Bryan Lask

University of London

Objective This study aimed to identify discrete neuropsychological profiles and their relationship to clinical symptoms in 253 female children and adolescents with anorexia nervosa (AN) and 170 healthy controls (HCs) using a standardised neuropsychological assessment battery. Method Hierarchical cluster analysis was used to identify the optimum nu...

Weaknesses in planning by patients with anorexia nervosa (AN) have been noted (e.g., Zakzanis, Campbell, & Polsinelli, 2010) and are generally based on adults. This study explored D-KEFS Tower Test performance to better understand learning styles and strategies used by child and adolescent patients with AN compared to healthy controls. Overall, no...

Background: Disturbed eating behavior and psychosocial variables have been found to influence metabolic control, but little is known about how these variables interact or how they influence metabolic control, separately and combined. Objective: To explore associations between metabolic control (measured by HbA1c) and eating disorder psychopathol...

This is the 2nd edition of the CRT Resource Pack, designed for professionals working with patients suffering from feeding and eating disorders. The content focuses primarily on the practicalities of delivering CRT, and includes an extensive list of games and task considered useful in remediating cognitive weaknesses in flexibility and central coher...

The Brixton Spatial Anticipation Test assesses individuals' cognitive flexibility in terms of rule detection and attainment. It has been used to assess executive functioning in both clinical and nonclinical adult samples. However, little is currently known about the suitability of this task for younger populations. The current study therefore aimed...

The rigid and obsessional features of anorexia nervosa (AN) have led researchers to explore possible underlying neuropsychological difficulties. Numerous studies have demonstrated poorer set-shifting in patients with AN. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN,...

An accurate weight perception has been associated with motivation to change eating habits in the case of under- or overweight. However, recent studies have reported frequent misperceptions among parents and their offspring, both in the form of under- and overestimation of weight status. The aim of the present study was to investigate weight percept...

The objective of this study was to compare body size estimation based on memory versus perception, in patients with anorexia nervosa (AN) and healthy controls, adjusting for possible confounders. Seventy-one women (AN: 37, controls: 35), aged 14-29 years, were assessed with a computerized body size estimation morphing program. Information was gathe...

Previous studies assessing the potency of cognitive remediation therapy (CRT) have largely focused on performance-based assessments and how these change during the course of the intervention. Little is known of behavioural manifestations of such changes, and no previous studies have studied parental reports before and after CRT. Patient and parenta...

The vast majority of studies in anorexia nervosa that have investigated the domains of central coherence, organizational strategy, and visuospatial memory have focused on adult samples. In addition, studies investigating visuospatial memory have focused on free recall. No study to date has reported the association between recognition memory and cen...

Anorexia nervosa (AN) in childhood and adolescence has a poor prognosis. It is possible that this may in part be due to the fact that cognitive weaknesses that appear to be risk factors for its development and maintenance are not being targeted in treatment. Through its focus on these deficits, cognitive remediation therapy (CRT) has been shown to...

Anorexia nervosa (AN) in childhood and adolescence has a poor prognosis. It is possible that this may in part be due to the fact that cognitive weaknesses that appear to be risk factors for its development and maintenance are not being targeted in treatment. Through its focus on these deficits, cognitive remediation therapy (CRT) has been shown to...

To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, dep...

Twenty-one years ago, Lask and colleagues first described pervasive refusal syndrome (PRS) as a child's "dramatic social withdrawal and determined refusal to walk, talk, eat, drink, or care for themselves in any way for several months" in the absence of an organic explanation. PRS has been conceptualised in a variety of ways since then. These have...

Background: Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility...

Verbal fluency performance is commonly evaluated in clinical neuropsychology, in particular for assessment of executive functioning. Fluency is usually assessed by the person's ability to produce as many words as possible from a given cue within a specific timeframe. The cues are typically phonemic, e.g. words beginning with a specific letter, or s...

Objective: Based on inconsistent findings in the literature, this study tested the hypothesis that "there is a season of birth bias for females with anorexia nervosa (AN)." Method: Females with AN, born in 1975 to 1996, were compared to females born in the same years and geographical regions by chi-square test for contingency tables with known p...

Season of birth bias has been observed for people with a number of disorders, including women with bulimia nervosa. However, inconsistent results and methodological weaknesses render previous conclusions about such bias uncertain. With an enhanced methodology, this study aims to test whether there is a season of birth bias for women with bulimia ne...

The Ravello Profile test battery was developed to ensure a consistent methodology when researching neuropsychological functioning in anorexia nervosa (AN). To date, 157 patients with AN have been assessed with the full Ravello Profile. The present review is the first study to systematically investigate the tests included in the battery. Fifteen exp...

The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. Th...

