Pica in childhood: concurrent and sequential psychiatric comorbidity

Abstract Objective: Pica is the persistent eating of non-nutritive, nonfood substances and is associated with serious medical consequences. There has been a lack of research into the psychiatric comorbidities of pica, despite being important for informing clinical care. The current study examines psychiatric comorbidities of pica in childhood and the longitudinal relationship between childhood pica and adolescent eating disorders. Methods: We analyzed data from the Avon Longitudinal Study of Parents and Children study. Pica and psychopathology, assessed with the Development and Well-Being Assessment and the Strengths and Difficulties Questionnaire, were assessed at about 7- and 10-years of age, reported eating disorders (ED) at 14-, 16-, and 18-years of age. We conducted linear and logistic regression models, adjusting for covariates, to identify concurrent psychiatric comorbidities, as well as risk for later EDs. Results. Pica was associated with increased odds of any psychiatric disorder and behavioral disorders in early childhood [OR = 7.30, p < .001 and OR = 5.65, p < .001, respectively] and mid-childhood [OR = 5.75, p < .001 and OR = 10.66, p < .001, respectively], and greater concurrent hyperactivity, conduct problems, peer problems, prosocial and emotional difficulties (p <.01 across analyses). We did not find evidence pica presence increased odds for concurrent emotional disorders nor for later ED risk. Discussion: The association between pica and psychiatric and behavioral disorders, indicates a likely shared aetiology. Our findings provide insight into the psychiatric characteristics of children with pica and highlight they may require complex behavioral support beyond their eating difficulties. [250] Public Significance (for IJED) This study investigated the relationship between pica (the eating of non-food substances) and mental health conditions in childhood. We found that in childhood, pica was associated with increased odds of having behavioral disorders (e.g., ADHD and conduct disorder) and mental disorder (e.g., anxiety or ADHD) but not emotional disorders (e.g., OCD and depression). Our findings suggest children with pica may require complex behavioral support beyond their eating difficulties. Competing Interest Statement The authors have declared no competing interest. Funding Statement Funding was provided by the Medical Research Foundation (MRF-058-0015-F-CHAW). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵* joint last authors Author Note Laura Rubino: laura.g.rubino{at}drexel.edu, Cynthia Bulik: cynthia_bulik{at}med.unc.edu, Samuel JRA Chawner: ChawnerSJ{at}cardiff.ac.uk, Nadia Micali: nadia.micali{at}regionh.dk; Laura Rubino: Conceptualization, Methodology, Formal Analysis, Writing-Original Draft; Cynthia Bulik: Conceptualization, Resources, Supervision; Samuel JRA Chawner: Conceptualization, Methodology, Formal Analysis, Funding Acquisition, Supervision Writing-Review and Edit; Nadia Micali: Conceptualization, Resources, Writing-Review and Edit, Funding Acquisition.; Code is available upon request. Please contact the first author at laura.g.rubino{at}drexel.edu with questions or for code. Funding was provided by the Medical Research Foundation (MRF-058-0015-F-CHAW). The authors have no conflict of interest to disclose. Correspondence should be addressed to Laura Rubino, Psychological and Behavioral Sciences, 3201 Chestnut Street, Philadelphia, PA, USA Email: laura.g.rubino{at}drexel.edu Data Availability Data is available given approval of a third party, ALSPAC. - ADHD - attention deficit hyperactivity disorder - ALSPAC - Avon Longitudinal Study of Parents and Children - AN - anorexia nervosa - BED - binge eating disorder - BN - bulimia nervosa - DSM-5 - Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition - ED - Eating Disorder - PD - purging disorder