The central role of disgust in disorders of food avoidance.

BACKGROUND: Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. METHOD: This exploratory, cross-sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self-reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. RESULTS: A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. CONCLUSIONS: Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.

Feeling and body investigators (FBI): ARFID division-An acceptance-based interoceptive exposure treatment for children with ARFID.

OBJECTIVE: Individuals with Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing health consequences from insufficient nutritional variety and/or quantity. Early medical conditions and/or somatic symptoms such as abdominal pain may lead some with ARFID to experience somatic sensations as aversive. As such, food avoidance may be part of a broader behavioral repertoire aimed at suppressing bodily sensations. Avoiding these necessary and informative signals (e.g., growls of hunger) may subvert the emergence of healthy self-awareness and self-regulation. Teaching children with ARFID to engage adaptively with bodily sensations may help decrease aversiveness, increase self-awareness, and increase approach behaviors. METHOD: Drawing from interventions for panic disorder and irritable bowel syndrome, we developed an acceptance-based interoceptive exposure treatment for young children with ARFID, Feeling and Body Investigators (FBI)-ARFID Division. Using playful cartoons and developmentally sensitive exposures, we teach young children how to map interoceptive sensations onto meanings (e.g., emotions) and actions (e.g., if I feel nervous, I'll hold someone's hand). RESULTS: We present a case study of a 4-year old child with lifelong poor appetite/food indifference. DISCUSSION: Some individuals with ARFID may avoid food to avoid internal sensations. Developmentally appropriate interoceptive exposures may decrease ARFID symptoms while increasing more general self-regulation skills.

Direct magnitude estimation of articulation rate in boys with fragile X syndrome.

PURPOSE: To compare the perceived articulation rate of boys with fragile X syndrome (FXS) with that of chronologically age-matched (CA) boys and to determine segmental and/or prosodic factors that account for perceived rate. METHOD: Ten listeners used direct magnitude estimation procedures to judge the articulation rates of 7 boys with FXS only, 5 boys with FXS and a diagnosis of autism spectrum disorder (ASD), and 12 CA boys during sentence repetition. Sentences had similar articulation rates in syllables per second as determined acoustically. Four segmental/prosodic factors were used to predict perceived rate: (a) percentage consonants correct, (b) overall fundamental frequency (F(0)) level, (c) sentence-final F(0) drop, and (d) acoustically determined articulation rate with the final word of the sentence excluded. RESULTS: Boys with FXS and ASD were judged to talk faster than CA controls. Multiple linear regression indicated that articulation rate with the final word of the sentence excluded and sentence-final F(0) drop accounted for 91% of the variance for perceived rate. CONCLUSIONS: Descriptions of speakers with FXS as having fast and/or fluctuating articulation rates may be influenced by autism status. Also, atypical sentence-final prosody may be related to perceived rate in boys with FXS and ASD.

Discourse skills of boys with fragile X syndrome in comparison to boys with Down syndrome.

PURPOSE: This study compared the conversational discourse skills of boys who have fragile X syndrome with and without autism spectrum disorder (ASD) with those of boys with Down syndrome and boys who are typically developing. METHOD: Participants were boys who have fragile X syndrome with (n = 26) and without (n = 28) ASD, boys with Down syndrome (n = 29), and boys who are typically developing (n = 22). Turns during an examiner-child interaction consisting of structured and semistructured activities were coded for the boys' ability to maintain a topic of conversation and the frequency of perseveration. RESULTS: The results revealed that boys who had both fragile X and ASD produced significantly more noncontingent discourse than did boys who had only fragile X, boys with Down syndrome, or typically developing boys. This finding was observed regardless of whether the topic was maintained or changed and whether the turn type was a response or initiation. Regardless of autism status, boys with fragile X used more perseveration than did boys in the other groups. CONCLUSION: These findings suggest that some aspects of the conversational discourse difficulties attributed to fragile X syndrome may be a function of the high rate of comorbidity between fragile X and autism, whereas some difficulties may be characteristic of fragile X syndrome.

Articulation rate and vowel space characteristics of young males with fragile X syndrome: preliminary acoustic findings.

PURPOSE: Increased speaking rate is a commonly reported perceptual characteristic among males with fragile X syndrome (FXS). The objective of this preliminary study was to determine articulation rate-one component of perceived speaking rate-and vowel space characteristics of young males with FXS. METHOD: Young males with FXS (n = 38), developmental age (DA)-matched males (n = 21), and chronological age (CA)-matched males (n = 16) were audiotaped while engaged in spontaneous conversation and a picture-naming task. Articulation rate in syllables per second during intelligible utterances and vowel space area/dispersion measures were acoustically determined for each speaker. RESULTS: Males with FXS did not articulate significantly faster than CA-matched males. Area and dispersion of the acoustic vowel space also were similar between the 2 groups. Males with FXS, however, used significantly shorter utterances and had a tendency to pause less often than CA-matched males. In addition, males with FXS exhibited greater intraspeaker variability of formants associated with the vowel /a/. CONCLUSIONS: These preliminary findings suggest that articulation rate may not be a primary factor contributing to perceived speaking rate of males with FXS. Limitations of the study relative to speech production tasks and utterance intelligibility are discussed.