Imperial College London

DrDashaNicholls

Faculty of MedicineDepartment of Brain Sciences

Clinical Reader in Child and Adolescent Psychiatry
 
 
 
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+44 (0)20 3313 8436d.nicholls

 
 
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7N2ACommonwealth BuildingHammersmith Campus

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Summary

 

Publications

Publication Type
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49 results found

Beykloo M, Nicholls D, Simic M, Brauer R, Mills E, Wong Iet al., A survey on self-reported psychotropic drug prescribing practices of eating disorder psychiatrists for the treatment of young people with anorexia nervosa, BMJ Open, ISSN: 2044-6055

Objectives: To survey current prescribing practices of psychotropic drugs by child and adolescent eating disorder (CAED) psychiatrists in the treatment of anorexia nervosa (AN). Design: Cross-sectional self-administered survey.Setting: All child and young people eating disorder services (CYP EDS) in England during a national training program. Participants: 44 child and adolescent eating disorder psychiatrists practicing in CYP EDS in England. Primary and secondary outcome measures: CAED psychiatrists completed a questionnaire regarding the pattern of psychopharmacological care in AN they provide and the medication treatment pattern at their CYP EDS. Secondary outcome measures included the process of continuing pharmacotherapy from secondary care to primary care. Results: Of the 77 CYP EDS representing every team in England, 44 teams represented by a CAED psychiatrist responded, despite 13 having no psychiatrists in post at the time of the study (response rate 69%). Most (40%) respondents estimated <10% of patients with AN were prescribed psychotropic medications. Olanzapine was reported as the most commonly prescribed medication for AN by 38% of respondents, followed by fluoxetine (29%) and sertraline (10%). The most common minimum olanzapine initiation dose in this study was at 2.5mg/day for a duration of 2 to 4 weeks, reaching a maximum dose of 5mg/day. Most (68%) reviewed medications every week (30%) or every two weeks (38%). Over 50% of respondents reported to continue olanzapine prescribing within the CYP EDS teams. Conclusions: This nationally representative survey showed that despite a lack of evidence, psychotropic medications are commonly prescribed to a minority of patients, most frequently olanzapine. Further evidence is needed on which patients may potentially benefit from pharmacotherapy as an adjunct to psychological interventions.

Journal article

Viner RM, Aswathikutty-Gireesh A, Stiglic N, Hudson LD, Goddings A-L, Ward JL, Nicholls DEet al., 2019, Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data., Lancet Child Adolesc Health

BACKGROUND: There is growing concern about the potential associations between social media use and mental health and wellbeing in young people. We explored associations between the frequency of social media use and later mental health and wellbeing in adolescents, and how these effects might be mediated. METHODS: We did secondary analyses of publicly available data from the Our Futures study, a nationally representative, longitudinal study of 12 866 young people from age 13 years to 16 years in England. The exposure considered was the frequency of social media use (from weekly or less to very frequent [multiple times daily]) at wave 1 (participants aged 13-14 years) through wave 3 of the study (participants aged 15-16 years). Outcomes were mental health at wave 2 (with high 12-item General Health Questionnaire [GHQ12] scores [≥3] indicating psychological distress), and wellbeing at wave 3 (life satisfaction, feeling life is worthwhile, happiness, and anxiety, rated from 1 to 10 by participants). Analyses were adjusted for a minimal sufficient confounding structure, and were done separately for boys and girls. Cyberbullying, sleep adequacy, and physical activity were assessed as potential mediators of the effects. FINDINGS: Very frequent use of social media increased from wave 1 to wave 3: from 34·4% (95% CI 32·4-36·4) to 61·9% (60·3-63·6) in boys, and 51·4% (49·5-53·3) to 75·4% (73·8-76·9) in girls. Very frequent social media use in wave 1 predicted a high GHQ12 score at wave 2 among girls (adjusted odds ratio [OR] 1·31 [95% CI 1·06-1·63], p=0·014; N=4429) and boys (1·67 [1·24-2·26], p=0·0009; N=4379). Persistent very frequent social media use across waves 1 and 2 predicted lower wellbeing among girls only (adjusted ORs 0·86 [0·74-0·99], N=3753, p=0·039 for life satisfaction; 0·80 [0·

