Child Eating Disorder Examination Research Articles

Adaptation and Validation of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) for Use in English among Adolescents in Urban India.

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an 'Eating Concerns and Restraint' subscale and a 'Weight and Shape Concerns' subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of 'Child Eating Pathology', as well as the two subscales. Internal consistency of the 'Weight and Shape Concerns' subscale (α = 0.825) and 'Eating Concerns and Restraint' subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India.

Multi-method evidence for a dual-pathway perspective of self-regulation in loss of control over eating among adolescents

ObjectiveDual-pathway models propose that loss of control over eating (LOC) is the result of an imbalance between weaker regulatory and stronger reactive processes. However, these processes are generally captured with only one assessment method, leading to mixed findings. Additionally, it is unclear whether regulatory difficulties are generic or food-specific. Therefore, the aim of this study was twofold: (1) to investigate the interaction between regulatory and reactive processes in predicting the presence of LOC in adolescents, using both self-report questionnaires and behavioral tasks, and (2) to examine whether generic or food-specific regulatory processes interact with reactive processes to predict the presence of LOC. MethodA community sample of 295 adolescents (10–17 years; 67.2% girls; M = 13 years; SD = 1.99) was allocated to a LOC-Group (n = 93) or a NoLOC-Group (n = 202) based on a self-report questionnaire which assessed whether participants had experienced LOC over the past month (Children's Eating Disorder Examination Questionnaire). Both self-report questionnaires and behavioral tasks were used to measure regulatory (Behavior Rating Inventory of Executive Function and go/no-go task, respectively) and reactive (Behavioral Activation Scale and dot probe task, respectively) processes. Some adolescents completed a generic go/no-go task and others a food-specific version. Binary logistic regressions were conducted with LOC as the categorical dependent variable and regulatory and reactive processes (and their interaction) as the independent variables. ResultsIn line with dual-pathway models, the combination of weaker regulatory and stronger reactive processes was associated with the presence of LOC. This was evident from both the self-report scales and the behavioral tasks. Preliminary results further suggest that regulatory difficulties seem to be food-specific. ConclusionsOur results provide multi-method evidence for the dual-pathway account of self-regulation in LOC among adolescents. Theoretical and practical implications are discussed.

Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology

ObjectiveThe purpose of this study was to investigate eating patterns among male and female adolescents with type 1 diabetes (T1D), and the associations with age, zBMI, eating disorder (ED) pathology, intentional insulin omission, and metabolic control. MethodThe sample consisted of 104 adolescents (58.6% females) with child-onset T1D, mean age of 15.7 years (SD 1.8) and mean zBMI of 0.4 (SD 0.8). The Child Eating Disorder Examination (ChEDE) assessed meal/snack frequency and ED pathology. T1D clinical data was obtained from the Norwegian Childhood Diabetes Registry. ResultsA significantly lower proportion of females than males (73.8% vs 97.7%) consumed breakfast on a daily basis. Approximately 50% of both genders ate lunch and 90% ate dinner daily. Among females, skipping breakfast was significantly associated with higher global ED psychopathology, shape concerns, self-induced vomiting, binge eating, insulin omission due to shape/weight concerns, and poorer metabolic control. Less frequent lunch consumption was significantly associated with poorer metabolic control. Skipping dinner was significantly associated with older age, higher dietary restraint, eating concerns, self-induced vomiting, and insulin omission. Among males, less frequent consumption of lunch and evening snacks was associated with attitudinal features of ED, including shape/weight concerns and dietary restraint. DiscussionAmong adolescents with T1D, irregular or infrequent meal consumption appears to signal potential ED pathology, as well as being associated with poorer metabolic control. These findings suggest the importance of routinely assessing eating patterns in adolescents with T1D to improve detection of ED pathology and to facilitate improved metabolic control and the associated risk of somatic complications.

Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes.

Background. Disturbed eating behavior and psychosocial variables have been found to influence metabolic control, but little is known about how these variables interact or how they influence metabolic control, separately and combined. Objective. To explore associations between metabolic control (measured by HbA1c) and eating disorder psychopathology, coping strategies, illness perceptions, and insulin beliefs in adolescents with type 1 diabetes. Methods. A total of 105 patients (41.9% males) with type 1 diabetes (12–20 years) were interviewed with the Child Eating Disorder Examination. In addition, self-report psychosocial questionnaires were completed. Clinical data, including HbA1c, was obtained from the Norwegian Childhood Diabetes Registry. Results. Significant gender differences were demonstrated. Among females, HbA1c correlated significantly with eating restriction (.29, p < .05), the illness perception dimensions consequences, personal control, coherence, and concern (ranging from .33 to .48), and the coping strategy ventilating negative feelings (−.26, p < .05). Illness perception personal control contributed significantly to HbA1c in a regression model, explaining 23% of the variance among females (β .48, p < .001). None of the variables were significantly associated with HbA1c among males. Conclusions. Illness perceptions appear to be important contributors to metabolic control in females, but not males, with type 1 diabetes.

