Lars Wichstrøm

Screening for pickiness - a validation study

Picky eating is prevalent in childhood and is associated with negative health outcomes. Therefore early detection of pickiness is pertinent. Because no psychometric measure of picky/fussy eating has been validated, we aimed to examine the screening efficiency of the 6-item ‘Food Fussiness’ (FF) scale from the Children’s Eating Behavior Questionnaire using structured psychiatric interviews (the Preschool Age Psychiatric Interview), providing meaningful cut-off values based on a large, representative sample of Norwegian 6xa0year olds (nu2009=u2009752). Screening efficiency was evaluated using receiver operating characteristic curve analysis, revealing excellent discrimination. The cut-point maximizing the sum of sensitivity and specificity for the scale was found at a score of 3.33 for severe cases and 3.00 when both moderate and severe pickiness were included. The results suggest that the FF scale may provide a tool for identification of clinically significant picky eating, although further assessment may be needed to separate moderate from severe cases.

Child and parent predictors of picky eating from preschool to school age

BackgroundPicky eating is prevalent in childhood. Because pickiness concerns parents and is associated with nutrient deficiency and psychological problems, the antecedents of pickiness need to be identified. We propose an etiological model of picky eating involving child temperament, sensory sensitivity and parent-child interaction.MethodsTwo cohorts of 4-year olds (born 2003 or 2004) in Trondheim, Norway were invited to participate (97.2% attendance; 82.0% consent rate, nxa0=xa02475) and a screen-stratified subsample of 1250 children was recruited. We interviewed 997 parents about their child’s pickiness and sensory sensitivity using the Preschool Age Psychiatric Assessment (PAPA). Two years later, 795 of the parents completed the interview. The Children’s Behavior Questionnaire (CBQ) was used to assess children’s temperament. Parent- child interactions were videotaped and parental sensitivity (i.e., parental awareness and appropriate responsiveness to children’s verbal and nonverbal cues) and structuring were rated using the Emotional Availability Scales (EAS).ResultsAt both measurement times, 26% of the children were categorized as picky eaters. Pickiness was moderately stable from preschool to school age (ORxa0=xa05.92, CIxa0=xa03.95, 8.86), and about half of those who displayed pickiness at age 4 were also picky eaters two years later. While accounting for pickiness at age 4, sensory sensitivity at age 4 predicted pickiness at age 6 (ORxa0=xa01.25, CIxa0=xa01.08, 2.23), whereas temperamental surgency (ORxa0=xa00.88, CIxa0=xa00.64, 1.22) and negative affectivity (ORxa0=xa01.17, CIxa0=xa00.75, 1.84) did not. Parental structuring was found to reduce the risk of children’s picky eating two years later (ORxa0=xa00.90, CIxa0=xa00.82, 0.99), whereas parental sensitivity increased the odds for pickiness (ORxa0=xa01.10, CIxa0=xa01.00, 1.21).ConclusionsAlthough pickiness is stable from preschool to school age, children who are more sensory sensitive are at higher risk for pickiness two years later, as are children whose parents display relatively higher levels of sensitivity and lower levels of structuring. Our findings suggest that interventions targeting children’s sensory sensitivity, as well as parental sensitivity and structuring, might reduce the risk of childhood pickiness. Health care providers should support parents of picky eaters in repeatedly offering unfamiliar and rejected foods to their children without pressure and acknowledging child autonomy.

Homotypic and heterotypic continuity of symptoms of psychiatric disorders from age 4 to 10 years: a dynamic panel model

