Feeding Disorders Research Articles

The Impact of High Levels of Compensatory Exercise on Treatment Outcomes in Threshold and Subthreshold Bulimia Nervosa.

Bulimia nervosa (BN) and other specific feeding or eating disorders with subthreshold BN symptoms (OSFED-BN) are characterized by recurrent binge eating episodes accompanied by compensatory behaviors, including excessive exercise. We aimed to examine the role of compensatory exercise on several clinical disorder-related variables and the treatment outcomes. The sample included 478 patients diagnosed with either BN or OSFED-BN admitted for a 16-week eating disorder-specific treatment program. A battery of questionnaires was administered to evaluate eating and general psychopathology, and personality traits. Other clinical disorder-related data, including levels of compensatory exercise, were assessed through a semi-structured clinical interview. Between-group comparisons of compensatory exercise levels were analyzed, as a predictive model of risk of poor treatment outcomes. Path analysis was conducted using structural equation models to estimate the direct and indirect effects between the main variables. Higher levels of self-reported compensatory exercise were associated with greater eating psychopathology, general psychopathology, and more dysfunctional personality traits and were a predictor of poor treatment outcomes. Additionally, these levels achieved a mediating role in several paths contributing to a higher likelihood of a poor outcome. Further research is required to determine how psychotherapeutic approaches can be optimized to adequately include adaptive exercise for these patients.

A Preliminary Assessment to Determine the Starting Point for Treatment of Pediatric Feeding Disorders

A Preliminary Assessment to Determine the Starting Point for Treatment of Pediatric Feeding Disorders

A Systematic Review and Comprehensive Discussion of Social Validity Measurement in Behavioural Intervention for Paediatric Feeding Disorders

Abstract Background Social validity in the field of applied behaviour analysis is the measurement of the social significance of goals, the social appropriateness of procedures, and the social importance of the effects of a treatment. There is a paucity of rigorous research on social validity measurement as it relates to feeding treatment. Objective To our knowledge, this is the first systematic review aiming to identify the gaps in and assess the current state of the science regarding comprehensive social validity measurement of paediatric feeding treatment. Method We conducted a systematic review following PRISMA guidelines using four ProQuest databases. Results The systematic review resulted in the identification of 26 eligible articles reporting findings related to social validity post-intensive treatment or describing new measurement systems that could be used to assess social validity more comprehensively. Collectively, caregivers rated behaviour-analytic treatments high in social validity and treatments were highly effective. Caregivers reported increased broader quality of life and lasting positive impacts, decreased stress, and lack of negative effects. Conclusion In the context of these results, we discuss behaviour-analytic feeding treatment within social validity’s comprehensive definition. We identify additional data-based research needs in this area and provide recommendations to spur new investigations. Social validity measurement requires refinement to further inform the standard of care. Paediatric feeding expertise and competency are crucial in navigating social validity considerations. Accurate dissemination is needed to increase earlier access to effective feeding treatment for families and specialised training for professionals to promote data-based and individualised decision-making in this vital area.

Assessing physiological arousal and emotional valence during behavioral intervention for pediatric feeding difficulties: A pilot study

AbstractThis study's purpose is to introduce a new measurement system that objectively assesses the social validity of behavioral feeding intervention from the child's perspective via the concurrent measurement of two dimensions of emotion. To date, the primary measures of social validity for behavioral feeding intervention are caregiver treatment acceptability and satisfaction surveys. This is the first study to objectively measure two dimensions of emotion, physiological arousal and emotional valence, while children received behavioral intervention for feeding difficulties. Data collectors used a new open‐source data collection software, cometrics, developed to synchronize and record physiological and observational data. Physiological data was collected using a wearable biosensor and observers recorded an index of child happiness, unhappiness, or neither using definitions by Phipps et al. (2022) for six children with a pediatric feeding disorder. Two out of six children needed programmed habituation to the device before data collection. All children assented to wearing the device during data collection. Recorded indices mapped to separable physiological states using electrodermal activity and its constituent components, skin conductance responses and skin conductance level, in addition to skin temperature. Findings demonstrated the feasibility of measuring two dimensions of child emotions during behavioral feeding intervention and revealed that children's physiological responses were distinctly different during intervals scored as happy, unhappy, or neither. This new data collection system has implications for future research on the child's emotional experience of behavioral feeding treatment and increases the possibilities for improving clinical practice.