Journal article

Nicholls D, Becker A, Food for thought: bringing eating disorders out of the shadows, British Journal of Psychiatry, ISSN: 0007-1250

Eating disorders are prevalent, potentially lethal, and treatable and yet remainunderprioritised within clinical care, research, and policy. Further, with rising public healthfocus on obesity, there is heightened risk for inadvertent exacerbation of disordered eatingand further marginalisation of these serious mental disorders. This editorial calls forcorrective action.

Journal article

Viner R, Ward J, Hudson L, Stiglic N, Nicholls Det al., The role of cyberbullying, sleep and physical activity in mediating the impact of social media use on mental health and wellbeing: findings from a national cohort of English young people, The Lancet Child and Adolescent Health, ISSN: 2352-4642

Journal article

Mitrofan O, Petkova H, Janssens A, Kelly J, Edwards E, Nicholls D, McNicholas F, Simic M, Eisler I, Ford T, Byford Set al., 2019, Care experiences of young people with eating disorders and their parents: qualitative study, BJPsych Open, Vol: 5, ISSN: 2056-4724

BackgroundPerspectives of young people with eating disorders and their parents on helpful aspects of care should be incorporated into evidence-based practice and service design, but data are limited.AimsTo explore patient and parent perspectives on positive and negative aspects of care for young people with eating disorders.MethodSix online focus groups with 19 young people aged 16–25 years with existing or past eating disorders and 11 parents.ResultsThematic analysis identified three key themes: the need to (a) shift from a weight-focused to a more holistic, individualised and consistent care approach, with a better balance in targeting psychological and physical problems from an early stage; (b) improve professionals' knowledge and attitude towards patients and their families at all levels of care from primary to ‘truly specialist’; (c) enhance peer and family support.ConclusionsYoung people and parents identified an array of limitations in approaches to care for young people with eating disorders and raised the need for change, particularly a move away from a primarily weight-focused treatment and a stronger emphasis on psychological needs and individualised care.

Journal article

Viner RM, Kinra S, Nicholls D, Cole T, Kessel A, Christie D, White B, Croker H, Wong ICK, Saxena Set al., 2018, Burden of child and adolescent obesity on health services in England, Arch Dis Child, Vol: 103, Pages: 247-254, ISSN: 0003-9888

OBJECTIVE: To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England. DESIGN: Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data. SETTING: Data on CYP aged 2-18 years from the Health Survey for England 2006 to 2013. MAIN OUTCOME MEASURES: Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI >/=99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function). RESULTS: 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13-18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management. CONCLUSIONS: There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.

Journal article

White B, Doyle J, Matschull K, Adamo M, Christie D, Nicholls D, Kinra S, Wong ICK, Viner RMet al., 2017, Outcomes of 50 patients entering an adolescent bariatric surgery programme, Arch Dis Child, ISSN: 0003-9888

OBJECTIVE: Bariatric surgery is the most effective intervention for weight loss and obesity-related comorbidities currently available. Little is known about adolescents entering National Health Service (NHS) bariatric programmes. We aimed to characterise those entering a pathway and report their outcomes. DESIGN: Prospective service evaluation of patients assessed within a single NHS adolescent bariatric service. RESULTS: 50 patients assessed between 26 July 2007 and 27 January 2014; 6 (12%) were not eligible for surgery, 7 (14%) actively opted out, 8 (16%) were lost to follow-up and 29 (58%) underwent surgery (18 sleeve gastrectomy (SG) 11 Roux-en-y gastric bypass (RYGB) and 0 adjustable gastric band). Mean (SD) age at initial assessment was 16.0 (1.3) years and 18.3 (1.3) at surgery (youngest 15.7 years). Mean time taken to surgery was 1.8 years; longer in those with higher body mass index (BMI) and aged below 14 at first assessment. Mean (SD) BMI at surgery was 53.1 (8.3) kg/m(2), lower in those undergoing RYGB (-5.2, 95% CI -11.6 to 1.13). Follow-up was inconsistent and challenging; 1/29 (3.5%) was transferred to a regional centre, 10/29 (34.5%) attended ongoing follow-up within our protocol, 6/29 (20.7%) had intermittent monitoring and 12/29 (41.4%) were lost to follow-up. Mean BMI change at 1 year (-14.0 kg/m(2)) and complications were similar to published cohorts. Data from 11 lost to follow-up were obtained and outcomes appeared similar to those who actively followed up. CONCLUSION: Adolescent bariatric surgery in the NHS appears effective, with outcomes similar to those reported internationally. Further work is needed to optimise postsurgical surveillance and reduce age at surgery.

