Bone health in adult women with ED: A longitudinal community-based study.

Although Eating Disorders (ED) are known to affect bone health and development, little is known about the longitudinal effect of ED and ED behaviours on bone health in community dwelling adult women. Women (n = 3507) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) participated in a two-phase prevalence study to assess lifetime ED and ED behaviours (fasting, restrictive eating, vomiting and misuse of medication). Crude and adjusted linear regression methods investigated the association between ED diagnoses and behaviours, and total body, hip, leg and arm bone mineral density (BMD) DXA scans at mean ages of 48 and 52 years. Lifetime occurrence of Anorexia Nervosa (AN) was associated with lower BMD Z-scores for the whole body (mean difference (MD) = -0.28; 95% CI: -0.49, -0.05), hip (MD = -0.45; 95% CI -0.74, -0.16), leg (MD = -0.28; 95% CI -0.52, -0.03) and arm (MD = -0.44; 95% CI -0.68, -0.19) compared to no ED. This effect was mostly accounted for by lowest ever BMI. In post-hoc analyses, Restrictive AN, but not Binge-Purge AN was associated with a lower total body BMD Z-scores (MD = -0.37; 95% CI -0.62, -0.12). Lifetime Fasting and Restrictive Eating were associated with low BMD of the total body, hip, arm and leg in adjusted analyses, all p < 0.05. Both lifetime ED diagnoses and ED behaviours in a large community sample were predictive of low BMD in mid-life. This study confirms that the effects of AN, fasting and restrictive eating, and low BMI on bone health seen in clinical samples also occur in community samples.

OBSERVATION AND COMPARISON OF MEALTIME BEHAVIORS IN A SAMPLE OF CHILDREN WITH AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDERS AND A CONTROL SAMPLE OF CHILDREN WITH TYPICAL DEVELOPMENT.

Despite widespread use of behavioral observations to evaluate child feeding behaviors in research and clinical practice, few studies have comprehensively characterized mealtimes or identified features that differentiate children with and without disordered feeding; these were the aims of the current study. Mealtime observations were conducted for 18 children with avoidant restrictive food intake disorder (ARFID) and 21 typically developing children. Observations were coded inductively, and associations between disorder and observed mealtime actions were examined. Most behaviors were observed across both clinical and nonclinical mealtimes, and many did not differ in frequency between children with and without ARFID. However, significant group differences were observed in the frequencies of behaviors relating to food intake, visual and physical engagement with feeding, and movement during mealtimes. The comparability of behaviors across clinical and nonclinical groups suggests that eating behaviors exist on a continuum from "normal" to "abnormal," with group differences relating to frequency rather than type of behavior. The behavioral differences observed in this study suggest that identification of children with ARFID should focus on child engagement with food and restlessness during mealtimes. Reliance on emotional and escape-maintained behaviors will lead to underrecognition of families in need of clinical support.

Screening Avoidant/Restrictive Food Intake Disorder (ARFID) in children: Outcomes from utilitarian versus specialist psychometrics.

This study assessed the specificity and sensitivity of two commonly used psychometric methods to assess ARFID in children. To achieve this, a sample of 329 mothers and one father completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and the Child Food Neophobia Scale (CFNS). A Receiver Operating Characteristic (ROC) analysis indicated that both measures were able to successfully differentiate a known clinical sample from those of typically developing population. Although the BPFAS was more accurate at differentiating ARFID from the general population, the CFNS was acceptable and on some metrics better than its longer counterpart. The ability of a food neophobia scale to differentiate clinical and population samples, and detect gradation of food avoidance within the population sample, suggests that the multitude of psychometric measures available may be measuring similar constructs. Therefore, confidence can be expected in cross-site comparisons despite each using different psychometric measures of food avoidance in children.

RELATIVE CONTRIBUTIONS OF PARENT-PERCEIVED CHILD CHARACTERISTICS TO VARIATION IN CHILD FEEDING BEHAVIOR.

