Imperial College London

DrDashaNicholls

Faculty of MedicineDepartment of Brain Sciences

Clinical Reader in Child and Adolescent Psychiatry
 
 
 
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d.nicholls

 
 
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Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

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95 results found

Pascual-Sanchez A, Hickey N, Mateu A, Martinez-Herves M, Kramer T, Nicholls Det al., 2021, Personality traits and self-esteem in traditional bullying and cyberbullying, PERSONALITY AND INDIVIDUAL DIFFERENCES, Vol: 177, ISSN: 0191-8869

Journal article

Pascual-Sanchez A, Mateu A, Martinez-Herves M, Hickey N, Kramer T, Nicholls Det al., 2021, How are parenting practices associated with bullying in adolescents? A cross-sectional study, CHILD AND ADOLESCENT MENTAL HEALTH, ISSN: 1475-357X

Journal article

Solmi F, Downs JL, Nicholls DE, 2021, COVID-19 and eating disorders in young people., Lancet Child Adolesc Health, Vol: 5, Pages: 316-318

Journal article

Rosello R, Gledhill J, Yi I, Watkins B, Harvey L, Hosking A, Viner R, Nicholls Det al., 2021, Early intervention in child and adolescent eating disorders: The role of a parenting group., Eur Eat Disord Rev, Vol: 29, Pages: 519-526

OBJECTIVE: Parental involvement is emphasised in treatment guidelines for Eating Disorders (ED). The primary aim of this phase II study was to estimate the impact of a parent group intervention delivered immediately post-diagnosis on weight gain and ED psychopathology in a cohort of young people referred to a community ED service. A secondary aim was to identify predictor variables for early treatment response in children whose parents attended the programme. METHOD: Parents of 64 new cases of Anorexia Nervosa (AN; n = 50) and Atypical Anorexia (AAN, n = 14) attended a 6 week parent group intervention in addition to treatment as usual in which patients were weighed and reviewed, but had no other contemporaneous psychological intervention. Age and gender adjusted BMI (%median [m] BMI) and ED psychopathology at baseline, 6-week and 6-month follow-up were analysed to assess weight gain and identify predictors of outcome. RESULTS: The intervention was associated with weight gain and improved ED psychopathology by the end of the programme; these gains were sustained at 6 months %mBMI at 6 weeks was the only predictor of outcome (%mBMI) at 6 months. CONCLUSIONS: This preliminary work highlights the positive benefit of an ED focused parent group early intervention that could be further evaluated.

Journal article

Burmester V, Graham E, Nicholls D, 2021, Physiological, emotional and neural responses to visual stimuli in eating disorders: a review, Journal of Eating Disorders, Vol: 9, ISSN: 2050-2974

BACKGROUND: Overconcern with food and shape/weight stimuli are central to eating disorder maintenance with attentional biases seen towards these images not present in healthy controls. These stimuli trigger changes in the physiological, emotional, and neural responses in people with eating disorders, and are regularly used in research and clinical practice. However, selection of stimuli for these treatments is frequently based on self-reported emotional ratings alone, and whether self-reports reflect objective responses is unknown. MAIN BODY: This review assessed the associations across emotional self-report, physiological, and neural responses to both food and body-shape/weight stimuli in people with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). For food stimuli, either an aversive or lack of physiological effect was generated in people with AN, together with a negative emotional response on neuroimaging, and high subjective anxiety ratings. People with BN showed a positive self-rating, an aversive physiological reaction, and a motivational neural response. In BED, an aversive physiological reaction was found in contrast to motivational/appetitive neural responses, with food images rated as pleasant. The results for shape/weight stimuli showed aversive responses in some physiological modalities, which was reflected in both the emotional and neural responses, but this aversive response was not consistent across physiological studies. CONCLUSIONS: Shape/weight stimuli are more reliable for use in therapy or research than food stimuli as the impact of these images is more consistent across subjective and objective responses. Care should be taken when using food stimuli due to the disconnect reported in this review.