Journal article

Pinhas L, Nicholls D, Crosby RD, Morris A, Lynn RM, Madden Set al., 2017, Classification of childhood onset eating disorders: A latent class analysis, Int J Eat Disord, Vol: 50, Pages: 657-664, ISSN: 0276-3478

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged </= 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, Canadian, and United Kingdom populations, respectively) presented with symptoms of greater weight preoccupation, fear of being fat, body image distortion, and over exercising, while Cluster 2 did not (all p < .05). Cluster 1 was older, had greater mean weight loss and was more likely to have been admitted to an inpatient unit and have unstable vital signs (all p < .01). Cluster 2 was more likely to present with a comorbid psychiatric disorder (p < .01). Clusters 1 and 2 closely resembled the DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder, respectively. Symptomatology and distribution were remarkably similar among countries, which lends support to two separate and distinct restrictive ED diagnoses.

Journal article

Nicholls D, 2017, Eating Disorders in Adolescence, Child Psychology and Psychiatry Frameworks for Clinical Training and Practice, Editors: Skuse, Bruce, Dowdney, Mrazek, Publisher: John Wiley & Sons, ISBN: 9781119170204

Comprehensive in its coverage of child emotional and behavioural development, emphasising evidence-based interventions, this book is valuable learning tool for all those training in clinical or educational psychology, social work, ...

Book chapter

Katzman DK, Madden S, Nicholls D, Mawjee K, Norris MLet al., 2017, From questions to answers: Examining the role of pediatric surveillance units in eating disorder research, Int J Eat Disord, Vol: 50, Pages: 259-265, ISSN: 0276-3478

Pediatric Surveillance Units (PSUs) provide a unique model for the study of pediatric eating disorders (EDs). Australia, Britain, and Canada have surveillance programs that have generated valuable epidemiological and clinical data on early-onset eating disorders (EOED). The PSUs represent an important collaborative tool that has helped shape our understanding of EOEDs and offers potential to contribute to decisions regarding health resource allocation and public health policy. This paper reviews the role of PSUs as a unique model to study pediatric EDs and its success in translating the knowledge generated by these programs into improving the health of children and adolescents with EDs worldwide.

Journal article

Mairs R, Nicholls D, 2016, Assessment and treatment of eating disorders in children and adolescents, Arch Dis Child, Vol: 101, Pages: 1168-1175, ISSN: 0003-9888

Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder.

Journal article

Nicholls D, Statham R, Costa S, Micali N, Viner RMet al., 2016, Childhood risk factors for lifetime bulimic or compulsive eating by age 30 years in a British national birth cohort, Appetite, Vol: 105, Pages: 266-273, ISSN: 0195-6663