The literature suggests that there is significant familial aggregation of eating disorders. A specific association has also been reported between childhood feeding problems and maternal eating disorder. This study investigates whether subgroups of children with early onset eating disturbance are distinguished by maternal eating disorder history. Th...

Nibbling has been defined by the Eating Disorder Examination (EDE 16.0) as eating in an unplanned and repetitious manner between meals and snacks without an accompanying sense of loss of control. We investigated the nature and frequency of nibbling in young women. Fifty-eight university women aged 19-41 years with an average BMI of 22.8 (4.8) were...

This study explores whether neurobiological status (indexed by regional cerebral blood flow) at initial presentation predicts neuropsychological status at four-year follow up in a sample of children with early onset anorexia nervosa. Neuropsychological assessment was conducted on 15 females four years after their initial treatment, and matched cont...

Oversettelser av utenlandske instrumenter gjøres ofte lokalt, uten noen kontroll av oversettelsesprosessen. Ved å følge oversettelsesprosedyrene som beskrives, vil man bedre sikre kvaliteten på instrumentene som brukes i klinisk og forskningsrelatert praksis.

A number of specific deficits in neuropsychological functioning in anorexia nervosa (AN) have been identified. However, it is not known whether these specific deficits cluster together to form one or more clear neuropsychological profiles. We present a case series of nine participants who were recruited as part of a wider, ongoing investigation of...

IntroductionThe modelCritical appraisalClinical implicationsConclusion AcknowledgementsReferences

Why is the brain important in eating disorders? This ground-breaking new book describes how increasingly sophisticated neuroscientific approaches are revealing much about the role of the brain in eating disorders. Even more importantly, it discusses how underlying brain abnormalities and dysfunction may contribute to the development and help in the...

The present study compared the Eating Disorder Examination (EDE; 16.0) and the Eating Disorder Examination-Questionnaire (EDE-Q; 6.0) and investigated the psychometric properties of the Norwegian translation of the EDE. Fifty-eight university women aged 19-41 years (mean BMI = 23) were assessed with the EDE and EDE-Q. Satisfactory internal consiste...

This study investigated body size estimation in Norwegian adolescents (aged 12-15; N=406) using a distorting photograph technique. The percentage of over- or underestimation was calculated for pictures of the subject, other persons and a neutral object. The Eating Disorders Inventory for Children (EDI-C) was also completed. Among adolescents at ris...

CRT is a treatment that focuses on the process rather than the content of thought and perception, the how rather than the what. It aims to remedy cognitive deficits or weaknesses that may contribute to the pathogenesis of anorexia nervosa. This resource pack is intended to support those who have already attended specialist training in using CRT. I...

Frampton, I., Wisting, L., Øverås, M., Midtsund, M. & Lask, B. (2011). Reliability and validity of the Norwegian translation of the Child Eating Disorder Examination (ChEDE). Scandinavian Journal of Psychology 52, 196–199. The Child Eating Disorder Examination (ChEDE) is a valid and reliable semi-structured interview, which measures eating-disorder...

Recent research suggests that neuropsychological factors may play an important role in the development and maintenance of anorexia nervosa. However, it has been difficult to draw firm conclusions because of the wide range of assessments and norms that have been used. The aim of the Ravello Profile is to define a common shared neuropsychological ass...

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is a relatively new intervention and targets neuropsychological deficits, such as set shifting difficulties, weak central coherence and visuospatial deficits. To date there are no published descriptions of CRT for adolescents with AN. CRT has been traditionally delivered on an individual...

IntroductionPsychopharmacologyThe educational contextPsychological treatmentConclusion References

Previous studies have demonstrated localised abnormalities of cerebral blood flow in anorexia nervosa, suggesting reduction of cerebral activity and function in specific regions. There is debate as to whether such findings are secondary to starvation or indicative of a primary abnormality predating the illness, representing an underlying biological...

The Eating Disorder Examination (EDE) is a semi-structured interview used worldwide for diagnostic purposes and to assess the core psychopathology of an eating disorder. The Eating Disorder Examination Questionnaire 6.0 (EDE-Q) has been developed as a self-report questionnaire version of the full-length interview. This study was conducted to establ...

Anorexia nervosa is a serious illness with major physical and psychological morbidity. It has largely been understood in terms of cultural and environmental explanations. However these are insufficient to explain the diverse clinical features of the illness, nor its rarity given the universality of sociocultural factors. Over the last 20 years, the...

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) should be considered in sudden onset, prepubertal Anorexia Nervosa (AN), arising shortly after an apparent streptococcal infection. However, the absence of a specific biological marker of PANDAS renders the diagnosis difficult. This paper critically rev...

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth th...