Journal article

Lock J, Le Grange D, Nicholls D, Couturier Jet al., 2021, Editorial: innovations in research and practice of family based treatment for eating disorders, Frontiers in Psychiatry, Vol: 11, Pages: 1-2, ISSN: 1664-0640

Journal article

Dewa L, Crandell C, Choong E, Jaques J, Bottle R, Kilkenny C, Lawrence-Jones A, Di Simplicio M, Nicholls D, Aylin Pet al., 2021, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown, Journal of Adolescent Health, ISSN: 1054-139X

PurposeExploring the impact of COVID-19 pandemic on young people’s mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using co-production methodology.MethodsThe mental health status of young people (aged 16-24) in April 2020 was established utilising a sequential explanatory co-produced mixed methods design. Factors associated with poor mental health status including coping strategies were also examined using an online survey and semi-structured interviews.Results30.3% had poor mental health and 10.8% had self-harmed since lockdown. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI 0.54-25.40). Behavioural disengagement (OR 1.462, 95% CI 1.22-1.76), self-blame (OR 1.307 95% CI 1.10-1.55), and substance use (OR 1.211 95% CI 1.02-1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07-1.15), sleep problems (OR 0.915 95% CI 0.88-0.95) and conscientiousness personality trait (OR 0.819 95% CI 0.69-0.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened and (3) mental health and non-mental health support needed during and after lockdown.ConclusionPoor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.

Journal article

Halls D, Leslie M, Leppanen J, Sedgewick F, Surguladze S, Fonville L, Lang K, Simic M, Nicholls D, Williams S, Tchanturia Ket al., 2021, The emotional face of anorexia nervosa: The neural correlates of emotional processing, Human Brain Mapping, ISSN: 1065-9471

Social–emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social–emotional processing in a large sample of individuals with AN.

Journal article

Ghaznavi I, Gillies D, Nicholls D, Edalat Aet al., 2020, Photorealistic avatars to enhance the efficacy of Selfattachment psychotherapy, Pages: 60-67

We have designed, developed, and tested an Immersive virtual reality (VR) platform to practice the protocols of Self-attachment psychotherapy. We made use of customized photorealistic avatars for the implementation of both the high-end version (based on Facebook's Oculus) and the low-end version (based on Google's cardboard) of our platform. Under the Selfattachment therapeutic framework, the causes of mental disorders such as chronic anxiety and depression are traced back to the individual's insecure attachment with their primary caregiver during childhood and their subsequent problems in affect regulation. The conventional approach (without VR) to Selfattachment requires that the individual uses their childhood photographs to recall their childhood memories and then imagine that the child that they were is present with them. They thus establish a compassionate relationship with their childhood self and then, using love songs and dancing, create an affectional bond with them. Their adult self subsequently role plays a good parent and interacts with their imagined childhood self to perform various developmental and re-parenting activities. The goal is to enhance their capacities for self-regulation of emotion, which can lead them into earning secure attachment. It is hypothesized that our immersive virtual reality platform - which enables the users to interact with their customized 3D photorealistic childhood avatar - offers either a better alternative or at least a complementary visual tool to the conventional imaginal approach to Self-attachment. The platform was developed in Unity 3D, a cross-platform game engine, and takes advantage of the itSeez3D Avatar SDK for generating a customized photorealistic 3D avatar head from a 2D childhood image of the user. The platform also offers facial and body animations for some of the basic emotional states such as Happy, Sad, Scared and Joyful and it allows modifications to the avatar body (height/ width) and clothing color.

Conference paper

Leslie M, Halls D, Leppanen J, Sedgewick F, Smith K, Hayward H, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Murphy D, Williams S, Tchanturia Ket al., 2020, Corrigendum: Neural correlates of theory of mind are preserved in young women with anorexia nervosa, Frontiers in Psychology, Vol: 11, Pages: 1-2, ISSN: 1664-1078

Journal article

Dewa L, Crandell C, Choong E, Jaques J, Bottle R, Kilkenny C, Lawrence-Jones A, Nicholls D, Di Simplicio M, Aylin Pet al., 2020, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown

Working paper

Leslie M, Halls D, Leppanen J, Sedgewick F, Hayward H, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Murphy D, Williams S, Tchanturia Ket al., 2020, Neural correlates of theory of mind are preserved in young women with anorexia nervosa, Frontiers in Psychology, Vol: 11, Pages: 1-8, ISSN: 1664-1078

