Understanding the Eating Disorder Affecting People with Prader-Willi Syndrome

The relationship between sensory processing disorders and eating problems among children with intellectual developmental deficits

Introduction

Sensory processing disorders are prevalent among children with intellectual developmental deficits and negatively impact their daily routines. Eating, which is a major part of daily routines, is known to be frequently impaired among children with intellectual developmental deficits. This study aimed to examine the relationships between sensory processing disorders and eating problems in children with different levels of intellectual developmental deficit.

Method

Participants were 91 children aged 4 to 9 years: 25 with mild intellectual developmental deficits, 32 with moderate intellectual developmental deficits and 34 with severe/profound intellectual developmental deficits. All participants were recruited from special education kindergartens/schools for children with intellectual developmental deficits. Participants' primary caregiver in school completed the screening tool of eating problems and the short sensory profile.

Findings

Significant correlations between sensory processing disorders and eating problems were found in each intellectual developmental deficit level ( r = −.40, p ≤ .05 to r = −.57, p ≤ .001), but most correlations were found among children with moderate and severe/profound level. Energy level significantly predicted aspiration frequency; smell/taste sensitivity significantly predicted food selectivity and food refusal frequency.

Conclusion

Eating problems should be screened among children with intellectual developmental deficits according to intellectual developmental deficit severity and other related factors such as sensory processing disorders. Applying this approach in occupational therapy intervention may contribute to a child's adaptive behaviour and performance in daily routines.

Compulsive behavior in Prader-Willi syndrome: examining severity in early childhood

Prader-Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia and food preoccupations. Researchers indicate that individuals with PWS, including young children, exhibit food and non-food-related compulsions. Normative rituals are also often present among typically developing preschoolers. However, it is unclear how these behaviors affect the child. Although preschoolers with PWS exhibit more types of rituals than other populations, it is uncertain if the severity of these behaviors differs from the rituals experienced during normative development. Thus, the purpose of this research was to determine whether the ritualistic behaviors exhibited by preschoolers with PWS differ in severity from those exhibited during normative development. We also sought to identify whether non-food ritualistic behavior was related to the hyperphagia in PWS. Parents of 68 children with PWS, 86 typically developing children, and 57 children with developmental delays completed questionnaires on rituals and eating behavior. Children with PWS exhibited more severe ritualistic behavior than typically developing children but not other children with developmental delays. However, the severity of non-food-related rituals was related to the severity of eating behavior in PWS. We hypothesize that this link between hyperphagia and non-food-related compulsivity may share a common underlying neurobiological mechanism.

Diagnosis and classification of eating disorders in adults with intellectual disability: the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) approach

BACKGROUND

Previous classifications of eating disorders [EDs] employed a narrower concept of EDs. They did not include the wide range of abnormal eating behaviours [AEBs], persistent feeding disorders and EDs psychopathology, aetiological and comorbidity factors seen in adults with intellectual disability [ID].

METHODS

The International Classification of Diseases--10 [ICD-10], ICD-10-MR, Diagnostic and Statistical Manual--IV [DSM-IV] and Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation[DC-LD] diagnostic approaches to EDs in adults with ID are compared.

RESULTS

The DC-LD encourages conceptually clearer and systematic hierarchical differential diagnostic classification of AEBs and EDs. The DC-LD also allows consideration of relevant aetiological and comorbidity issues. DC-LD-based multi-axial case formulation supports the multimodal clinical assessment of AEBs and EDs.

CONCLUSIONS

Further research should develop similar systematic and evidence-based multicomponent clinical diagnostic, management and service models for adults with ID and EDs.

Eating disorders in adults with intellectual disability

There is an increasing focus on the nutrition of people with intellectual disability (ID), but less interest in the range of eating disorders (EDs) that they may exhibit and the bio-psycho-social impact of these conditions. Despite diagnostic and methodological difficulties, psychopathology and ED research studies suggest that 3-42% of institutionalized adults with ID and 1-19% of adults with ID in the community have diagnosable EDs. Weight surveys indicate that 2-35% of adults with ID are obese and 5-43% are significantly underweight, but the contribution of diagnosable EDs is unknown. Such data and case reports suggest that EDs are associated with considerable physical, behavioural, psychiatric and social comorbidity. Review papers have focused on the aetiology and treatment of pica, rumination, regurgitation, psychogenic vomiting and food faddiness/refusal. Emerging clinical issues are the development of appropriate diagnostic criteria, multimodal assessment and clinically effective treatment approaches. Key service issues include staff training to improve awareness, addressing comorbidity and access issues, and maintaining support for adults with ID and EDs, and their carers. Research should confirm the multifaceted aetiology and comorbidity of EDs. Then multicomponent assessment and treatment models for EDs can be developed and evaluated.