Previous studies have shown that symptoms of obsessive compulsive disorder are common in both adults and children and adolescents with anorexia nervosa. Until now, no study has explored the specific obsessive compulsive symptoms shown in children and adolescents with AN. In this study we report types of symptoms displayed by young people with AN an...

Target weights are an arbitrary means of determining return to physical health in patients with anorexia nervosa (AN) and lack reliability and validity. Transabdominal pelvic ultrasound scanning (U/S) offers a more objective method of ascertaining physical well being by the ability to determine reproductive maturity. This study aimed to explore the...

In the absence of a strong evidence base for treatment of eating disorders, it is inevitable that there will be disagreement about what is the most appropriate treatment service. Much of K. Halmi’s overview of what constitutes such a service is helpful and uncontroversial. In this commentary, I will focus on what I believe to have been neglected, i...

Recent research in anorexia nervosa has demonstrated specific and persistent neuropsychologica deficits associated with specific, localized and unilateral abnormalities on neuroimaging. These point to an underlying neurobiological substrate, with a disconnection in neural circuitry being implicated. This article summarizes the most relevant studies...

Anorexia nervosa is a condition full of irony and paradox. Perhaps the most enigmatic of these is that professionals tend to hold the same morbid preoccupation with weight, BMI and targets as do our patients. In this article we outline why we believe that an over-emphasis on weight/BMI and targets is inappropriate, misleading and potentially harmfu...

This study aimed to investigate the initial psychometric properties and to establish norms for the Clinical Impairment Assessment (CIA v. 3.0) among a nonclinical sample of young adult women. The CIA is a brief, 16-item self-report measure designed to assess psychosocial impairment due to eating disorder features over the past 28 days. We administe...

In England and Wales the compulsory treatment of young people with severe eating disorders is controversial. There is a concern that such treatment may impair patient autonomy and negatively influence the outcome. In this study, based in a specialist hospital, we compared patients treated under parental consent with those detained under the Mental...

The Body Checking Questionnaire is a brief self-report questionnaire designed to specifically assess body checking behaviours. The ritualistic checking of weight and shape may intensify body size preoccupation and maintain disordered eating behaviours, such as purging or restrictive eating. This study describes the translation and cross-cultural ad...

A season of birth (SoB) bias is said to be present if the SoB pattern for a particular group varies from the pattern within the normal population. Significant biases have been found for several disorders including eating disorders (EDs). This article critically reviews the existing literature on SoB in ED in order to inform future hypothesis-based...

The reported abnormalities of brain function in anorexia nervosa (AN) include impairment of neural circuits involving cortical (orbito-frontal, somatosensory and parietal) and sub-cortical (amygdala, hippocampus, thalamus, hypothalamus and striatum) structures. The insular cortex serves an integrative function for all the structures relevant to the...

Substantial evidence exists for the concept of pediatric autoimmune neuropsychiatric disorders associated with streptoccoccal infection (PANDAS) such as some cases of obsessive-compulsive disorder and tics/Tourette's syndrome. More recently PANDAS-AN has been described. The aim of this article is to provide a critical review of this concept. The li...

: The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents. A review of current classifications and related literature in child development is provided. Problems with current classificatio...

This study aimed to determine the validity and psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in British adolescent girls with and without eating disorders. Sixty patients and 60 age-matched controls completed the SAWBS Inventory and measures of eating disorder symptoms, body shape concerns, and depression. Pat...

Pelvic ultrasonography is generally regarded as the gold standard for determination of pelvic maturity and hence the need for further weight gain in patients with anorexia nervosa. Many clinicians, however, have limited knowledge of this technique. Here, we describe the use of pelvic ultrasonography in anorexia nervosa and present an algorithm to a...

Background Numerous studies have addressed obsessive– compulsive features in adults with anorexia nervosa (AN), but few have been conducted with younger patients. The aim of this study was to describe the frequency and severity of obsessive–compulsive disorder (OCD) symptoms and obsessive–compulsive personality (OCP) traits, and to explore the rela...

Objective Neuroimaging and neuropsychology studies in anorexia nervosa have produced conflicting results due to confounding variables of comorbidity, psychotropic medication, age of onset, states of starvation and the absence of homogenous samples and suitable control groups. The aim of this study is to determine if consistent functional abnormalit...

There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group...

The Eating Disorder Examination (EDE) is a reliable and valid semistructured interview that measures the specific psychopathology of anorexia nervosa (AN) and bulimia nervosa. The current study aims to investigate the psychometric properties of the child adaptation of the EDE (ChEDE 12.0). The ChEDE was administered to 15 children with AN, 15 child...

Previous neuroimaging studies in early-onset anorexia nervosa provide evidence of limbic system dysfunction. The current study adds support to the possibility by revealing a significant association between unilateral reduction of blood flow in the temporal region and impaired visuospatial ability, impaired visual memory, and enhanced speed of infor...