People with anorexia nervosa (AN)commonly exhibit social difficulties, which may be related to problems with understanding the perspectives of others, commonly known as Theory of Mind (ToM) processing. However, there is a dearth of literature investigating the neural basis of these differences in ToM and at what age they emerge.This study aimed to test for differences in the neural correlates of ToM processes in young women with AN, and young women weight-restored from AN, as compared to healthy control participants(HC). Based on previous findings in AN, we hypothesised that young women with current or prior AN, as compared to HCs,would exhibit a reduced neural response in the medial prefrontal cortex, the inferior frontal gyrus, and the temporo-parietal junction whilst completing a ToMtask.We recruited 73 young women with AN, 45 weight-restored young women, and 70 young women without a history of AN to take part in the current study. Whilst undergoing a functional magnetic resonance imaging(fMRI)scan, participants completed the Frith-Happé task, which is a commonly-used measure of ToM with demonstrated reliability and validity in adult populations. In this task, participantsviewed the movements of triangles, which depicted either action movements, simple interactions, or complex social interactions.Viewing trials with more complex social interactions in the Frith-Happé task was associated with increased brain activation in regions including the right temporo-parietal junction, the bilateral medial prefrontal cortex, the cerebellum, and the dorsolateral prefrontal cortex. There were no group differences in neural activation in response to the ToM contrast. Overall, these results suggest that the neural basis of spontaneous mentalising is preserved in most young women with AN.

Journal article

Mateu A, Martinez-Herves M, Nicholls D, Kramer T, Pascual-Sanchez Aet al., 2020, Cyberbullying and post-traumatic stress symptoms in UK adolescents, Archives of Disease in Childhood, ISSN: 0003-9888

Journal article

Alberts Z, Fewtrell M, Nicholls DE, Biassoni L, Easty M, Hudson LDet al., 2020, Bone mineral density in Anorexia Nervosa versus Avoidant Restrictive Food Intake Disorder, BONE, Vol: 134, ISSN: 8756-3282

Journal article

Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong ICet al., 2020, Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT, Programme Grants for Applied Research, Vol: 8, Pages: 1-264, ISSN: 2050-4322

<jats:sec id="abs1-1"><jats:title>Background</jats:title><jats:p>Five linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.</jats:p></jats:sec><jats:sec id="abs1-2"><jats:title>Objectives</jats:title><jats:p>(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).</jats:p></jats:sec><jats:sec id="abs1-3"><jats:title>Methods</jats:title><jats:p>Five substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.</jats:p></jats:sec><jats:sec id="abs1-4"><jats:title>Results</jats:title><jats:p>Study A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledg

Journal article

Nicholls D, Becker A, 2020, Food for thought: bringing eating disorders out of the shadows, British Journal of Psychiatry, Vol: 216, Pages: 67-68, 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

Neale J, Pais SMA, Nicholls D, Chapman S, Hudson LDet al., 2020, What Are the Effects of Restrictive Eating Disorders on Growth and Puberty and Are Effects Permanent? A Systematic Review and Meta-Analysis., J Adolesc Health, Vol: 66, Pages: 144-156

PURPOSE: The objective of the study was to examine (1) the effect of restrictive eating disorders (EDs) on growth and pubertal development in children and young people (CYP) and (2) potential reversibility of this with recovery and associated factors. EDs can impact growth and puberty in CYP, but reports have conflicted over effect on height and permanence of growth impairment and pubertal delay. METHODS: This is a systematic review and meta-analysis, searching PubMed, EMBASE, PsycINFO, and Web of Science from May 31, 2018, to inception. We included observational studies or systematic reviews regarding growth and puberty in EDs in CYP aged <18 years or in studies reporting outcomes in adults known to have had an ED under age 18 years. Cross-sectional studies were pooled for meta-analysis for effects on height. RESULTS: A total of 27 studies were included. Growth and pubertal delay were commonly reported, but evidence for catch-up growth found in the majority. However, catch-up growth was not seen in all and may be suboptimal. Meta-analysis of 459 subjects (213 with anorexia nervosa and 246 controls) found no significant difference in height at baseline, with weighted mean difference -.13 cm (95% CI -2.64 to 2.38 cm; p = .9; I2 = 68.5%). Younger age and longer duration of illness are potential risks for growth delay; weight gain appears protective for catch-up growth. Findings are primarily generalisable to females, given limited data on males. CONCLUSIONS: CYP with restrictive EDs are at risk of growth impairment and pubertal delay, though potentially reversible. Attention to growth in EDs is important, especially in the young. Weight restoration should be encouraged to avoid adverse effects and allow opportunity for catch-up.

