitivities: GROK 3 emphasized therapeutic communication and relational trust, Gemini 2.5 Flash applied a highly structured, rule-based style focused on procedural compliance, while ChatGPT 4.0 provided concise and practical suggestions. Despite thematic overlaps, these varying approaches shaped how effectively the models aligned with Turkiye’s clinical realities. Notably, LLMs frequently acted as “thinking companions,” offering ethical and legal justifications while leaving interpretive responsibility with clinicians. Conclusion LLMs in CAP hold promise not only as cognitive aids but also as emotionally attuned, context-sensitive companions in ethical decision-making processes. Their effectiveness depends not just on algorithmic precision but also on explainability, empathy, and cultural alignment. Rather than replacing clinician judgment, LLMs may serve to ease emotional burden, enhance therapeutic reflection, and foster ethically sound care in complex, high-pressure situations.

Food addiction has become an increasingly interesting issue. However, it is not yet included in diagnostic classification systems, especially in societies where the prevalence of obesity has increased from childhood. The results indicating the biological, behavioral, and psychological aspects of food addiction, which are common with other addictions, have been gradually increasing. In this review, it is aimed to discuss the concept of food addiction in the light of the current literature and to review the evidence regarding its etiology, clinical significance, and intervention methods.

Background Executive functioning (EF) difficulties may play a significant role in the vicious cycle of overeating and metabolic disturbances. We aimed to investigate the correlates of EF difficulties in terms of food addiction symptoms, eating attitudes, and metabolic syndrome markers among adolescents seeking obesity treatment. Methods Thirty-five adolescents seeking obesity treatment were included. Executive functioning difficulties were assessed using both performance tasks (i.e. Stroop’s task and Cancellation task) and parent reports on the Behavior Rating Inventory of Executive Function (BRIEF). Other measurements included adolescent self-reports of food addiction symptoms on the Yale Food Addiction Scale (YFAS) and eating attitudes on the Eating Attitudes Test-40 (EAT-40). Results The mean total symptom score was 4.66 (± 1.45) on the YFAS. The most commonly endorsed symptoms were ‘Repeated unsuccessful attempts to stop or decrease food consumption’ in 94.3% ( N  = 32), ‘Tolerance to the same amount of certain foods and consuming increasing amounts’ in 80.0% ( N  = 28), and ‘Continuing to eat despite knowing the negative consequences’ in 77.1% (N = 27) of the sample. 48.6% of the adolescents with obesity (N = 17) met the criteria for diagnostic evaluation threshold according to YFAS, which was related to worse performance in Stroop Task and parent-reported difficulties in Emotional Control (p < .05 for both). Food addiction symptoms had differences in correlations with EF difficulties. “Eating for longer durations and higher amounts than intended” was related to difficulties in Emotional Control and Working Memory (p < .05 for both). “Continuing to eat despite knowing the negative consequences” was associated with difficulties in Shift, Emotional Control, Initiate, Plan/Organize, and Organization of Materials (p < .05 for all). Dieting was the only disordered eating attitude significantly correlated with EF difficulties. Specifically, less endorsement of dieting was correlated with difficulties in Inhibit and Working Memory (p < .05). Moreover, executive functioning difficulties were related to increased body mass index and waist circumference, in addition to worse metabolic parameters including fasting blood glucose, insulin, HOMA-IR, triglycerides, and blood pressure measurements. Conclusion Our study points out that specific EF difficulties were related to food addiction symptoms, dieting, and metabolic syndrome markers among adolescents with obesity. Further studies are needed to with larger and more diverse samples. Plain English Summary This study explored how thinking skills, known as executive functions, are connected to eating habits, food addiction symptoms, and health markers in teenagers receiving treatment for obesity. Executive functions help people control their behavior, plan ahead, switch between tasks, and manage emotions. We worked with 35 adolescents who were seeking help for obesity.We tested their executive functions using both performance tasks and questionnaires completed by their parents. The teenagers also answered questions about food addiction and eating attitudes, and we measured their body weight, waist size, and various health indicators like blood sugar, insulin, and blood pressure. Almost half of the participants met the criteria for food addiction. Common signs included repeatedly failing to cut down on certain foods, needing more of the same food to feel satisfied, and continuing to eat despite knowing it could cause harm. Those with food addiction had more difficulties with emotional control, working memory, and other thinking skills. Lower interest in dieting was linked to poorer self-control and working memory. Importantly, teenagers with greater executive function difficulties tended to have higher body weight, larger waistlines, and less healthy metabolic measures. These findings suggest that challenges with thinking and self-control skills may play an important role in both unhealthy eating behaviors and physical health problems in adolescents with obesity. Understanding and addressing these thinking skills could help improve treatment for young people struggling with obesity and related health issues.

Background Metabolic control is of critical importance in children with Type 1 Diabetes Mellitus (T1DM) for the stabilization of blood glucose levels and long-term health outcomes. Dietary choices play an important role in glucose control and the prevention of diabetes-related complications. This study aims to investigate the relationship between food addiction, eating attitudes, and psychiatric symptoms with metabolic control in adolescents diagnosed with T1DM. Methods Participants ( N  = 100) were assessed using the Yale Food Addiction Scale (Y-FAS), Eating Attitudes Test-40 (EAT-40), and Brief Symptom Inventory (BSI) to evaluate food addiction, eating attitudes, and psychiatric symptoms. Metabolic parameters of adolescents with T1DM, such as body mass index (BMI), HbA1c levels, insulin dosage, duration of diabetes, and the incidence of ketoacidosis and hypoglycemia, were recorded. Results The study found that 15% of adolescents had food addiction criteria, and 17% were prone to disordered eating behaviors. The presence of a history of hypoglycemia was related to a higher total symptom score on YFAS and higher total scores, depression, anxiety, somatization, and hostility subscale scores on BSI ( p  <.05 for all). BMI was positively correlated with anxiety about gaining weight on EAT-40 and higher total scores, depression, and anxiety subscale scores on BSI ( p  <.05 for all). As the BMI percentile group increased from normal to overweight/obesity, more food addiction symptoms were observed, and significant increases were found in depression, anxiety, negative self-perception, and somatization subscale scores, and the BSI total score ( p  <.05 for all). Conclusions Findings suggest that adolescents with T1DM may have a higher susceptibility to food addiction and eating disorders compared to the rates reported in the general population. Hypoglycemia can be a metabolic risk factor for food addiction in adolescents with T1DM. Psychological problems such as depression, anxiety, and somatization in adolescents with T1DM are associated with poor metabolic control. Further studies are needed with larger and more diverse samples. Plain English Summary Adolescence is a difficult period for patients with type 1 diabetes due to problems in following dietary management. Consuming certain foods may become addictive, similar to well-known substance or alcohol addictions, and complicate the treatment of diabetes. This study showed links between food addiction and diabetes-related parameters among adolescents with type 1 diabetes. On the other hand, some of the eating attitudes may be related to increased risk for eating disorders, such as anxiety about gaining weight among type 1 diabetes patients with obesity. Moreover, findings point out that there may be associations between psychological difficulties and poor glycemic control.