Patients with anorexia nervosa (AN) born in the northern and southern hemispheres are more likely to be born during spring months than at any other time of the year. It has been hypothesized that environmental temperature at the time of conception may have a significant role in this pattern of findings. The current study aims to investigate the pat...

Abnormal patterns of family functioning have often been reported in anorexia nervosa. Moreover, members of families with an adult with eating disorders have different family functioning perspectives. This study investigated whether differences in family members' perspectives, similar to the ones found in families of adults with eating disorders, ca...

Pervasive refusal syndrome is a severe, pervasive and life-threatening disorder. Most commonly seen in girls between the ages of 8 and 15, although also affecting boys and younger age groups, it is characterised by a profound and pervasive refusal to eat, drink, talk, walk and engage in any form of self-care. A determined resistance to treatment is...

One expression of the core psychopathology of eating disorders is the repeated checking and avoidance of shape or weight. Two studies are reported. The primary purpose of the first was to describe the phenomenology of such body checking and avoidance. The aim of the second was to compare body checking and avoidance in women with and without a clini...

A controlled trial of the effectiveness of family therapy for asthmatic children has been completed, and the results indicate that family therapy may have a part to play in the management of asthma. Our observations have shown that an interaction of psychosocial factors can have a significant effect on the course of the asthma by setting up a circu...

phenothiazines, anti-depressants, tranquillizers, lithium, behaviour therapy, family therapy and the current rising star, cognitive therapy. Within family therapy, following the early influence of the psycho- dynamic schools, many others emerged in rapid succession, including the structural, strategic and paradoxical schools, whilst at present the...

The performance of a pictorial assessment instrument and suggestions for clinical application are described. The stylized family illustrations include the following patterns: normal family, detouring, two-generational enmeshment, three-generational enmeshment, parental child, undermined mother and chaotic family. Ninety-eight individuals, five year...

Pediatricians and their colleagues often have considerable difficulty in understanding and managing poor adherence. It is hard to comprehend why children with life-threatening illnesses do not adhere to their treatment regimens and even more difficult to comprehend why their parents do not provide optimal care. Yet, clinical experience indicates th...

The Pros and Cons of Anorexia Nervosa (P-CAN) Scale was developed out of a previous qualitative study [Int J Eat Disord 25 (1999) 177] in which the positive and negative aspects of anorexia nervosa (AN) were elicited from individuals with AN. Principal components analysis was then used in an adult sample to reduce the number of items and to derive...

This study, part of a continuing effort to understand the pathophysiology of the brain in early-onset anorexia nervosa, attempts to validate findings from an earlier study of regional cerebral blood flow and to correlate any abnormalities in blood flow with eating disorder psychopathology. Fifteen newly referred children and adolescents with a diag...

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did th...

Conflict is an everyday phenomenon, a part of everyday life. It is hardly surprising that it also occurs in a clinical setting, not only between clinicians and within teams, but also between patients, their families and clinicians. This is all the more the likely in a setting that deals with a chronic disease such as CF. The physical, emotional, so...

While the majority of patients with cystic fibrosis (CF) survive well into adulthood, some do so against the odds. The severity of their illness, their psychosocial environment, or their failure to adhere to treatment are such that survival could not have been predicted. It appears that some patients are more resilient than others. Some specific co...

due to the shortage of organs, half of the patients on the waiting list for transplantations die. Clinicians have a duty to identify those patients whom might benefit most. The correlation between psychosocial factors and survival in children who have received lung transplantation for CF has not been investigated. to examine: (1) differences in phy...

Twenty years allow plenty of time to reflect on mistakes and learn from experience. Particular insights include the following:(1) Never be satisfied with one's therapy.(2) There is something new to be learned in every session.(3) Listen to instinct and, whenever possible, share this (gently) with the family.(4) Put the counter-transference back in...

This study investigated the relationship between dissociation and psychological symptoms in adolescent girls with anorexia. First, the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) were examined using data from 181 nonclinical adolescent boys and girls. Thereafter, A-DES scores and correlations with a range of psy...

While women with anorexia nervosa are more likely to be born in March through June (in the northern hemisphere), there is no coherent model that explains this association. This study examined the birth pattern of adult restrictive and binge-purge anorexics and whether environmental temperature at assumed conception is a relevant factor. Retrospecti...

To determine the optimal weight-to-height ratio to achieve maturity of the reproductive organs when visualized by pelvic ultrasound in adolescent girls with anorexia nervosa. To examine the distribution of weight-to-height ratios in the group of adolescents in whom pelvic maturity was attained. Adolescent girls with anorexia nervosa received serial...