The Detection of Eating Disorder Symptoms in Adolescence: A Comparison Between the Children's Eating Disorder Examination and the Children's Eating Disorder Examination Questionnaire

Introduction:Eating disorder symptoms already occur in childhood and adolescence and are predictive of full-blown eating disorders and obesity later in life. To enhance the quality of assessment in youngsters, this study examined the convergence between the clinical interview, the Child Eating Disorder Examination (ChEDE), and the self-report questionnaire, the Child Eating Disorder Examination-Questionnaire (ChEDE-Q).Method:Both instruments were administered in 12- to 16-year-old boys and girls retrieved from the general population (N= 57,Mage= 13.4).Results:The results showed that there was a strong correlation between the interview and the questionnaire and that the subscale scores of the two research instruments did not significantly differ.Discussion:The present study is among the first to confirm the utility of the ChEDE-Q to screen for eating disorder symptoms in adolescents from the general population. Large-scale studies should further determine whether these preliminary findings can be generalised.

A psychometric examination of a modified eight-item version of the Children’s Eating Disorder Examination.

Eating and body image disturbances in children are typically assessed using the Children's Eating Disorder Examination (ChEDE); however, support for the reliability and validity of scores on this measure is mixed. Furthermore, previous studies suggest that scores obtained from a simplified 8-item version of the ChEDE may be more reliable and useful for research purposes than scores obtained from the full scale. The present study sought to psychometrically evaluate the reliability and factor structure of this brief 8-item scale. Two separate community-based samples of 6- to 11-year-olds (N = 535) were administered the ChEDE as part of a broader assessment battery. The brief 8-item model provided a good fit to the data, as determined by confirmatory factor analysis. Additionally, scores obtained from the 8-item scale, as well as a global ChEDE score, provided reliable measures of a child's eating disorder symptoms, and were superior to the original 4 subscales in both healthy-weight and overweight/obese samples. The brief 8-item scale may therefore be used by researchers who want a reliable and valid index of global eating disorder psychopathology without doing a full interview.

Content of children's loss of control eating episodes assessed by self-report and laboratory test meal.

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self-report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7-12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p = .076. In exploratory analyses among the seven children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi-structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self-reported episodes. Replication is warranted in larger studies.

Punishment and Reward Sensitivity: Are Naturally Occurring Clusters in These Traits Related to Eating and Weight Problems in Adolescents?

Little is known about the role of sensitivity to punishment (SP) and reward (SR) in eating problems during adolescence. Therefore, the aim of the present study was to examine the naturally occurring clusters of high and low SP and SR among nonclinical adolescents and the between-cluster differences in various eating problems and weight. A total of 579 adolescents (14-19 years, 39.8% boys) completed the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Behavioural Inhibition System and Behavioural Activation System scales (BIS/BAS scales), the Dutch Eating Behaviour Questionnaire and the Child Eating Disorder Examination Questionnaire and were weighed and measured. On the basis of the SPSRQ, four clusters were established, interpreted as lowSP × lowSR, lowSP × highSR, highSP × highSR and highSP × lowSR. These were associated with eating problems but not with adjusted body mass index. It seemed that specifically the highSP × highSR cluster outscored the other clusters on eating problems. These results were partly replicated with the BIS/BAS scales, although less significant relations between the clusters and eating problems were found. The implications of the findings in terms of possible risk and protective clusters are discussed.

Neurocognitive functioning in adolescents with eating disorders: A population-based study

IntroductionNeurocognitive deficits have been identified in eating disorders, including anorexia nervosa and bulimia nervosa. However, current data do not allow for firm conclusions regarding the nature or extent of these deficits. The current study aimed to evaluate neurocognitive functioning in a population-based sample of adolescents with and without eating disorders.MethodsParticipants (N=669) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Cognitive testing was conducted using the computerised CogState assessment battery. Eating disorder symptoms were assessed using questions adapted from the Child Eating Disorder Examination and Eating Disorder Examination–Questionnaire. Adolescents who met full or partial criteria for a DSM-IV eating disorder (n=58) were compared to adolescents with no significant eating pathology (n=592).ResultsThe eating disorder sample showed impaired performance on measures of executive functioning, including global processing and set shifting, but performed better than control participants on measures of visual attention and vigilance.ConclusionsThis is the first study to evaluate neurocognitive functioning in a population-based sample of adolescents with eating disorders. Support is provided for weak central coherence and set-shifting difficulties early in the course of eating disorders. Research is needed to determine if these deficits precede and predict eating disorder onset.

