A Duke professor recently discovered the link between picky eating in childhood and a host of underlying psychological problems that could carry into adulthood.

In an attempt to find the “nature of selective eating," Nancy Zucker, director of the Duke Center for Eating Disorders and associate professor of psychiatry and behavioral sciences, conducted a study and showed an association between picky eating and a number of psychological disorders such as anxiety, depression and attention-deficit hyperactivity disorder. The study—which analyzed psychological and behavioral traits in children that correlated to their eating habits and was published in the journal Pediatrics—also serves to remove the stigma surrounding selective eating in both children and adults.

“I hope that [the research] will give college students who are selective eaters feel more compassion for themselves and have their friends feel more compassion, because selective eating is actually pretty complicated," Zucker said. "These folks are more anxious, more depressed."

Zucker's interest in studying selective eating first started when she noticed a lack of previous research in the area.

"When you look to the literature to find some guidance about how to help them, there really wasn’t a lot there," she said. "[I wanted to] try to learn more about it, so we could intervene more effectively.”

The study started with a group of children who received regular pediatric checkups from Duke University Health System. Zucker’s colleagues—Helen Egger, associate professor of psychiatry and behavioral sciences and Adrian Angold, associate professor emeritus of psychiatry—had been using a community sample of these kids between the ages of two and six to investigate anxiety disorders in preschoolers.

From this cohort, around 3,400 children went through a screening process to see if they qualified for the study, and a final sample of around 900 was selected. The families of the children were then interviewed in their homes and received the Preschool Age Psychiatric Assessment. The PAPA, which Egger helped develop, gauges a child's emotions and behavior by asking parents questions—including how often the child is left home alone and how age appropriate the child’s friend are.

The study reported that children with selective eating habits, moderate or severe, display higher levels of anxiety and depression.

“We would classify two levels of selective eating: severe and moderate," Zucker said. "In the severe group were children who couldn’t eat outside the home because their eating [preference] was so severe. They were twice as likely to have a depressive disorder diagnosis and seven times as likely to be diagnosed with social anxiety."

Although the moderate group also had higher levels of anxiety and depression, the symptoms did not reach clinical thresholds of severity. Zucker said, however, that even mildly elevated levels of anxiety and depression can stay with children until adulthood.

To overcome selective eating, Zucker recommends children with selective eating habits practice eating new foods during a time other than dinner.

"Don’t make trying new foods happen at dinner or at the family meal time because you really want those to be a safe place," she said. "You practice trying new foods like you practice an instrument or like you practice a sport. You find a time after school where you are going to do a food adventure to see what foods taste like.”

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Zucker hopes that this research will have a social impact as well as a psychological one. She explained that on campus, for example, the study could reach out to students who are selective eaters and establish a support system to provide the help and guidance they need.