BACKGROUNDnChildhood psychiatric disorders and their symptoms evince both within-disorder (homotypic) and between-disorder (heterotypic) continuities. These continuities may be due to earlier symptoms causing later symptoms or, alternatively, that the same (unknown) causes (e.g., genetics) are operating across time. Applying a novel data analytic approach, we disentangle these two explanations.nnnMETHODSnParticipants in a Norwegian community study were assessed biennially from 4 to 10xa0years of age with clinical interviews (nxa0=xa01,042). Prospective reciprocal relations between symptoms of disorders were analyzed with a dynamic panel model within a structural equationxa0framework, adjusting for all unmeasured time-invariant confounders and time-varying negative life-events.nnnRESULTSnHomotypic continuities in symptoms characterized all disorders; strongest for attention-deficit/hyperactivity disorder (ADHD) (rxa0=xa0.32-.62), moderate for behavioral disorders (rxa0=xa0.31-.48) and for anxiety and depression (rxa0=xa0.15-.40), and stronger between 8 and 10 than between 4 and 6xa0years. Heterotypic continuity also characterized all disorders. A dynamic panel model showed that most continuities were due to unmeasured time-invariant factors rather than effects of earlier symptoms on later symptoms, although symptoms of behavioral disorders, which evinced two-year homotypic continuity (Bxa0=xa0.14, 95% CI: .04, .25), did influence later symptoms of ADHD (Bxa0=xa0.13, CI: .03, .23), and earlier ADHD symptoms influenced later anxiety disorder symptoms (Bxa0=xa0.07, CI: .01, .12).nnnCONCLUSIONSnHomotypic and heterotypic continuities of symptoms of childhood psychiatric disorders are mostly due to unobserved time-invariant factors. Nonetheless, symptoms of earlier behavioral disorders may affect later symptoms of such disorders and of ADHD, and ADHD may increase the risk of later anxiety. Thus, even if interventions do not alter basic etiological factors, symptom reduction may itself cause later symptom reduction.

Explaining the relationship between temperament and symptoms of psychiatric disorders from preschool to middle childhood: hybrid fixed and random effects models of Norwegian and Spanish children

BACKGROUNDnFour explanations for the concurrent and prospective associations between temperament and psychopathology in children have been suggested: predisposition, complication/scar, common cause/continuity, and pathoplasty/exacerbation. Because the confounding effects of common causes have not been ruled out in prior work, the support for the various explanations is uncertain.nnnMETHODSnScreen-stratified community samples of 4-year olds in Trondheim, Norway (nxa0=xa01,042), and 3-year olds in Barcelona, Spain (nxa0=xa0622), were assessed biennially for symptoms of attention-deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct (CD), anxiety, and depressive disorders through interviewer-based psychiatric interviews across four waves of data collection. The parents completed child temperament ratings. The data were analyzed with random and fixed effects regression adjusted for all time-invariant unmeasured confounders (e.g., genetics, common methods bias, item overlap).nnnRESULTSnIn both Norway and Spain and across ages, negative affect predisposed children to symptoms of all disorders except CD, low effortful control predisposed children to ADHD and ODD-symptoms, and surgency predisposed children to increased ADHD-symptoms. Complication effects were observed in the Spanish children for ADHD-symptoms, which increased surgency and diminished effortful control, and for ODD-symptoms, which decreased surgency. The common cause and pathoplasty/exacerbation explanations were not supported.nnnCONCLUSIONSnThe present results are consistent with the view that temperament plays a causal role in the development of symptoms of psychiatric disorders in children. Because temperament is malleable, interventions targeting the affective, attentional, and behavioral regulatory components of temperament may reduce psychopathology in children.

Body composition impacts appetite regulation in middle childhood. A prospective study of Norwegian community children

BackgroundResearch suggests a role for both fat mass and muscle mass in appetite regulation, but the longitudinal relationships between them have not yet been examined in children. The present study therefore aimed to explore the prospective relationships between fat mass, muscle mass and the appetitive traits food responsiveness and satiety responsiveness in middle childhood.MethodsFood responsiveness and satiety responsiveness were measured using the parent-reported Children’s Eating Behavior Questionnaire in a representative sample of Norwegian 6xa0year olds, followed up at 8 and 10xa0years of age (nxa0=xa0807). Body composition was measured by bioelectrical impedance.ResultsApplying a structural equation modeling framework we found that higher fat mass predicted greater increases in food responsiveness over time, whereas greater muscle mass predicted decreases in satiety responsiveness. This pattern was consistent both from ages 6 to 8 and from ages 8 to 10xa0years.ConclusionsOur study is the first to reveal that fat mass and muscle mass predict distinct changes in different appetitive traits over time. Replication of findings in non-European populations are needed, as are studies of children in other age groups. Future studies should also aim to reveal the underlying mechanisms.

