In the interest of more systematically documenting the early signs of autism, and of testing specific hypotheses regarding their underlying neurodevelopmental substrates, we have initiated a longitudinal study of high-risk infants, all of whom have an older sibling diagnosed with an autistic spectrum disorder. Our sample currently includes 150 infant siblings, including 65 who have been followed to age 24 months, who are the focus of this paper. We have also followed a comparison group of low-risk infants. Our measures include a novel observational scale (the first, to our knowledge, that is designed to assess autism-specific behavior in infants), a computerized visual orienting task, and standardized measures of temperament, cognitive and language development. Our preliminary results indicate that by 12 months of age, siblings who are later diagnosed with autism may be distinguished from other siblings and low-risk controls on the basis of: (1) several specific behavioral markers, including atypicalities in eye contact, visual tracking, disengagement of visual attention, orienting to name, imitation, social smiling, reactivity, social interest and affect, and sensory-oriented behaviors; (2) prolonged latency to disengage visual attention; (3) a characteristic pattern of early temperament, with marked passivity and decreased activity level at 6 months, followed by extreme distress reactions, a tendency to fixate on particular objects in the environment, and decreased expression of positive affect by 12 months; and (4) delayed expressive and receptive language. We discuss these findings in the context of various neural networks thought to underlie neurodevelopmental abnormalities in autism, including poor visual orienting. Over time, as we are able to prospectively study larger numbers and to examine interrelationships among both early-developing behaviors and biological indices of interest, we hope this work will advance current understanding of the neurodevelopmental origins of autism.

Context Evidence-based treatment trials for adolescents with anorexia nervosa are few. Objective To evaluate the relative efficacy of family-based treatment (FBT) and adolescent focused individual therapy (AFT) for adolescents with anorexia nervosa on full remission. Design Randomized controlled trial. Setting Stanford University and The University of Chicago (April 2005 until March 2009) Participants One hundred and twenty one participants, ages 12 through 18 years with DSM-IV diagnosis of anorexia nervosa except for not requiring ammenorhea. Interventions Twenty four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), 6 months and 12 months follow-up post treatment. Main outcome measures Full remission from anorexia nervosa defined as normal weight (>95% of expected gender, age, weight for height) and mean global Eating Disorder Examination (EDE) score within 1 standard deviation of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were fully remitted) and changes in Body Mass Index (BMI) percentile and eating related psychopathology. Results There were no differences in full remission between treatments at EOT. However, at both 6 and 12 month follow-up FBT was significantly superior to AFT on this measure. FBT was significantly superior for partial remission at EOT but not at follow-up. In addition, BMI percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes on the EDE at EOT than those in AFT, but there were no differences at follow-up. Conclusions Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points. Clinical Trials Registry Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa (NCT00149786)

Context Interpersonal psychotherapy (IPT) is an effective specialty treatment for binge eating disorder (BED). Behavioral weight loss treatment (BWL) and guided self-help based on cognitive behavior therapy (CBTgsh) have both resulted in short-term reductions in binge eating in obese patients with BED. Objective To test whether patients with BED require specialty therapy beyond BWL and whether IPT is more effective than either BWL or CBTgsh in patients with a high negative affect during a 2-year follow-up. Design Randomized, active control efficacy trial. Setting University outpatient clinics. Participants Two hundred five women and men with a body mass index between 27 and 45 who met DSM-IV criteria for BED. Intervention Twenty sessions of IPT or BWL or 10 sessions of CBTgsh during 6 months. Main Outcome Measures Binge eating assessed by the Eating Disorder Examination. Results At 2-year follow-up, both IPT and CBTgsh resulted in greater remission from binge eating than BWL (P < .05; odds ratios: BWL vs CBTgsh, 2.3; BWL vs IPT, 2.6; and CBTgsh vs IPT, 1.2). Self-esteem (P < .05) and global Eating Disorder Examination (P < .05) scores were moderators of treatment outcome. The odds ratios for low and high global Eating Disorder Examination scores were 2.8 for BWL, 2.9 for CBTgsh, and 0.73 for IPT; for self-esteem, they were 2.4 for BWL, 1.9 for CBTgsh, and 0.9 for IPT. Conclusions Interpersonal psychotherapy and CBTgsh are significantly more effective than BWL in eliminating binge eating after 2 years. Guided self-help based on cognitive behavior therapy is a first-line treatment option for most patients with BED, with IPT (or full cognitive behavior therapy) used for patients with low self-esteem and high eating disorder psychopathology. Trial Registration clinicaltrials.gov Identifier: NCT00060762

No abstract

Picky eating is a common disorder during childhood often causing considerable parental anxiety. This study examined the incidence, point prevalence, persistence and characteristics of picky eating in a prospective study of 120 children and their parents followed from 2 to 11 years. At any given age between 13% and 22% of the children were reported to be picky eaters. Incidence declined over time whereas point prevalence increased indicating that picky eating is often a chronic problem with 40% having a duration of more than 2-years. Those with longer duration differed from those with short duration having more strong likes and dislikes of food and not accepting new foods. Parents of picky eaters were more likely to report that their children consumed a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and threw tantrums when denied foods. They were also more likely to report struggles over feeding, preparing special meals, and commenting on their child's eating. Hence, picky eating is a prevalent concern of parents and may remain so through childhood. It appears to be a relatively stable trait reflecting an individual eating style. However no significant effects on growth were observed.

Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.

No abstract

Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.