ПЕРЕВОД И МЕЖКУЛЬТУРНАЯ АДАПТАЦИЯ «ИНСТРУМЕНТА СКРИНИНГА ТРУДНОСТЕЙ С КОРМЛЕНИЕМ/ГЛОТАНИЕМ И НЕДОСТАТОЧНОСТИ ПИТАНИЯ У ДЕТЕЙ С ДЕТСКИМ ЦЕРЕБРАЛЬНЫМ ПАРАЛИЧОМ (FNST)»

Children with cerebral palsy (CP) often have feeding and swallowing difficulties, which can lead to malnutrition and low body weight gain and negatively affect growth and development. In order to identify feeding difficulties and malnutrition in children with CP and timely access to specialists, the FNST (Feeding Nutrition Screening Tool) English-language questionnaire has been developed and validated. The purpose of the research was to translate into Russian and carry out a cross-cultural adaptation of the FNST screening tool. Methods used: the translation and cross-cultural adaptation of the questionnaire content consisted of seven stages in accordance with the standards of the International Society for Pharmacoeconomics Research and Evaluation of Results (ISPOR). Preliminary testing of the pre-final version of the tool was conducted with the participation of 30 parents/caretakers of CP patients and 10 practitioners. The stages of the work were carried out at the National Medical Research Center for Children’s Health, I.M. Sechenov First Moscow State Medical University and Moscow State Linguistic University (all three are located in Moscow, Russia). The pre-final version was adopted with minor changes. Results: the final Russian-language adapted 4-point screening tool represents a short and simple questionnaire to identify feeding disorders and malnutrition in children with CP aged 2 to 19 y/o and to ensure the possibility of timely dietary intervention. The translation of the questionnaire into Russian and its cross-cultural adaptation have preserved functional, structural and operational equivalence. Conclusion: a Russian-language version of the FNST questionnaire has been created and adapted for screening for eating disorders in children with CP, which is the first necessary step for its further official validation and implementation.

Preparedness of Speech Language Pathologists and Occupational Therapists to Treat Pediatric Feeding Disorder: A Cross-Sectional Survey.

Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown. A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines. Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers. While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway.

Mealtime Skill Independence: from Pouch-to-Spoon Fading to Using Chopsticks

AbstractCompared to solids, less paediatric feeding research has targeted liquids, medication, and teaching independence skills (e.g., fork, chopsticks). No research to our knowledge has reported transitioning from spout squeeze ‘baby food’ pouches, increasing finger-feeding, and teaching steps in scooping, sipping, and biting off portions. We detail a clinical case and depict data teaching comprehensive mealtime independence using multi-element and multiple-baseline designs. A 3-year-old male with paediatric feeding disorder, avoidant/restrictive food intake disorder (ARFID), and autism spectrum disorder (level 3) had only one independent skill (yogurt pouch via spout). He did not finger-feed, self-spoon-feed, self-drink, or cup-drink. He participated in a home-based intensive 2-week behaviour-analytic treatment programme. We conducted an assessment comparing novel pouch transition apparatuses, then used pouch-to-spoon fading to teach spoon self-feeding. We taught independence in finger-feeding, open-cup drinking, and four methods of medication administration, then open-cup bolus sipping, self-scooping, biting off portions, fork, and chopsticks (11 skills). He met 100% of goals. Caregivers reported high social validity and relevant culturally significant information, and gains generalised and maintained in follow-up.

Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers.

Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorder treatments and how it might vary among some populations. Seekers of treatment for eating disorders (N=1,995) completed an online assessment of clinical demographic and anthropometric characteristics, barriers to eating disorder treatment access, and eating disorder symptomatology. Analyses were conducted to identify treatment access barriers, compare barriers to treatment access across demographic groups, and investigate relationships between barriers to treatment access and eating disorder symptoms. Financial barriers (e.g., lack of insurance coverage) were the most frequently reported barrier to treatment access. Participants with historically underrepresented identities and with a diagnosis of other specified feeding or eating disorder (OSFED) reported more barriers related to financial challenges, geographic location, eating disorder identification, sociocultural factors, and treatment quality compared with those with historically represented identities (e.g., White and cisgender persons). Higher frequencies of reported barriers to treatment access were associated with more severe eating disorder symptoms and poorer illness trajectories. Financial barriers were the most significant impediment to accessing treatment among individuals seeking eating disorder treatment. Barriers to treatment access disproportionally affected underrepresented groups and those with an OSFED diagnosis.

Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding.

Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning. This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions. Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided. Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.

Eating Disorders Among Saudi Dietitians: Prevalence and Analysis

Eating disorders (EDs) involve persistently disturbed eating and related behaviors that result in altered consumption or absorption of food with potential physical or psychological function impairment. There are four major types of EDs: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified. This investigation aimed to study the prevalence of EDs by assessing the nutritional status of nutrition students and dietitians from multiple provinces in Saudi Arabia. A cross-sectional study included 175 male and female nutrition students and dietitians. EDs were diagnosed using the Eating Attitudes Test – 26 item (EAT-26) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Dietary intake was estimated using repeated 24-hour recall records. Diets were analyzed using food processor nutrition and fitness software. The intakes were compared with the recommended dietary allowances (RDA). The mean participant age was 24.62 ± 4 years. According to EAT-26 diagnostic criteria, the prevalence of EDs was 15.4%. The ED participants had normal body mass index values of 23.6 ± 3.47kg/m2. The diet analysis showed that these subjects had a lower intake of energy, macronutrients, and micronutrients but higher intakes of other micronutrients than the RDA. Nine (33.3%) of the subjects were students and 18 (66.7%) were dietitians. l EDs were more prevalent among dietitians than students. The EDs included a high number of other specified feeding or eating disorders and unspecified eating disorder cases. Subjects with ED had an unbalanced diet and poor nutrition. Our investigation concluded that the prevalence of EDs in Saudi Arabia was 15.4% among nutrition students and dietitians. Moreover, EDs were more prevalent in some provinces of Saudi Arabia. Intakes of energy, macronutrients, and some micronutrients were low, while those of other micronutrients were higher than the RDA.

Long-Term Outcomes after Behavior-Analytic Intervention for Pediatric Feeding Disorders

AbstractMany children with autism spectrum disorder experience feeding difficulties that can lead to increased health risks (e.g., severe nutrition deficiencies, obesity-related illnesses) if left untreated. Intensive feeding programs that use behavior-analytic interventions have reported positive outcomes for treating challenging behavior associated with pediatric feeding disorders at discharge and up to 1 year post discharge. Whether these children achieve and maintain long-term goals is unknown. The purpose of the current study was to evaluate outcomes of behavior-analytic intervention for pediatric feeding disorders among children with and without autism spectrum disorder in an intensive feeding program post discharge. Caregivers of former patients reported on the positive and negative impact of the program and their child’s growth and diet variety at follow-up. 85% of caregivers reported the program had a positive impact. Increases in height-for-age z scores were significant from admission to discharge from the intensive program, and progress in growth and diet variety remained the same or improved for most children at follow-up. Results suggest that behavior-analytic intervention in an intensive feeding program produced positive short- and long-term outcomes for children and their families.

Adaptive design trials in eating disorder research: A scoping review.

