Search

Objective: The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist., Method: The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%)., Results: The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score., Discussion: The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years., (© 2015 Wiley Periodicals, Inc.)

Objective: Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM-5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter-rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample., Method: We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8-18 years) to 19 Boston-area pediatric gastroenterology clinics for evidence of DSM-5 ARFID., Results: We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding (n = 19) or limited diet due to sensory features of the food (n = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems., Discussion: In a pediatric treatment-seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over-inclusive even in a population where eating/feeding difficulties are expected., (© 2014 Wiley Periodicals, Inc.)

Objective: Pica and rumination disorder (RD)-formerly classified within DSM-IV Feeding and Eating Disorders of Infancy or Early Childhood-are now classified within DSM-5 Feeding and Eating Disorders. Though pica and RD have been studied in select populations (e.g., pregnant women, intellectually disabled persons), their typical features and overall prevalence remain unknown. This study examined the clinical characteristics and frequency of DSM-5 pica and RD among individuals seeking treatment for eating disorders and obesity., Method: We conducted structured interviews with adolescent and young adult females from a residential eating disorder center (N = 149), and adult males and females with overweight or obesity from an outpatient weight-loss clinic (N = 100)., Results: Several participants reported ingesting non-nutritive substances (e.g., ice) for weight-control purposes. However, only 1.3% (n = 2; 95% CI: .06% to 5.1%) at the residential eating disorder center and 0% at the weight-loss clinic met DSM-5 criteria for pica, consuming gum and plastic. Although no eating disorder participants were eligible for an RD diagnosis due to DSM-5 trumping rules, 7.4% (n = 11; 95% CI: 4.0% to 12.9%) endorsed rumination behavior under varying degrees of volitional control. At the weight-loss clinic, 2.0% (n = 2; 95% CI: 0.1% to 7.4%) had RD., Discussion: DSM-5 pica and RD were rare in our sample of individuals seeking treatment for eating disorders and obesity, but related behaviors were more common. The wide range of pica and rumination presentations highlights the challenges of differential diagnosis with other forms of disordered eating., (© 2014 Wiley Periodicals, Inc.)

Objective: The aim of this study was to examine the differences among three subtypes of feeding disorders (FD), defined through the criteria of the DC:0-3R: "Infantile Anorexia" (IA), "Feeding Disorder Associated with Insults to the Gastrointestinal Tract" (FDIGT), and "Sensory Food Aversions" (SFA), by exploring mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes., Method: The sample consisted of 146 Italian mother-child pairs, of which 51 children with IA, 47 children with FDIGT, and 48 mothers and their children with SFA. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their children's temperament and emotional/behavioral functioning., Results: Analyses revealed significant differences between the diagnostic groups of FD in relation to mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes., Discussion: Both interactional and individual variables may contribute differently to specific FD and outcomes during childhood. Definitions by FD subtypes, using operational diagnostic criteria, and the assessment of mother-child interactions are relevant to target interventions strategies to treat specific disorders., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: To evaluate over time feeding behavior and emotional-behavioral functioning in a sample of children diagnosed with Infantile Anorexia (IA) and a group of typically developing children; and to investigate the relationship between maternal psychological functioning and the children's feeding patterns and emotional-behavioral functioning., Method: Seventy-two children diagnosed with IA and 70 children in the control group were prospectively evaluated through several measures at two, five, and eight years of age., Results: Our findings revealed partial improvement in the nutritional status of the children with IA. However, they continued to show ongoing eating problems and, in addition, anxiety/depression and withdrawal, as well as rule-breaking behaviors and social problems. There were significant correlations between the children's eating problems and their emotional difficulties and their mothers' increased emotional distress and disturbed eating attitudes., Discussion: Our longitudinal study points out that the natural course of untreated IA is characterized by the persistence of difficulties in eating behavior and emotional-behavioral adjustment in both, the children and their mothers., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: To review the literature related to the current DSM-IV-TR diagnostic criteria for feeding disorder of infancy or early childhood; pica; rumination disorder; and other childhood presentations that are characterized by avoidance of food or restricted food intake, with the purpose of informing options for DSM-V., Method: Articles were identified by computerized and manual searches and reviewed to evaluate the evidence supporting possible options for revision of criteria., Results: The study of childhood feeding and eating disturbances has been hampered by inconsistencies in classification and use of terminology. Greater clarity around subtypes of feeding and eating problems in children would benefit clinicians and patients alike., Discussion: A number of suggestions supported by existing evidence are made that provide clearer descriptions of subtypes to improve clinical utility and to promote research.