Continuity in Primary School Children’s Eating Problems and the Influence of Parental Feeding Strategies

Eating problems are highly prevalent and seem to show continuity in children. Nevertheless, the effect of different maternal and paternal feeding practices on changes in these problems is not fully understood yet. This study examines short-term continuity in primary school children's overeating, loss of control (over eating), restraint and concerns (about eating, body shape and weight) and the predictive value of parental feeding strategies on change in these eating problems. Children (8-12years, n=613, 46.5% girls) completed the Child Eating Disorder Examination Questionnaire (ChEDE-Q) twice with the second measurement (T2) taking place 6months after the first (T1). Parents (n=714, 57.7% mothers) completed the Child Feeding Questionnaire (CFQ) at T1 to assess the level of controlling feeding strategies. More overeating, restraint and concerns at T1 predicted higher levels of the same eating problems 6months later, whereas more of loss of control at T1 predicted lower levels of loss of control 6months later. Additionally, the interaction between maternal pressure and the gender of the child was predictive for increases in overeating, whereas the interaction between paternal monitoring and gender of the child was a marginally significant predictor for decreases in overeating. These findings point to the possible negative and positive effects of parental feeding practices as well as to the possible larger influence of mothers on their daughters' and of fathers on their sons' eating behaviors. The importance of studying mothers and fathers, as well as daughters and sons, and of including different feeding strategies and eating problems is discussed.

Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes

Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention.

The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison

To evaluate and compare the dual-pathway, original cognitive-behavioural, and enhanced "transdiagnostic" cognitive-behavioural models of binge eating, using prospective data from a pre-adolescent sample. Models were tested using multilevel longitudinal structural equation modelling. Participants were 236 children (48% male) aged between 8 and 13 years at baseline, who were interviewed annually over a 2-year period. Binge eating was assessed using the Child Eating Disorder Examination. The dual-pathway and enhanced cognitive-behavioural models provided an acceptable fit to the data, whereas the original cognitive-behavioural model did not. Partial support is provided for the prospective validity of the dual-pathway and enhanced cognitive-behavioural models of binge eating in childhood. Results suggest that body dissatisfaction and weight and shape over-evaluation may both contribute to dieting behaviour in youth, and that dieting and affect-related difficulties both require consideration in theories of binge eating development.

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents

Shape and weight concerns among overweight pre-adolescents heighten risk for eating disorders and weight gain. Treatment and prevention efforts require consideration of psychosocial factors that co-occur with these concerns. This study involved 200 overweight pre-adolescents, aged 7-12years (M age=9.8; SD=1.4), presenting for family-based weight control treatment. Hierarchical regression was used to examine the influence of pre-adolescents' individual characteristics and social experiences, and their parents' psychological symptoms, on shape and weight concerns as assessed by the Child Eating Disorder Examination. Findings revealed that higher levels of dietary restraint, greater feelings of loneliness, elevated experiences with weight-related teasing, and higher levels of parents' eating disorder symptoms predicted higher shape and weight concerns among overweight pre-adolescents. Interventions addressing overweight pre-adolescents' disordered eating behaviors and social functioning, as well as their parents' disordered eating behaviors and attitudes, may be indicated for those endorsing shape and weight concerns.

Reliability and validity of the Norwegian translation of the Child Eating Disorder Examination (ChEDE)

The Child Eating Disorder Examination (ChEDE) is a valid and reliable semi-structured interview, which measures eating-disorder specific psychopathology in children and young adolescents. The instrument is an adaptation of version 12.0D of the original Eating Disorder Examination (EDE 12.0) for adults. The Norwegian translation of the ChEDE is currently the only instrument for assessing eating disorder psychopathology in Norwegian children and adolescents. This study aimed to investigate the psychometric properties of the Norwegian translation of the ChEDE 12.0. The Norwegian version of ChEDE 12.0 was administered to 15 Norwegian children with anorexia nervosa (AN), 15 children with diabetes mellitus type 1 (DM) and two groups of 15 age-matched controls. The groups were compared using a matched pairs design. The results showed that the subscale scores of the AN group were significantly higher than those of the other groups, and the DM comparison group did not differ from its control group. The current AN group scored significantly higher on the Shape Concern subscale than the previous UK sample, with implications for construct validity or cross-cultural effects worthy of further study. Inter-rater reliability was generally high (r=0.91 to 1.00), although there were significant differences between raters on specific items for individual participants. Alpha coefficients for each of the ChEDE subscales indicated a high degree of internal consistency. It was concluded that the Norwegian version of the ChEDE 12 has adequate psychometric properties and can be recommended for clinical and research use with young people with eating disorders in Norway.