This scoping review sought to map the breadth of literature on the use of adaptive design trials in eating disorder research. A systematic literature search was conducted in Medline, Scopus, PsycInfo, Emcare, Econlit, CINAHL and ProQuest Dissertations and Theses. Articles were included if they reported on an intervention targeting any type of eating disorder (including anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorders), and employed the use of an adaptive design trial to evaluate the intervention. Two independent reviewers screened citations for inclusion, and data abstraction was performed by one reviewer and verified by a second. We identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder conducted in the USA and Australia. All employed adaptive treatment arm switching based on early response to treatment and identified a priori stopping rules. None of the studies included value of information analysis to guide adaptive design decisions and none included lived experience perspectives. The limited use of adaptive designs in eating disorder trials represents a missed opportunity to improve enrolment targets, attrition rates, treatment outcomes and trial efficiency. We outline the range of adaptive methodologies, how they could be applied to eating disorder research, and the specific operational and statistical considerations relevant to adaptive design trials. Adaptive design trials are increasingly employed as flexible, efficient alternatives to fixed trial designs, but they are not often used in eating disorder research. This first scoping review identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder that employed treatment arm switching adaptive methodology. We make recommendations on the use of adaptive design trials for future eating disorder trials.

Improved Chemical and Radiochemical Synthesis of Neuropeptide Y Y2 Receptor Antagonist N-Methyl-JNJ-31020028 and Preclinical Positron Emission Tomography Studies.

Neuropeptide Y (NPY) is one of the most abundant peptides in the central nervous system of mammals and is involved in several physiological processes through NPY Y1, Y2, Y4 and Y5 receptors. Of those, the Y2 receptor has particular relevance for its autoreceptor role in inhibiting the release of NPY and other neurotransmitters and for its involvement in relevant mechanisms such as feeding behaviour, cognitive processes, emotion regulation, circadian rhythms and disorders such as epilepsy and cancer. PET imaging of the Y2 receptor can provide a valuable platform to understand this receptor's functional role and evaluate its potential as a therapeutic target. In this work, we set out to refine the chemical and radiochemical synthesis of the Y2 receptor antagonist N-[11C]Me-JNJ31020028 for in vivo PET imaging studies. The non-radioactive reference compound, N-Me-JNJ-31020028, was synthesised through batch synthesis and continuous flow methodology, with 43% and 92% yields, respectively. N-[11C]Me-JNJ-31020028 was obtained with a radiochemical purity > 99%, RCY of 31% and molar activity of 156 GBq/μmol. PET imaging clearly showed the tracer's biodistribution in several areas of the mouse brain and gut where Y2 receptors are known to be expressed.

Clinical Application and Fading of Synchronous Reinforcement for Increasing Self-Feeding for a Child with Autism Spectrum Disorder and History of Trauma

In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.

Noncontingent reinforcement in the treatment of pediatric feeding disorder: A concise review.

This concise review summarizes the literature on noncontingent reinforcement in the treatment of pediatric feeding disorder from 2018 to 2022. We reviewed 15 published behavior-analytic feeding studies to identify how often the term noncontingent reinforcement is used, what form of noncontingent reinforcement is delivered, and what the effects of noncontingent reinforcement are on behavior when it is included in treatment. Implications and directions for future research are discussed.

Pediatric Feeding Disorder and the School-Based Speech-Language Pathologist: An Evidence-Based Update for Clinical Practice.

This prologue introduces the forum "Pediatric Feeding Disorder and the School-Based SLP: An Evidence-Based Update for Clinical Practice" and informs the reader of the scope of articles presented. The guest prologue author provides a brief history of pediatric feeding and swallowing services in the public-school setting, including previous forums on swallowing and feeding services in the schools (Logemann & O'Toole, 2000; McNeilly & Sheppard, 2008). The concepts that have been learned since the 2008 forum are shared. The contributing authors in the forum are introduced, and a summary is provided for each of the articles. The articles provide evidence-based information on topics that are uniquely of interest to school-based speech-language pathologists managing pediatric feeding and swallowing in their districts. The topics shared in this forum range from relevant information on anatomy, physiology, developmental milestones, and differential diagnosis to therapeutic practice when identifying and treating pediatric feeding and swallowing in the school setting. The forum also includes focused articles on the necessity of collaboration with families during the treatment process, current information on legal parameters dealing with school-based pediatric feeding disorder services, and a framework for assessment and treating pediatric feeding disorder in the school setting.