Objective: This study investigated the diagnostic validity of the DSM-IV-TR criteria for binge eating disorder as well as proposed diagnostic criteria in younger children with and without loss of control (LOC) eating., Method: A total of 60 children with at least one episode of loss of control over eating within the past 3 months and 60 matched children without LOC history were recruited from the community. Clinical interviews and self-report questionnaires were used to assess psychopathology., Results: Hierarchical cluster analyses produced clusters of high recurrent LOC eating, low recurrent LOC eating, and no or sporadic LOC eating. The children with high recurrent LOC eating had eating disorder and general psychopathology comparable to that documented in clinical eating disorders. The DSM-IV-TR criteria and the criterion of "undue influence of weight or shape on self-evaluation" could at lower thresholds than for adults be used to identify children with high recurrent LOC eating., Discussion: Overall, this evaluation of the diagnostic validity of binge eating disorder in middle childhood suggests that only a few modifications to the adult DSM-IV-TR criteria are necessary to identify children with LOC eating suffering from clinically significant eating disorder psychopathology and increased general psychopathology., ((c) 2008 by Wiley Periodicals, Inc.)

Objective: To examine the prevalence of picky eating and the relationship between picky eating, previously supported correlates of picky eating, other child eating and behavioral problems and maternal eating problems in children aged 8-12 years., Method: In a cohort study, 426 8- to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small town community. Potential child eating behaviors associated with picky eating were reported by mothers using the Stanford Feeding Questionnaire. Child eating attitudes and disturbances were obtained from the McKnight Risk Factor Survey, food preferences and avoidances from a food preference list, child behavioral problems were assessed by the Child Behavior Checklist. To assess maternal eating disturbances EDI-subscales 1-3 as well as TFEQ-subscales "disinhibition" and "restraint" were used., Results: Picky and nonpicky eaters differed significantly on all of the child eating behaviors found to be correlates of picky eating in a previous study with younger children. Overall, picky children were reported to avoid foods in general more often than nonpicky eaters. Picky children did not differ from nonpicky children with regard to their own and maternal eating disturbances. However, picky children displayed more problem behaviors comprising both internalizing and externalizing behaviors., Conclusion: The present study does not support the concept that picky eating is associated with disordered eating but rather with a range of behavioral problems.

Objective: Evaluate the clinical characteristics of feeding difficulties in 30 community (i.e., nonreferred) infants in the first 2 years of life, and their correlation with mother/child interactions., Method: An "in depth" mental health evaluation of feeding difficulties, and the psychosocial functioning of the child in other areas. The mother-infant relationship and the feeding interactions were also assessed., Results: Four "groups" were identified. (1) Young infant with difficulties in regulating states and sucking. (2) Older infant with difficulties in self-regulation, focusing, hyper-alert, and with aversion to feeding. (3) Older infants hypersensitive to stimuli (taste, odor) and with difficulties in chewing. (4) Group of with varied and unique feeding problems (pica, rumination)., Conclusion: Feeding problems tend to have patterns according to the age of the baby in a nonreferred sample. They are not associated with an altered parent-infant relationship nor poor feeding technique. Parents often adapt successfully to the uniqueness of the baby to maintain weight gain., ((c) 2008 by Wiley Periodicals, Inc.)

Objective: The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties., Method: Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants., Results: Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal., Conclusion: Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.