OBJECTIVE: To examine whether previously identified childhood risk factors for bulimia or compulsive eating (BCE) predict self-reported lifetime BCE by age 30 years in a prospective birth cohort. METHOD: Using data from the 1970 British Cohort Study at birth, 5, and 10 years, associations between 22 putative childhood risk factors and self-reported lifetime BCE at 30 years were examined, adjusting for sex and socioeconomic status. RESULTS: Only female sex (odds ratio (OR): 9.2; 95% confidence interval (CI): 1.9-43.7; p = 0.005), low self-esteem (OR:2.9; 95%CI: 1.1-7.5; p = 0.03) and high maternal education (OR:5.4; 95%CI: 2.0-14.8; p = 0.001) were significantly associated with higher risk of BCE, whereas high SES at 10 years was significantly protective (OR:0.2; 95%CI: 0.1-0.8; p = 0.022) of BCE in fully adjusted multivariable logistic regression analysis. DISCUSSION: Our findings do not support a strong role for childhood weight status and eating behaviours in the development of bulimia and compulsive eating pathology, rather suggesting a focus on self esteem may have greater relative importance. Findings in relation to maternal education and SES need further exploration.

Journal article

O'Connor G, Nicholls D, Hudson L, Singhal Aet al., 2016, Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa: A Multicenter Randomized Controlled Trial, Nutr Clin Pract, Vol: 31, Pages: 681-689, ISSN: 0884-5336

BACKGROUND: Refeeding patients with anorexia nervosa (AN) is associated with high morbidity and mortality. A lack of evidence from interventional studies has hindered refeeding practice and led to worldwide disparities in management recommendations. In the first randomized controlled trial in this area, we tested the hypothesis that refeeding adolescents with AN with a higher energy intake than what many guidelines recommend improved anthropometric outcomes without adversely affecting cardiac and biochemical markers associated with refeeding. MATERIALS AND METHODS: Participants aged 10-16 years with a body mass index (BMI) <78% of the median (mBMI) for age and sex were recruited from 6 UK hospitals and randomly allocated to start refeeding at 1200 kcal/d (n = 18, intervention) or 500 kcal/d (n = 18, control). RESULTS: Compared with controls, adolescents randomized to high energy intake had greater weight gain (mean difference between groups after 10 days of refeeding, -1.2% mBMI; 95% confidence interval, -2.4% to 0.0%; P = .05), but randomized groups did not differ statistically in QTc interval and other outcomes. The nadir in postrefeeding phosphate concentration was significantly related to percentage mBMI at the start of refeeding (baseline; P = .04) and baseline white blood cell count (P = .005) but not to baseline energy intake (P = .08). CONCLUSIONS: Refeeding adolescents with AN with a higher energy intake was associated with greater weight gain but without an increase in complications associated with refeeding when compared with a more cautious refeeding protocol-thus challenging current refeeding recommendations.

Journal article

Robinson PH, Nicholls D, 2015, Critical Care for Anorexia Nervosa The MARSIPAN Guidelines in Practice, Publisher: Springer, ISBN: 9783319081748

This book focuses on the role of the psychiatric, medical, nutritional and psychiatric assessment and management of severely ill patients with anorexia nervosa.

Book

White B, Doyle J, Colville S, Nicholls D, Viner RM, Christie Det al., 2015, Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success, Clin Obes, Vol: 5, Pages: 312-324, ISSN: 1758-8103

The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.

Journal article

Wells JC, Haroun D, Williams JE, Nicholls D, Darch T, Eaton S, Fewtrell MSet al., 2015, Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA, Eur J Clin Nutr, Vol: 69, Pages: 1330-1335, ISSN: 0954-3007

BACKGROUND/OBJECTIVES: Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients. SUBJECTS/METHODS: Body composition of 13 females with ED and 117 controls, aged 10-18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman. RESULTS: Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5 +/- 36% and underestimated FFM by 1 +/- 9% in ED patients. CONCLUSION: Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients.

Journal article

Nicholls D, Barrett E, 2014, Eating Disorders, Clinical Topics in Child and Adolescent Psychiatry, Editors: Huline-Dickens, Publisher: RCPsych Publications, ISBN: 9781909726178

This is a comprehensive update on the field that will inform the clinical practice of all child and adolescent mental health professionals.