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

Avoidant Restrictive Food Intake Disorder in a 28 year old man: a case report

IntroductionAvoidant Restrictive Food Intake Disorder is a disorder included among the eating disorders criteria group. Prevalence and incidence rates of ARFID in the general population remain largely unknown. Despite ongoing variability in the interpretation of diagnostic criteria in clinical practice, good progress has been made regarding recognition and assessment of ARFID. Different approaches to treatment are currently being explored, with reported outcomes for ARFID vary, consistent with the heterogeneity of the disorder. At present, there is insufficient evidence to determine the likely course and prognosis.ObjectivesReview what avoidant restrictive food intake disorder consists of, the challenges it presents, as well as its prognosis and potential treatments.MethodsPresentation of a patient’s case and review of existing literature, in regards to ARFID.Results The patient in question is not clear he can be diagnosed of avoidant restrictive food intake disorder given his OCD symptoms, which are intertwined. That said, he does not have body dysmorphophobia and does check for all the ARFID criteria. Their prognosis is not good, having failed several psychological and pharmacological treatments. In literature, there is not much evidence around the disease because of its novelty, being recently included in the DSM 5 as a new class of eating disorders (EDs), not finding high quality studies (meta analysis, systematic review). ARFID is characterised by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional suplemments, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptom. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalisation with multidisciplinary care (paediatrician, nutritional therapist, dietitian, psychologists, and speech therapists). In regards to potential treatments, there is no evidence-based psychological treatment suitable for all forms of ARFID at this time. Several groups are currently evaluating the efficacy of new psychological treatments for ARFID, particularly, family-based and cognitive-behavioural approaches, but results have not yet been published.ConclusionsFuture directions for research could be usefully informed by closer collaboration with other fields, including feeding disorders, emotion processing and regulation, neurodevelopment, and appetite.Disclosure of InterestNone Declared

Dysphagia Service Delivery in the Educational Setting: Pediatric Feeding Disorder and the Culturally Responsive Clinician.

This article addresses considerations for the speech-language pathologist to ensure culturally competent dysphagia management in the school setting for children with oral motor, swallowing, and pediatric feeding disorders (PFDs). There is also discussion of the multifactorial cultural and linguistic influences that impact collaborative educational decisions when establishing and implementing school-based dysphagia services. The consideration of cultural and linguistic factors for the child with oral motor, swallowing, and/or PFDs is essential when diagnosing, treating, and planning for dysphagia service delivery. By recognizing and including culturally appropriate interventions and recommendations, speech-language pathologists enhance opportunities for positive outcomes and treatment efficacy when providing pediatric dysphagia services in the educational setting for children from culturally and linguistically diverse backgrounds.

Cross-Cultural Adaptation and Validation of the Greek Cypriot Montreal Children’s Hospital Feeding Scale

Introduction: Assessing pediatric feeding disorders (PFD) is essential for a child’s development to prevent severe consequences. The assessment procedures for PFD may include parents’ questionnaires such as the Montreal Children’s Hospital Feeding Scale (MCH-FS). The aim of this study was the cross-cultural adaptation of the MCH-FS to the Greek language. Methods: One hundred parents of Greek Cypriot children with PFD (clinical group) and 100 parents of healthy Greek Cypriot children (control group) aged 6 months to 16 years old participated in the study and completed the MCH-FS. World Health Organization (WHO) guidelines were implemented for translation and cultural adaptation. Results: The internal consistency was excellent, α = 0.85 (ICC: 0.817–0.891). Content validity was significant (S-CVI = 1) with an agreement equal to 14. A strong and significant correlation of MCH-FS was computed according to principal component analysis (14 items ranging between −0.6 and 0.7). The Kaiser-Meyer-Olkin factor analysis was equal to 0.91 with substantial correlations (Bartlett’s test = 0.001, 654,804). The MCH-FS cut-off point between the two groups was 38.00 (AUC: 0.901 [95% CI: 0.859–0.942], p U = 992.00, p p Conclusion: The MCH-FS had good psychometric properties in its current form in Greek. It is suggested that the MCH-FS can be used as a valid tool for children with PFD in the Greek Cypriot population.