Emotional Feeding and Emotional Eating: Reciprocal Processes and the Influence of Negative Affectivity

Emotional eating, that is, eating more in response to negative mood, is often seen in children. But the origins of emotional eating remain unclear. In a representative community sample of Norwegian 4-year-olds followed up at ages 6, 8, and 10xa0years (analysis sample: nxa0=xa0801), one potential developmental pathway was examined: a reciprocal relation between parental emotional feeding and child emotional eating. The results revealed that higher levels of emotional feeding predicted higher levels of emotional eating and vice versa, adjusting for body mass index and initial levels of feeding and eating. Higher levels of temperamental negative affectivity (at age 4) increased the risk for future emotional eating and feeding.

Quality of life among adolescents living in residential youth care:do domain-specific self-esteem and psychopathology contribute?

PurposeMany adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology.MethodsAll youth in Norwegian RYC institutions between the ages 12–23xa0years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants’ primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R).ResultsAfter adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (βxa0=xa00.57) and physical appearance (βxa0=xa00.25) domains significantly predicted concurrent QoL.ConclusionsThe self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.

Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood

OBJECTIVE: The prospective relation between physical activity and Diagnostic and Statistical Manual of Mental Disorders-defined major depression in middle childhood is unknown, as is the stability of depression. We therefore aimed to (1) determine whether there are reciprocal relations between moderate-to-vigorous physical activity (MVPA) and sedentary behavior, on one hand, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defined symptoms of major depressive disorder, on the other and (2) assess the extent of stability in depressive symptoms from age 6 to 10 years. METHODS: A community sample of children living in Trondheim, Norway, comprising a total of 795 6-year-old children was followed up at 8 (n = 699) and 10 (n = 702) years of age. Physical activity was recorded by accelerometry and symptoms of major depression were measured through semistructured clinical interviews of parents and children. Bidirectional relationships between MVPA, sedentary activity, and symptoms of depression were analyzed through autoregressive cross-lagged models, and adjusted for symptoms of comorbid psychiatric disorders and BMI. RESULTS: At both age 6 and 8 years, higher MVPA predicted fewer symptoms of major depressive disorders 2 years later. Sedentary behavior did not predict depression, and depression predicted neither MVPA nor sedentary activity. The number of symptoms of major depression declined from ages 6 to 8 years and evidenced modest continuity. CONCLUSIONS: MVPA predicts fewer symptoms of major depression in middle childhood, and increasing MVPA may serve as a complementary method to prevent and treat childhood depression.

Emotion Understanding in Preschool Children with Mild-to-Severe Hearing Loss

Abstract Deaf and hard of hearing school-aged children are at risk for delayed development of emotion understanding; however, little is known about this during the preschool years. We compared the level of emotion understanding in a group of 35 4–5-year-old children who use hearing aids to that of 130 children with typical hearing. Moreover, we investigated the parents’ perception of their childs level of emotion understanding. Children were assessed with the Test of Emotion Comprehension. Parents were presented with the same test and asked to guess what their child answered on each item. The results showed that children with hearing loss performed at the same level as typically hearing children, despite having lower vocabulary scores. Parents of children with hearing loss were more accurate in their estimations of their childs competence, and higher accuracy was associated with better emotion understanding. These findings may have implications for early intervention planning.

Change in Attachment Predicts Change in Emotion Regulation Particularly Among 5-HTTLPR Short-Allele Homozygotes

In view of the theory that the attachment relationship provides a foundation for the development of emotion regulation, here, we evaluated (a) whether change in attachment security from 4 to 6 years predicts change in emotion regulation from 6 to 8 years and (b) whether 5-HTTLPR moderates this relation in a Norwegian community sample (n = 678, 99.7% Caucasian). Attachment was measured with the Manchester Child Attachment Story Task, and teachers completed the Emotion Regulation Checklist. Attachment security was modestly stable, with children becoming more secure over time. Regression analyses revealed that increased attachment security from 4 to 6 forecasted increases in emotion regulation from 6 to 8 and decreased attachment security forecasted decreases in emotion regulation. This effect was strongest among the 5-HTTLPR short-allele homozygotes and, according to competitive model fitting, in a differential-susceptibility manner.