Book chapter

OConnor G, Nicholls D, 2013, Refeeding Hypophosphatemia in Adolescents With Anorexia Nervosa, Nutrition in Clinical Practice, Vol: 28, Pages: 358-364, ISSN: 0884-5336

Journal article

Hudson LD, Cumby C, Klaber RE, Nicholls DE, Winyard PJ, Viner RMet al., 2013, Low levels of knowledge on the assessment of underweight in children and adolescents among middle-grade doctors in England and Wales, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 98, Pages: 309-311, ISSN: 0003-9888

Journal article

Nicholls D, 2013, Aetiology, Eating Disorders in Childhood and Adolescence, Editors: Lask, Bryant-Waugh, Publisher: Routledge, ISBN: 9780415686419

This fully revised edition offers a distillation of current information relating to the younger population, and contains brand new chapters on areas of experience, research and practice including: The perspective of a young person going ...

Book chapter

Lynn RM, Viner RM, Nicholls DE, 2012, Ascertainment of early onset eating disorders: a pilot for developing a national child psychiatric surveillance system, Child and Adolescent Mental Health, Vol: 17, Pages: 109-112, ISSN: 1475-357X

Journal article

Nicholls D, Davies H, 2012, Treating Eating Disorders in Middle Childhood, The Oxford Handbook of Child and Adolescent Eating Disorders: Developmental Perspectives, Editors: Lock, Publisher: OUP USA, ISBN: 9780199744459

This book considers the risk, diagnosis, treatment, and outcome of eating disorders in children and adolescents from a developmental perspective.

Book chapter

Nicholls DE, Yi I, 2012, Early intervention in eating disorders: a parent group approach, Early Interv Psychiatry, Vol: 6, Pages: 357-367, ISSN: 1751-7885

AIM: Early intervention in eating disorders (EDs) has been a neglected area. Peak onset is in adolescence, suggesting that early intervention should include parents. We synthesize findings from five key theoretical domains, and present pilot data from a phase-specific early intervention for new onset EDs in young people. METHODS: From literature searches, we reviewed current knowledge on risk factors for EDs; ED prevention in young people; the evidence base for treatment for young people with EDs; early intervention in other mental health fields; and parenting interventions. Based on these findings, we devised and piloted a parent group intervention. RESULTS: Presenting features are typically parental concern about changes in eating behaviour and/or weight loss. There is a delay between symptom onset and help seeking, by which time the illness is well established. Early intervention should therefore target parents and be delivered at secondary rather than primary care. Effective treatments favour family-focused interventions with parental responsibility for symptom management. We hypothesized that a parents' group might be effective for addressing the specific emotional experience of parents in the early stages and their relative lack of knowledge and understanding. Pilot data show significant improvements in knowledge, skills, confidence, understanding and their child's adherence to meal plans as a result of a 6-week parent group intervention. CONCLUSION: A parent group intervention addressing themes identified from risk factor, prevention and treatment research is a potentially promising approach to early intervention for EDs. The impact of the intervention on patient outcome needs evaluation.

Journal article

White B, Nicholls D, Christie D, Cole TJ, Viner RMet al., 2012, Childhood psychological function and obesity risk across the lifecourse: findings from the 1970 British Cohort Study, Int J Obes (Lond), Vol: 36, Pages: 511-516, ISSN: 0307-0565

BACKGROUND: Psychological comorbidities of obesity are well recognised. However, the role of childhood psychological problems in the aetiology of later obesity has been little studied. DESIGN: Secondary analyses of a national birth cohort (1970 British Cohort Study). ANALYSIS: Logistic regression models to predict obesity risk at 26, 30 and 34 years related to hypothesised predictors: maternal and teacher reported child psychological function at 5 and 10 years (general behavioural, conduct, emotional or attentional/hyperactivity problems) and maternal psychological function. RESULTS: General behavioural problems at age 5 years increased the risk of obesity at 30 and 34 years. Persistence of these problems through childhood further increased the obesity risk. Inattention/hyperactivity at 10 years similarly increased risk of obesity at 30 years (adjusted odds ratios (AOR) 1.3). Chronic conduct problems at 5 and 10 years also increased the obesity risk at 30 years (AOR 1.6 (1.1, 2.4) P<0.05). Childhood emotional disorders and maternal psychological function were not associated with adult obesity. CONCLUSION: Children with early and persistent behavioural problems, particularly conduct problems, hyperactivity and inattention in early and mid-childhood are at an increased risk of obesity in adult life. The promotion of child and adolescent mental health and well-being may form an important part of future obesity prevention strategies. The promotion of healthy eating and activity should form part of secondary prevention and management strategies for children with disruptive behaviour disorders.