Few studies have examined the relative impact of co-occurring child characteristics on problematic feeding behavior. The aim of the current study was to assess the relative contributions of parent-perceived child characteristics in multivariable models of child feeding behavior. One hundred sixty-one mothers reported on their child's feeding behavior and a number of key child characteristics. These characteristics were entered into controlled multivariable models of child feeding behavior, using child and parent frequency domains of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; W. Crist et al., 1994) as outcome measures. Child feeding problems were positively associated with food neophobia and external behavioral and social issues, but not with most domains of temperamental difficulty or sensory sensitivity. Feeding problem frequency was associated with externalizing symptoms whereas parental perceptions of problems and coping were associated with social-interaction problems in the child. Population feeding problems appear to be external and interactive problems rather than driven by innate or internalizing factors. The association with externalizing symptoms suggests that feeding problems at this level may fall within a wider profile of challenging behavior; however, the existence of problematic feeding behaviors may constitute a challenge for parents only when the child's social interactions also are seen to be deficient.

Screening for feeding disorders. Creating critical values using the behavioural pediatrics feeding assessment scale.

The aim of the current study was to discriminate between clinical and non-clinical samples on the Behavioural Pediatrics Feeding Assessment Scale (BPFAS). The objective was to present a cut-off value, that was derived statistically, which could be used to screen for feeding disorders. A sample of five hundred and seventy-three families with a target child ranging in age from 20 to 85 months took part in the current study. Sixty-four children had a known diagnosis of a feeding disorder and were embedded into a typically developing sample of families that had not sought professional intervention. All families completed the BPFAS in order to provide a known database to measure discriminative statistics. The Receiver Operating Characteristic (ROC) analysis indicated that the cut off value for the BPFAS was a Child Frequency score of 61 and a Child Problem score of six. This offered an 87% accuracy rate at these values. The current study offered definitive evidence that the BPFAS was accurate (both sensitive and specific) to determine differences between clinical and non-clinical samples in the United Kingdom. It is therefore advocated that BPFAS should be adopted in future studies exploring the impact of feeding disorders and problems in both clinical and research settings.

Measuring oral sensitivity in clinical practice: a quick and reliable behavioural method.

This article aims to offer a behavioural assessment strategy for oral sensitivity that can be readily applied in the clinical setting. Four children, ranging in age and with a variety of developmental and medical problems, were used as test cases for a task analysis of tolerance to touch probes in and around the mouth. In all cases, the assessment was sensitive to weekly measures of an intervention for oral sensitivity over a 3-week period. Employing an inexpensive, direct, specific to the individual, replicable, reliable, and effective measure for a specific sensory problem would fit better with the edicts of evidence-based practice. The current method offered the initial evidence towards this goal.

Developmental differences in sensory decision making involved in deciding to try a novel fruit.

OBJECTIVES: This research compared sensory processing and personality traits involved in deciding to try a novel fruit (guava) in adults and children. DESIGN: The research employed an age, sex, and food neophobia matched between-participant design to examine sensory decision making in choosing to eat a novel fruit. METHODS: Forty-four adults (Study 1) and 68 children (Study 2) took part. In each study, participants were separated into two groups to investigate whether prior assessment of a familiar and liked fruit (apple) that shares similar visual characteristics to the target novel fruit (guava) increased the likelihood that an individual would decide to try it. All participants completed appetitive and familiarity ratings by sensory stages: vision, smell, and touch, prior to trying (tasting) the fruit. Participants (or their parents) also completed the general and food neophobia scales and adults also completed the sensation-seeking scale. RESULTS: Twenty-eight adults (64%) tried the guava and 16 did not (36%). In the second study, 22 children decided not to try the novel fruit (32%). Significant predictors of whether the adult tried the target fruit were Thrill and Adventure Seeking, Experience Seeking, General Neophobia, and 'appealing to touch'. In children, Food Neophobia, concurrent presentation of a familiar fruit alongside the target and visual assessment of the target predicted decision to try the novel fruit. CONCLUSIONS: This study suggests that touch is pertinent to adults' decision to try a novel fruit, whereas visual cues appear to be more important for children.

Identifying clinically relevant feeding problems and disorders.

This paper outlines what is currently understood, and what can be hypothesized about paediatric feeding dysfunctions. The paper highlights the current lack of awareness of psychological factors implicated in infant and child feeding, and promotes a behavioural approach to the identification, referral and treatment of non-organic derived feeding problems and disorders. Potential risk factors to poor feeding development are outlined, and characteristic child and caregiver behaviours which may signify problems with feeding are suggested. The aim of this paper is to promote early identification of these symptoms in frontline healthcare in the hope of increasing early intervention before physical complaints, medical complications and/or disorders arise.