Psychological and Psychosocial Impairment in Preschoolers With Selective Eating

Abstract

We examined the clinical significance of moderate and severe selective eating (SE). Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are intended to guide health care providers to recognize when SE is a problem worthy of intervention. METHODS: A population cohort sample of 917 children aged 24 to 71 months and designated caregivers were recruited via primary care practices at a major medical center in the Southeast as part of an epidemiologic study of preschool anxiety. Caregivers were administered structured diagnostic interviews (the Preschool Age Psychiatric Assessment) regarding the child's eating and related selfregulatory capacities, psychiatric symptoms, functioning, and home environment variables. A subset of 188 dyads were assessed a second time ∼24.7 months from the initial assessment. RESULTS: Both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attention-deficit/hyperactivity disorder) both concurrently and prospectively. However, the severity of psychopathological symptoms worsened as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion. CONCLUSIONS: Findings suggest that health care providers should intervene at even moderate levels of SE. SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, an eating disorder that encapsulates maladaptive food restriction, which is new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. WHAT'S KNOWN ON THIS SUBJECT: Selective eating is a common, burdensome eating pattern in young children. A significant subset remain selective eaters at least until adolescence and, for some, adulthood. The question is whether selective eating is a serious enough developmental pattern to warrant intervention. WHAT THIS STUDY ADDS: This study examines whether selective eating, at 2 levels of severity, is associated with current and future psychological problems. Because moderate levels of selective eating were associated with impairment, selective eating falls within the diagnosis of avoidant/restrictive food intake disorder.