Journal article

Pooni J, Ninteman A, Bryant-Waugh R, Nicholls D, Mandy Wet al., 2012, Investigating autism spectrum disorder and autistic traits in early onset eating disorder, Int J Eat Disord, Vol: 45, Pages: 583-591, ISSN: 0276-3478

OBJECTIVE: To investigate whether young people (8-16 years) with an eating disorder have a higher prevalence of autism spectrum disorder (ASDs) and elevated autistic traits compared to typically developing (TD) peers. METHOD: Twenty-two participants with early onset eating disorder (EOED) were assessed using standardized ASD measures and compared to IQ matched TD (n = 24) and ASD (n = 20) controls. RESULTS: An ASD diagnosis was no more common in EOED than in TD controls. However, repetitive and stereotyped behavior was more often observed in the EOED group and, compared to TD controls, there was a trend (p = .07) toward greater autistic social impairment in EOED. DISCUSSION: Whilst participants with EOED did not show increased ASD prevalence, they did have elevated autistic traits of clinical significance, particularly repetitive and stereotyped behavior. Further work is required to determine whether inflexibility and social difficulties in EOED have identical phenomenology and etiology to those seen in ASD.

Journal article

Koskina A, Arkell J, Butcher G, Currie A, Gowers S, Key A, Millar H, Nicholls D, Ringwood S, Robinson P, Venkatraman L, Wurr K, Schmidt Uet al., 2012, Service providers' perceptions of the strengths and prospective improvements in UK eating disorder services: findings from a Royal College survey, Eur Eat Disord Rev, Vol: 20, Pages: 225-231, ISSN: 1072-4133

AIMS AND METHODS: This study aims to explore perceptions of eating disorder service strengths and to develop a clearer picture of improvements clinicians would like to see occur in the services they lead. A survey designed by the Royal College of Psychiatrists' Section of Eating Disorders was completed by 83 lead clinicians in both public and private sector services in the UK and Eire. Content analysis was performed, and common themes were identified. RESULTS: Five main strengths of a service were identified as follows: quality of treatment (n = 36), staff skills (n = 21), continuity of care (n = 15), family involvement (n = 12) and accessibility and availability (n = 11). These themes also arose when clinicians evaluated areas they wished to develop and improve. CONCLUSIONS: Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.

Journal article

Hudson LD, Nicholls DE, Lynn RM, Viner RMet al., 2012, Medical instability and growth of children and adolescents with early onset eating disorders, Arch Dis Child, Vol: 97, Pages: 779-784, ISSN: 0003-9888

OBJECTIVE: Little is known about the physical burden of early onset eating disorders (EOEDs). Most published data on physical instability and growth in malnutrition come from specialist centres, or from the developing world where aetiology differs. The authors present data on physical status at presentation from population-based surveillance systems in the UK and Ireland. DESIGN: Prospective surveillance study. PARTICIPANTS: All suspected cases of EOED in children under 13 years of age reported by paediatricians and psychiatrists via the British Paediatric Surveillance System (BPSU) and Child and Adolescent Psychiatric Surveillance System (CAPSS) in the UK and Ireland from March 2005 to May 2006 (15 months). RESULTS: 208 cases were identified (24% reported by paediatricians). Median age was 11.8 years (IQR 1.74). 171 (82%) were female (78% premenarcheal and 60% prepubertal). 74% of males were prepubertal. 35% of cases had medical instability at presentation (60% bradycardia, 54% hypotension, 34% dehydration, 26% hypothermia). 52% of cases required admission at diagnosis (73% to a paediatric ward). 41% of cases with medical instability were not underweight, that is, they had body mass index (BMI) z-scores above -2.0 (2nd centile). Sensitivities for identifying medical instability with BMI z-score <-3 or 70% median BMI were 31% and 15%, respectively. Menarcheal status did not predict risk of medical instability. CONCLUSIONS: EOEDs present with severe levels of physical instability and frequently to paediatricians. As anthropological indices alone are poor markers for medical instability, clinical assessment is essential. Doctors providing care for children have a central role in both the recognition and management of EOEDs.

