A Moving Target

Harshman, Stephanie; Jo, Jenny H.; Kuhnle, Megan; Hauser, Kristine; Murray, Helen Burton; Becker, Kendra R.; Misra, Madhusmita; Eddy, Kamryn T.; Micali, Nadia; Lawson, Elizabeth A.; Thomas, Jennifer J.

doi:10.4088/jcp.20m13831

Cited by 23 publications

(17 citation statements)

References 40 publications

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“…Few cases were identified via DSM - 5 ARFID criteria A2 (nutritional deficiency) and A3 (dependence on supplements). The distribution of criteria A1 to A4 is heavily affected by method and setting of ascertainment, and it has previously been shown that criteria A1 and A4 are the most prevalent criteria when screening from the general population, whereas criteria A2 and A3 tend to be more prevalent in clinical samples . However, that the NPR does not contain diagnoses given in primary health care—a setting in which nutritional deficiencies in children would be likely to be detected and registered—might have additionally contributed to the low prevalence of criteria A2 and A3 in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Avoidant restrictive food intake disorder (ARFID) is a serious feeding and eating disorder formally recognized in DSM - 5 in 2013 and first included into the International Classification of Diseases, 11th Revision ( ICD - 11 ) in 2022 . Characterized by an extremely limited range or amount of food consumed and resulting in persistent failure to meet nutritional and/or energy needs, ARFID is associated with considerable individual, family, and social impairment, and medical consequences can be life threatening. Unlike anorexia nervosa, dietary restriction in ARFID is not motivated by body image concerns or drive for thinness but rather based on sensory sensitivity to food qualities (eg, texture, smell, taste), lack of interest in food/eating (ie, low appetite), and/or fear of aversive somatic consequences of food intake (eg, choking, vomiting, allergic reactions), often in response to aversive eating experiences .…”

Section: Introductionmentioning

confidence: 99%

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Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

et al. 2023

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ImportanceAvoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research.ObjectiveTo estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype.Design, Setting, and ParticipantsThis nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022.Main Outcomes and MeasuresFrom CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype.ResultsOf 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86).Conclusions and RelevancePrevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

et al. 2023

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“…Especially in small children, criterion A4 can be difficult to evaluate, as parents often put a lot of effort into adjusting (family) life to their child’s demands around eating. More detailed guidelines on how to operationalize the A4 criterion in different age groups would be helpful for future research (for suggestions see (Harshman et al, 2021)).…”

Section: Discussionmentioning

confidence: 99%

Development of a parent-reported screening tool for avoidant/restrictive food intake disorder (ARFID): Initial validation and prevalence in 4-7-year-old Japanese children

Dinkler

Yasumitsu‐Lovell

Eitoku

et al. 2021

Preprint

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The prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) in the general child population is still largely unknown and validated screening instruments are lacking. The aims of this study were to investigate the prevalence of children screening positive for ARFID in a Japanese birth cohort using a newly developed parent-reported screening tool, and to provide preliminary evidence for the validity of the new screening tool. Data were collected from 3,728 4-7-year-old children born in Kochi prefecture (response rate was 56.5%), Japan, between 2011 and 2014; a sub-sample of the Japan Environment and Children's Study (JECS). Parents completed a questionnaire including the ARFID screener and several other measures to assess convergent validity. The point prevalence of children screening positive for ARFID was 1.3%; half of them met criteria for ARFID based on psychosocial impairment alone, while the other half met diagnostic criteria relating to physical impairment (and additional psychosocial impairment in many cases). Sensory sensitivity to food characteristics (63%) and/or lack of interest in eating (51%) were the most prevalent drivers of food avoidance. Children screening positive for ARFID were lighter in weight and shorter in height, they showed more problem behaviors related to mealtimes and nutritional intake, and they were more often selective eaters and more responsive to satiety, providing preliminary support for the validity of the new screening tool. This is the largest screening study to date of ARFID in children up to 7 years. Future studies should examine the diagnostic validity of the new ARFID screener using clinically ascertained cases. Further research on ARFID prevalence in the general population is needed.

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“…Importantly, and in contrast to the ‘classic’ EDs anorexia nervosa and bulimia nervosa, the restriction of food intake is not driven by weight or shape concerns (American Psychiatric Association, 2013). In addition to these nutritional and growth‐related concerns, ARFID often causes clinically significant social distress and impairment (Harshman et al., 2021). The fear of not having access to preferred foods may prohibit patients from engaging in social and extracurricular activities outside the home.…”

Section: Introduction and Aimsmentioning

confidence: 99%

“…In addition to these nutritional and growth‐related concerns, ARFID often causes clinically significant social distress and impairment (Harshman et al., 2021). The fear of not having access to preferred foods may prohibit patients from engaging in social and extracurricular activities outside the home.…”

Section: Introduction and Aimsmentioning

confidence: 99%

Self‐reported expertise and confidence in diagnosing and treating avoidant restrictive food intake disorder among Swedish clinicians

Dinkler

Hedlund

Bulik

2023

Euro Eating Disorders Rev

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Objective: To assess self-reported knowledge and confidence regarding avoidant restrictive food intake disorder (ARFID) diagnosis and treatment in Swedish clinicians from various disciplines. Method:The study included 489 clinicians who attended educational lectures about ARFID. Participants responded to 20 ARFID-related questions and statements using the online audience engagement platform Mentimeter. Items assessed ARFID-related knowledge, education, and experience, as well as treatment methods offered to ARFID patients at clinicians' healthcare units. Results: We found predominantly correct responses to three basic knowledgebased items about ARFID. However, most participants (64.0%) reported never having received education about ARFID, and few participants reported feeling confident in their ability to diagnose (13.4%) and treat (10.7%) ARFID. Nearly half the sample reported either not knowing which ARFID treatments their unit offered (22.3%) or that no treatment was offered (21.3%). Conclusion:Experience and confidence in diagnosing and treating ARFID are generally low in Swedish clinicians, and many individuals with ARFID do not receive treatment. We identify a pressing need for resources, clearer organisation, and structure, and for additional education and training opportunities for clinicians meeting individuals with ARFID.

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A Moving Target

Cited by 23 publications

References 40 publications

Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years

Development of a parent-reported screening tool for avoidant/restrictive food intake disorder (ARFID): Initial validation and prevalence in 4-7-year-old Japanese children

Self‐reported expertise and confidence in diagnosing and treating avoidant restrictive food intake disorder among Swedish clinicians

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