Cognitive Development in Children With Anorexia

The severity of growth deficiency and IQ, whereas that 55% of the infants who were failing to thrive exhibited developmental delay. Children with a history of FTT were found to have more learning difficulties and evidenced developmental delay at follow-up 5 years after the initial presentation.

FTT alone is sufficient to cause developmental delays. However, a critical problem with many previous studies is that FTT is frequently confounded with psychosocial risk factors (including low socioeconomic status [SES], maternal education levels, and maternal deprivation) that are independently related to lower Mental Developmental Index (MDI) scores. As a result, psychosocial factors may contribute to the apparent association between FTT and cognitive delay. Consequently, the conclusion that FTT is sufficient to cause significant cognitive delay requires additional exploration.

The tendency to confound FTT and psychosocial risk factors grew from early studies that used nonorganic FTT and maternal deprivation as synonymous terms. Whereas several authors have proposed that FTT should be considered a single symptom that describes growth deficiency, others have used nonorganic FTT as a clinical syndrome that encompasses children who exhibit FTT in addition to psychosocial risk factors. Consequently, several authors have argued strongly for disentangling FTT (growth deficiency) from psychosocial factors and examining FTT as a single symptom of a feeding disorder, rather than a clinical syndrome. Such a distinction is critically important for identifying the developmental consequences specifically related to growth deficiency, as well as the multiple pathways that can lead to growth deficiency. Although many factors, genetic and environmental, can contribute to cognitive development in young children, seems apart the effects of growth deficiency and psychosocial risk on cognitive development.

The study described in this article focused on infantile anorexia, a feeding disorder that is characterized by extreme food refusal, growth deficiency, and an apparent lack of appetite. Importantly, infantile anorexia is not associated with maternal deprivation or neglect, and most children with this feeding disorder come from middle- to upper-middle-class families. Therefore, studying this population affords the opportunity to disentangle the contributions of growth deficiency and psychosocial risk factors to cognitive outcomes.

Infantile anorexia was first described in a series of case studies by Chatoor and Egan,18 and at that time it was referred to as a separation disorder. Infantile anorexia arises in the first 3 years of life, most commonly between the ages of 9 and 18 months, as infants become more autonomous and make the transition to spoon- and self-feeding. Children with infantile anorexia fail to communicate signals of hunger, but they show a strong interest in exploration, play, and/or interaction with their caregivers. They exhibit extreme food refusal and frequently fail to take in sufficient calories to sustain growth. As a result, these children display acute and/or chronic malnutrition.

Drawing from the rich literature on growth deficiency and the multiple factors that can have an impact on the cognitive development of young children, this article examines the relationship of cognitive development to physical growth, mother–toddler interactions during feeding and play, maternal education, and SES. We examine these relationships in a group of children who have infantile anorexia and exhibit growth deficiency, a control group of picky eaters with normal weight, and a second control group of healthy eaters with normal weight.

Infantile anorexia seems associated with lower scores on the MDI. Although toddlers with infantile anorexia do exhibit growth deficiency, they typically do not experience maternal neglect and tend to be from middle- to upper-middle-class families.

Psychosocial variables (SES, maternal education, quality of mother–child interactions) and growth deficiency may be make independent contributions to MDI scores.
ES, maternal education, and the quality of mother–toddler interactions would be stronger predictors of cognitive development than growth deficiency.

References

1. Irene Chatoor, Jaclyn Surles, Jody Ganiban, Leila Beker, Laura McWade Paez, Benny Kerzner. Failure to Thrive and Cognitive Development in Toddlers With Infantile Anorexia PEDIATRICS Vol. 113 No. 5 May 1, 2004
pp. e440 -e447
2. Galler JR, Ramsey F, Solimano G, Lowell WE, Mason E. The influence of early malnutrition on subsequent behavioral development: I. Degree of impairment in intellectual performance. J Am Acad Child Psychiatry.1983;22 :8– 15
3. Oates RK, Peacock A, Forrest D. Long-term effects of nonorganic failure to thrive. Pediatrics.1985;75 :36– 40
4. Chatoor I, Ganiban J, Hirsch R, Spurrell E, Reiss D. Maternal characteristics and toddler temperament in infantile anorexia. J Am Acad Child Adolesc. Psychiatry.2000;39 :743– 751
5. Mackner LM, Starr RH, Black MM. The cumulative effect of neglect and failure to thrive on cognitive functioning. Child Abuse Negl.1997;21 :691– 700
6. Drewett RF, Corbett SS, Wright CM. Cognitive and educational attainments at school age of children who failed to thrive in infancy: a population-based study. J Child Psychol Psychiatry.1999;40 :551– 561
Singer TW, Fagan JF. Cognitive development 7. n the failure-to-thrive infant: a three-year longitudinal study. J Pediatr Psychol.1984;9 :363– 383
8. Dykman RA, Casey PH, Ackerman PT, McPherson WB. Behavioral and cognitive status in school-aged children with a history of failure to thrive during early childhood. Clin Pediatr.2001;40 :63– 70

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