The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight and obese children

Objectives This study aimed to (1) determine the prevalence of binge eating and overeating in 8- to 13-year-old children; (2) identify factors that cross-sectionally predict binge eating and overeating; and (3) identify factors that prospectively predict onset of binge eating and overeating. Methods Participants were 259 boys and girls who were assessed at baseline and one-year follow-up, using a range of semi-structured interviews that included the Child Eating Disorder Examination. Results At baseline, 9% of children reported binge eating and 6% reported overeating. Obese children were most at risk for these behaviours. Dietary restraint and the tendency to use food to regulate emotions were significant in predicting binge eating onset prospectively, and eating concern was significant in predicting binge eating cross-sectionally. Conclusion Results provide support for current cognitive-behavioural models of binge eating, and have implications for guiding binge eating prevention and intervention efforts with children.

Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

OBJECTIVE—The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes.RESEARCH DESIGN AND METHODS—In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9–13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control.RESULTS—Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset (χ2 = 46.0, 5 d.f., P < 0.0001) and accounted for 48.2% of the variance.CONCLUSIONS—Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance–based self-worth as well as higher BMI percentile 1–2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value.

Overconcern with weight and shape is not the same as body dissatisfaction: Evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls ( N = 259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.

Eating Disorders and Disturbance in Children and Adolescents With Cystic Fibrosis

People with cystic fibrosis are considered at risk for developing anorexia (Raymond et al., 2000), but studies have used methodologically flawed measures. Using improved methodology, the current study examines the prevalence of eating disorders/disturbance in adolescents with CF. Method: 55 adolescents with CF, age range 11–17 years (mean 14.2 years) randomly selected were administered the Child Eating Disorder Examination (Bryant-Waugh, Cooper, Taylor, & Lask, 1996). Results: No participant met full criteria for a diagnosis of anorexia or bulimia. Of those with a BMI ≤ 17.5, 5% avoided weight gain. Fifty-three percent demonstrated disturbed eating attitudes and 16% disturbed eating behaviours. Discussion: The study finds that gold standard diagnostic methods indicate the prevalence of disturbed eating attitudes and behaviors in CF.

Assessing eating disordered behaviour in overweight children and adolescents: bridging the gap between a self-report questionnaire and a gold standard interview

The current study compared two measurements assessing eating disorder psychopathology in overweight children and adolescents: an interview and a self-report questionnaire. An adjusted version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) was compared with the Child Eating Disorder Examination interview (ChEDE), which is considered the gold standard. Thirty-eight overweight children and adolescents (aged 8-14) participated in the study. Regarding objective bulimic episodes, the current study found that using smaller chunks of information decreased the discrepancy between interview and questionnaire. The chances are that the gap between ChEDE-Q and ChEDE can be reduced if more attention is paid to children’s abilities concerning the understanding of complex concepts. (Netherlands Journal of Psychology, 63, 102-106)

Assessment of binge eating in overweight youth using a questionnaire version of the child eating disorder examination with instructions

Existing self-report methods for assessing eating disorder (ED) symptoms in youth do not adequately measure binge eating and lack sufficient psychometric support. The Youth Eating Disorder Examination-Questionnaire (YEDE-Q), a self-report version of the Child Eating Disorder Examination (ChEDE), was designed to assess the spectrum of ED psychopathology in youth. The YEDE-Q was compared to the ChEDE and the Questionnaire for Eating and Weight Patterns-Adolescent version (QEWP-A) in a sample of 35 overweight adolescents aged 12-17. The YEDE-Q showed significant agreement (ps < .001) with the ChEDE on all four subscale scores, the global score, and measurement of objective bulimic episodes. The YEDE-Q and the QEWP-A showed significant agreement (ps < .001) on the measurement of shape and weight concerns. The YEDE-Q appears promising in the assessment of eating-related pathology in overweight adolescents, but remains in need of validation in children and ED populations.