Preliminary validation of the pica, ARFID and rumination disorder interview ARFID questionnaire (PARDI-AR-Q).

BACKGROUND: The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a structured interview that can be used to determine diagnosis, presenting characteristics, and severity across three disorders, including avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the psychometric properties of a questionnaire focused specifically on ARFID (PARDI-AR-Q), which has the potential to provide related information with less participant burden. METHODS: Adolescents and adults (n = 71, ages 14-40 years) with ARFID (n = 42) and healthy control participants (HC, n = 29) completed the PARDI-AR-Q and other measures. A subset of the ARFID group (n = 27) also completed the PARDI interview. RESULTS: An exploratory factor analysis of proposed subscale items identified three factors corresponding to the ARFID phenotypes of avoidance based on the sensory characteristics of food, lack of interest in eating or food, and concern about aversive consequences of eating. Further analyses supported the internal consistency and convergent validity of the PARDI-AR-Q subscales, and subscale ratings on the questionnaire showed large and significant correlations (all p-values < 0.001; r's ranging from 0.48 to 0.77) with the corresponding subscales on the interview. The ARFID group scored significantly higher than HC on all subscales. Furthermore, 90% of the ARFID group scored positive on the PARDI-AR-Q diagnostic algorithm while 93% of the HC scored negative. CONCLUSIONS: Though replication in larger and more diverse samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report measure for possible ARFID in clinical or research settings.

Healthy feeding habits: efficacy results from a cluster-randomized, controlled exploratory trial of a novel, habit-based intervention with parents.

BACKGROUND: As dietary gatekeepers for young children, parents are often the proximal target of family-based dietary interventions. Habit theory offers a novel approach to modifying parental feeding, based on "context-dependent repetition" to promote automatic responding and to reduce decisional conflict. OBJECTIVE: This exploratory trial evaluated an intervention promoting habit formation for 3 parental feeding behaviors: serving fruit/vegetables, serving healthy snacks, and serving nonsweetened drinks. The primary outcome was parental habit strength for each behavior. The secondary outcome was children's food intake. DESIGN: Parents of children aged 2-6 y (n = 126) were recruited from 6 children's centers in London and cluster-randomized to intervention (n = 3) or no-treatment control (n = 3) conditions. Parents in the intervention group (n = 58) received training on habit formation for 3 feeding behaviors; control participants (n = 68) were asked only to complete the measures. At baseline and after treatment, parents completed validated measures of subjective "automaticity" for feeding behaviors and a brief child food-frequency measure. Parents in the intervention group were interviewed about the program. The change between groups, after clustering was controlled for, was analyzed. RESULTS: For all parental feeding behaviors, automaticity increased more in the intervention group than in the control group (P < 0.01 for all). Significant intervention effects on children's intake of vegetables (P = 0.003), healthy snacks (P = 0.009), and water (P = 0.032) were observed. Changes in children's food intake correlated with changes in parental automaticity of feeding behaviors, and program acceptability was high. CONCLUSIONS: A habit-based intervention successfully modified parental feeding behaviors, affected children's diets positively, and was well received by parents. Habit theory provides a promising new tool to support family-based obesity prevention. This trial was registered as ISRCTN09910187.

Facilitating or undermining? The effect of reward on food acceptance. A narrative review.

Using rewards in child feeding is commonplace and viewed as effective by parents, although some express concern about using 'bribery'. Psychological and economic theorists emphasize the beneficial effects of rewards in enhancing performance, although, there is evidence that the offer of rewards undermines intrinsic motivation and decreases enjoyment of the rewarded task. In the food domain, results have been mixed, but this may be explained, at least partly in terms of the measured outcome (liking vs intake) and the initial level of motivation towards the target foods (liked vs disliked). Where intake is the outcome, rewards have had broadly positive effects, but when it is liking, rewards can have negative effects if the target food is already liked. Another issue concerns the type of reward offered. While offering food as a reward appear to be universally negative, there is evidence to suggest that non-food tangible rewards (e.g., stickers), or non-tangible rewards (praise) can be highly effective in encouraging children to taste new or less liked foods sufficiently often to benefit from the 'mere exposure' effect. We suggest that the judicious use of rewards may facilitate children's acceptance of healthy foods.

Eating for pleasure or profit: the effect of incentives on children's enjoyment of vegetables.

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Genetic and environmental influences on children's food neophobia.

BACKGROUND: Food neophobia in children has been associated with a low intake of fruit, vegetables, and protein foods. The design of effective interventions to improve children's diets would be facilitated by a better understanding of the determinants of neophobia. OBJECTIVE: Our objective was to quantify the contribution of genetic and environmental differences to variation in child food neophobia. DESIGN: Parents of twins aged 8-11 y (n = 5390 pairs) completed questionnaires about their children's eating habits, including a measure of food neophobia. RESULTS: The results showed that neophobia is highly heritable. The heritability estimate from model fitting was 0.78 (95% CI: 0.76, 0.79). A further 22% of the variance was explained by nonshared environmental factors, with no influence of shared environmental factors. CONCLUSIONS: Neophobia appears to be a heritable trait, but almost a quarter of the phenotypic variation is accounted for by nonshared environmental factors. An important aim for future research is the identification of influential aspects of the environment specific to individual children.

Age and gender differences in children's food preferences.

The present study was conducted to examine the developmental patterning of food preferences in a large sample of British schoolchildren and to investigate possible gender differences. Using a cross-sectional survey design, the study was carried out in three primary and three secondary schools in West London, UK. A total of 1291 children aged from 4 to 16 years completed a 115-item food preference questionnaire in class time, supervised by class teachers and assistants. Children indicated whether they had ever tried each item and, if so, how much they liked it. We observed age-related increases in the number of foods tried (P<0.001), liked (P<0.005) and disliked (P<0.05). Controlling for the number of foods tried rendered the increase in dislikes non-significant and reversed the age effect on the number liked. Girls liked fruit (P<0.05) and vegetables (P<0.001) more than boys did; boys liked fatty and sugary foods (P<0.005), meat (P<0.001), processed meat products (P<0.001) and eggs (P<0.05) more than girls did. Some age differences were apparent in liking for categories of food, although the effects were not linear. Across ages and genders, children rated fatty and sugary foods most highly, although ratings for fruit were also high. Children's food preferences overall are not consistent with a healthy diet. Interventions should focus on increasing the familiarity, availability and accessibility of healthy foods and should be mindful of the need to target messages appropriately for boys who have less healthful food preferences than girls at all ages.

Increasing children's acceptance of vegetables; a randomized trial of parent-led exposure.

Despite considerable epidemiological evidence of the health benefits of a diet high in fruit and vegetables, consumption in pre-school children remains well below recommended levels. This study evaluated the effectiveness of an exposure-based intervention, carried out by parents in the home, in increasing children's liking for a previously disliked vegetable. 156 parents of 2-6 year old children were randomly assigned to Exposure, Information or Control groups after a pre-intervention taste test at which a 'target' vegetable was selected. Parents in the Exposure group gave their child a taste of this vegetable daily for 14 days, parents in the Information group were given nutritional advice and a leaflet, and parents in the Control group received no further intervention. All participants took part in a post-intervention taste test. Greater increases in liking, ranking and consumption of the 'target' vegetable from pre- to post-intervention occurred in the Exposure group than in either of the other two groups. Only the Exposure group showed significant increases across all three outcomes. It can be concluded that a parent-led, exposure-based intervention involving daily tasting of a vegetable holds promise for improving children's acceptance of vegetables. These findings suggest a parental advice strategy which could be disseminated directly to parents or by health professionals.