Journal article

House J, Schmidt U, Craig M, Landau S, Simic M, Nicholls D, Hugo P, Berelowitz M, Eisler Iet al., 2012, Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders, Int J Eat Disord, Vol: 45, Pages: 949-956, ISSN: 0276-3478

OBJECTIVE: To explore the role of specialist outpatient eating disorders services and investigate how direct access to these affects rates of referral, admissions for inpatient treatment, and continuity of care. METHOD: Services beyond primary care in Greater London retrospectively identified adolescents who presented with an eating disorder over a 2-year period. Data concerning service use were collected from clinical casenotes. RESULTS: In areas where specialist outpatient services were available, 2-3 times more cases were identified than in areas without such services. Where initial outpatient treatment was in specialist rather than nonspecialist services, there was a significantly lower rate of admission for inpatient treatment and considerably higher consistency of care. DISCUSSION: Developing specialist outpatient services with direct access from primary care is likely to lead to improvements in treatment and reduce overall costs.

Journal article

Croker H, Viner RM, Nicholls D, Haroun D, Chadwick P, Edwards C, Wells JC, Wardle Jet al., 2012, Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial, Int J Obes (Lond), Vol: 36, Pages: 16-26, ISSN: 0307-0565

BACKGROUND: The best outcomes for treating childhood obesity have come from comprehensive family-based programmes. However there are questions over their generalizability. OBJECTIVE: To examine the acceptability and effectiveness of 'family-based behavioural treatment' (FBBT) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service (NHS) setting. METHODS: In this parallel group, randomized controlled trial, 72 obese children were randomized to FBBT or a waiting-list control. Primary outcomes were body mass index (BMI) and BMI s.d. scores (SDSs). Secondary outcomes were weight, weight SDSs, height, height SDSs, waist, waist SDSs, FM index, FFM index, blood pressure (BP) and psychosocial measures. The outcomes were assessed at baseline and after treatment, with analyses of 6-month data performed on an intent-to-treat (ITT) basis. Follow-up anthropometric data were collected at 12 months for the treatment group. RESULTS: ITT analyses included all children with baseline data (n=60). There were significant BMI SDS changes (P<0.01) for the treatment and control groups of -0.11 (0.16) and -0.10 (1.6). The treatment group showed a significant reduction in systolic BP (-0.24 (0.7), P<0.05) and improvements in quality of life and eating attitudes (P<0.05), with no significant changes for the control group. However the between-group treatment effects for BMI, body composition, BP and psychosocial outcomes were not significant. There was no overall change in BMI or BMI SDSs from 0-12 months for the treatment group. No adverse effects were reported. CONCLUSIONS: Both treatment and control groups experienced significant reductions in the level of overweight, but with no significant difference between them. There were no significant group differences for any of the secondary outcomes. This trial was registered at http://www.controlled-trials.com/ under ISRCTN 51382628.

Journal article

Nicholls D, Bryant-Waugh R, 2011, Diagnosis and Classification of Disordered Eating in Childhood, Eating Disorders in Children and Adolescents A Clinical Handbook, Editors: Le Grange, Lock, Publisher: Guilford Press, ISBN: 9781609184933

Bringing together leading authorities, this comprehensive volume integrates the best current knowledge and treatment approaches for eating disorders in children and adolescents.

Book chapter

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