Hana F. Zickgraf

Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD.

This studys objective was to examine associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD (autism spectrum disorder) including self-injury, depressive symptoms, functional communication, social skill deficits and parent stress, in a well-characterized sample of youth with ASD. Fifty-nine verbally fluent participants (7-17 years; 93% Caucasian) diagnosed with ASD and their parents completed semistructured diagnostic interviews to confirm ASD diagnosis and assess for anxiety disorders. Parents completed questionnaires on child behavior and social skill as well as parental stress. Co-occurring anxiety disorders were associated with more parent-reported self-injurious behavior, depressive symptoms, and parental stress in youth with ASD, after controlling for other influential variables (e.g., ASD severity, cognitive ability, medication status). In contrast, youth with co-occurring anxiety disorders appeared to have significantly stronger parent-reported functional communication than youth with ASD alone as well as a comparable ability, according to parents, to initiate social interaction and develop relationships. Findings support a profile of challenges and relative strengths associated with the presence of anxiety disorders in youth with ASD. Though more research is needed to determine the direction of these associations, results provide further rationale for improving recognition and targeted treatment of this comorbidity in clinical practice.

Adult picky eating. Phenomenology, taste sensitivity, and psychological correlates.

OBJECTIVES To explore psychosocial correlates of picky eating in adults, document differences in the taste sensitivity of picky and non-picky eating adults, and examine behavioral characteristics of this understudied phenomenon. METHODS In Study One, 489 participants completed a survey on food choice and habits, including questions that asked participants to self-identify as picky eaters. Picky and non-picky eaters were compared on their rates of endorsement of a range of food selection behaviors and attitudes. In Study Two, participants who identified as either picky or non-picky responded to questionnaire measures of obsessive compulsive disorder, depression, disordered eating symptoms, disgust sensitivity, and food and general neophobia. Participants also rated the intensity of bitter and sweet solutions at three concentrations on a Labeled Magnitude Scale. RESULTS In Study One, picky eaters were more likely to endorse a variety of anomalous eating behaviors and attitudes toward food, including rejection of foods based on sensory characteristics (taste, color, texture). Picky eaters were less likely to endorse enjoyment of eating, and more likely to report that they were unhealthy eaters. In Study Two, picky eaters had significantly higher OCD symptoms, disgust sensitivity, and food neophobia than non-picky eaters, and were more likely to score within the clinical range of depression symptoms, but did not have higher scores on measures of disordered eating or general neophobia. Picky eaters rated both bitter and sweet tastants as more intense than did non-picky eaters. DISCUSSIONS Implications of findings for the future study of the correlates and mechanisms of Avoidant/Restrictive Food Intake Disorder are discussed.

Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms

BackgroundOne presentation of Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by picky eating, i.e., selective eating based on the sensory properties of food. The present study has two aims. The first is to describe distress and impairment in individuals with ARFID secondary to picky eating. The second is to determine whether eating behaviors hypothesized to be specific to picky eating can differentiate picky eaters with and without ARFID from typical eaters (e.g., individuals not reporting picky or disordered eating) and individuals who strongly endorse attitudes associated with anorexia and bulimia (eating disordered attitudes).MethodsParticipants were recruited from Amazon’s Mechanical Turk (N = 325) and an online support group for adult picky eaters (N = 81). Participants were grouped based on endorsement of picky eating, ARFID symptoms, and elevated eating disordered attitudes on the Eating Attitudes Test (EAT-26). The resulting four eating behavior groups were compared on measures of distress and impairment (e.g., anxiety/depression and, obsessive compulsive disorder symptoms, eating-related quality of life) and on measures of eating behaviors associated with picky eating (e.g., food neophobia, inflexibility about preparation and presentation of preferred foods, sensitivity to sensory stimuli, and eating from a very narrow range of foods). The groups were compared using one way ANOVA with post-hoc Tamhane’s T2 tests.ResultsOn measures of distress and impairment, participants with ARFID reported higher scores than both typical eaters and picky eaters without ARFID, and comparable scores to those with disordered eating attitudes. Three of four measures of picky eating behavior, eating inflexibility, food neophobia, and eating from a range of 20 or fewer foods, distinguished picky eaters with and without ARFID form typical eaters and those with disordered eating attitudes. Picky eaters with ARFID reported greater food neophobia and eating inflexibility, and were more likely to eat from a narrow range of foods, compared to picky eaters without ARFID.ConclusionsAdult picky eaters can be differentiated from those with symptoms of anorexia and bulimia by their stronger endorsement of food neophobia and inflexible eating behaviors, and by eating from a very narrow range of foods. Picky eaters with ARFID symptoms can be differentiated from picky eaters without these symptoms on the basis of these three eating behaviors, and by their higher endorsement of internalizing distress, OCD symptoms, and eating-related quality of life impairment. This study provides evidence that ARFID symptoms exist independently of symptoms of other eating disorders and are characterized by several distinct eating behaviors. In a clinical analogue sample of disordered eaters, ARFID symptoms were associated with distress and impairment at levels comparable to symptoms of anorexia and bulimia.

Habit reversal training in trichotillomania: guide for the clinician

Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the clients unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the clients specific needs. These include awareness training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the client’s unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the client’s specific needs. These include awareness training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.

Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disorder characterized by inadequate nutritional or caloric intake leading to weight loss, nutritional deficiency, supplement dependence, and/or significant psychosocial impairment. DSM-5 lists three different eating patterns that can lead to symptoms of ARFID: avoidance of foods due to their sensory properties (e.g., picky eating), poor appetite or limited interest in eating, or fear of negative consequences from eating. Research on the prevalence and psychopathology of ARFID is limited by the lack of validated instruments to measure these eating behaviors. The present study describes the development and validation of the nine-item ARFID screen (NIAS), a brief multidimensional instrument to measure ARFID-associated eating behaviors. Participants were 455 adults recruited on Amazons Mechanical Turk, 505 adults recruited from a nationally-representative subject pool, and 311 undergraduates participating in research for course credit. Exploratory and confirmatory factor analyses provided evidence for three factors. The NIAS subscales demonstrated high internal consistency, test-retest reliability, invariant item loadings between two samples, and convergent/discriminant validity with other measures of picky eating, appetite, fear of negative consequences, and psychopathology. The scales were also correlated with measures of ARFID-like symptoms (e.g., low BMI, low fruit/vegetable variety and intake, and eating-related psychosocial interference/distress), although the picky eating, appetite, and fear scales had distinct independent relationships with these constructs. The NIAS is a brief, reliable instrument that may be used to further investigate ARFID-related eating behaviors.

Picky eating and fruit and vegetable consumption in college students

Picky eating (PE) may be an important individual-level factor related to fruit and vegetable (F&V) consumption in adulthood. Past studies showing negative relationships between Adult PE and F&V servings and variety have been limited by measurement issues. The purpose of the present study was replicate these relationships in college students using a well-validated F&V screener and comprehensive measure of adult PE. 1219 college students completed an online survey which included measures of adult PE, F&V daily servings, F&V variety, and other eating behaviors. Partial correlations were calculated, controlling for demographic factors and traditional disordered eating behavior, between the variables of interest. Factor analysis was also utilized to confirm the factor structure of the Adult Picky Eating Questionnaire (APEQ) in a college sample. Partial correlations revealed significant negative relationships between PE and measures of F&V servings and variety. Factor analysis confirmed the utility of the APEQ in a college sample. College students who reported higher levels of PE behaviors and attitudes were more likely to eat less fruits and vegetables, and reported lower F&V variety. Given that F&V servings and variety are related to adequate nutrient intake, and greater F&V consumption is a protective factor against chronic disease risk, the rigid inflexible eating patterns associated with adult PE should be further explored in future research aimed at increasing F&V consumption.

A multidimensional approach to understanding the potential risk factors and covariates of adult picky eating

OBJECTIVE Adult picky eating (PE) has received increased attention in the eating behavior literature due to its important association with adult avoidant-restrictive food intake disorder (ARFID). The current study tested a model of potential risk factors of adult PE behavior, including perceived early parental feeding practices. An exploratory model was also utilized to understand associations with different aspects of adult PE behaviors. METHODS A sample of 1339 US adults recruited through Amazons MTurk completed an online survey that included the recently developed Adult Picky Eating Questionnaire (APEQ), retrospective reports of parental feeding practices, and other measures of eating behavior and demographic variables. A structural equation modeling procedure tested a series of regression models that included BMI and disordered eating behaviors as covariates. RESULTS SEM modeling indicated that retrospective reports of greater parental pressure to eat, higher disgust sensitivity, lower PE age of onset, and experiencing an aversive food event were associated with general adult PE behavior. Results also indicated parental encouragement of healthy eating may be a protective factor, and that men endorsed higher levels of adult PE. Exploratory analyses indicated that cross-sectional predictors and covariates were differentially related to specific aspects of PE as measured by the APEQ subscales. CONCLUSIONS Early experiences, including parental approaches to feeding, appear to be potential risk factors of PE behavior in adults. A nuanced understanding of adult PE is important for the prevention and treatment of severe PE behaviors, related psychosocial impairment, and ARFID.

Asymmetrical Social Mach Bands Exaggeration of Social Identities on the More Esteemed Side of Group Borders

Perceptual processes generally enhance borders, because of their high information value. Mach bands are an example in vision. In the social world, borders are also of special significance; one side of a border is generally more esteemed or valued than the other. We claim that entities (individuals, groups) that are just over the border on the positive side tend to exaggerate their membership on the positive side (asymmetrical social Mach bands). We demonstrate this by showing that (a) master’s-degree universities use the word university to describe themselves more than major graduate universities do, (b) small international airports use the word international to describe themselves more than major airports do, and (c) University of Pennsylvania students, who are affiliated with a “marginal” Ivy League school, use the word Ivy to describe their school more than Harvard students do.

Sensory sensitivity mediates the relationship between anxiety and picky eating in children/ adolescents ages 8–17, and in college undergraduates: A replication and age-upward extension

This study explores the relationships among anxiety, sensitivity to sensory stimuli, and picky eating (PE). An earlier study in 95 children ages 5-10 found that sensory sensitivity fully mediated the relationship between anxiety and picky eating. We replicated this finding in a sample of 158 children, ages 8-17, and in 813 young adult college students. As in the previous child sample, the relationship between anxiety and picky eating appears to be mediated by sensory sensitivity. This relationship extends into adolescence and young adulthood and holds even in a sample of children with obsessive-compulsive-spectrum and anxiety disorders. However, there may be developmental differences in the relationship between sensory sensitivity and PE; the magnitude of this relationship was significantly greater for children than young adults. Although there was a trend towards a stronger relationship in a subsample of young adults with high anxiety, the effect was still smaller than that observed in children, suggesting that this difference is developmental and not completely driven by higher anxiety in the child sample. Sensory sensitivity is a candidate mechanism of picky eating, although the cross-sectional nature of this study means that we cannot address whether it is an etiological or maintaining mechanism, or both. Implications for behavioral treatment of picky eating in clinically anxious and non-clinical samples are discussed.