Journal article

Lock J, Nicholls D, 2020, Toward a greater understanding of the ways family-based treatment addresses the full range of psychopathology of adolescent anorexia nervosa, Frontiers in Psychiatry, Vol: 10, Pages: 1-8, ISSN: 1664-0640

Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT.

Journal article

Petkova H, Simic M, Nicholls D, Ford T, Prina AM, Stuart R, Livingstone N, Kelly G, Macdonald G, Eisler I, Gowers S, Barrett BM, Byford Set al., 2019, Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study, BMJ Open, Vol: 9, Pages: 1-9, ISSN: 2044-6055

Objectives This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.Design Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.Setting The study was based in the UK and Ireland.Participants Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.Main outcome measures Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.Results 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.Conclusion These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.

Journal article

Viner RM, Aswothikutty-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 & ADOLESCENT HEALTH, Vol: 3, Pages: 685-696, ISSN: 2352-4642

Journal article

Viner R, Ward J, Hudson L, Stiglic N, Nicholls Det al., 2019, Roles 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, Vol: 3, Pages: 685-696, ISSN: 2352-4642

BackgroundThere 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.MethodsWe 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.FindingsVery 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

Journal article

Beykloo M, Nicholls D, Simic M, Brauer R, Mills E, Wong Iet al., 2019, A survey on self-reported psychotropic drug prescribing practices of eating disorder psychiatrists for the treatment of young people with anorexia nervosa, BMJ Open, Vol: 9, 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

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

Nicholls D, 2018, ARFID and other eating disorders of childhood, Eating Disorders and Obesity in Children and Adolescents, Pages: 29-33, ISBN: 9780323548533

Avoidant restrictive food intake disorder (ARFID) does not exclusively occur in childhood, although most literature to date relates to this age group. Data supporting the subcategorization of ARFID are emerging; a transdiagnostic approach to restrictive eating disorders (EDs) based on neurobiological commonalities also has merit. Prevalence data suggest ARFID is more common than EDs in middle childhood, but not all reach clinical care. Research on pica and rumination disorder, which are also relatively common in the population, is limited. Childhood-onset anorexia nervosa (AN) is emerging as distinct from adolescent-onset AN in risk and outcome.

Book chapter

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

Lewis B, Nicholls D, 2016, Behavioural eating disorders, Paediatrics and Child Health (United Kingdom), Vol: 26, Pages: 519-526, ISSN: 1751-7222

The eating disorders, anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED), manifest through distorted or chaotic eating and in the case of AN and BN are characterised by a morbid preoccupation with weight and shape. Whilst recent changes in diagnostic criteria have changed the landscape to some extent, eating disorders and partial syndromes, including avoidant/restrictive food intake disorder (ARFID), remain relatively common and early recognition and intervention is helpful. Aetiology is multifactorial, with high heritability. Prognosis overall is good but treatment can be long and intensive, significantly impacting families. An integrated multidisciplinary approach is essential, working collaboratively with families and young people. Psychological interventions focus on the eating disorder, supported by medical monitoring and dietetic guidance. Although working with families is the backbone of treatment for AN, young people also need opportunities for confidential discussion. For BN, family or individual approaches may be equally effective. Evidence for effectiveness of psychopharmacological agents is limited in both AN and BN. Psychological and pharmacological approaches may both be of benefit for BED. Cases of ARFID require individualised approaches, often involving anxiety reduction. Paediatric expertise is of particular value in the assessment and management of acute malnutrition and complications secondary to disordered eating behaviours, in the early stages of re-feeding, and in the monitoring and management of long-term complications such as growth retardation, pubertal delay and osteopenia. This article offers an overview of eating disorders in children offering advice for clinicians who will undoubtedly encounter them in clinical practice.

Journal article

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