Avoidant Restrictive Food Intake Disorder—What Are We Missing? What Are We Waiting for?

Grubb, Laura K.

doi:10.1001/jamapediatrics.2021.3858

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…At present, our knowledge of the heterogeneity in ARFID is limited. 25 Past research has been constrained by small sample sizes, non-standardised clinical assessment, and retrospective reviews of medical records, categorising patients into one of the three drivers. Here, we report on associations 1) among ARFID symptoms and 2) between different types of anxiety traits and ARFID symptoms.…”

Section: Introductionmentioning

confidence: 99%

The clinical presentation of avoidant restrictive food intake disorder is largely independent of sex, autism spectrum disorder and anxiety traits

Watts

Archibald

Hembry

et al. 2023

Preprint

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Importance Avoidant restrictive food intake disorder (ARFID) is a newly recognised eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and in the International Classification of Diseases, Eleventh Revision which shows great heterogeneity in its clinical presentation. Objectives Here, we examined the clinical characteristics of ARFID and explored the associations between ARFID symptoms and traits of anxiety. We also investigated whether individuals with ARFID show a different clinical presentation based on their biological sex or comorbid autism spectrum disorder (ASD) diagnosis. Design, Setting, and Participants We recruited 261 consecutive patients from the specialised ARFID outpatient service at the Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre, Maudsley Hospital, London, United Kingdom. Main Outcomes and Measures The parents of the patients completed the Pica, ARFID, Rumination Disorder - ARFID - Questionnaire (PARDI-AR-Q), the Revised Children's Anxiety and Depression Scale (RCADS) and reported biological sex of their offspring. Age, height, and weight were obtained from medical records. Clinicians reported on comorbid ASD diagnosis and anxiety traits using the Current View Tool. Results This cross-sectional study included 261 child and adolescent ARFID patients (133 [51%] female) with a median age of 12.7 years (IQR=9.2 to 15.8). Patients' BMI-for-age z-scores ranged from -6.75 to 4.07 (median = -1.07, IQR = -2.25 to -0.01). Patients' comorbid traits of anxiety had the highest correlations with symptoms on the concern about aversive consequences driver of ARFID: panic disorder correlated with physical feelings of panic and anxiety when eating (r=0.53, p=7.74 x 10-31) and being afraid to eat (r=0.42, p=5.13 x 10-21); generalised anxiety correlated with physical feelings of panic and anxiety when eating (r=0.44, p=7.72 x 10-23); and separation anxiety correlated with avoiding eating situations (r=0.36, p=2.01 x 10-15). Sensory sensitivity to the appearance of food positively correlated with separation anxiety (r=0.40, p=1.52 x 10-16) and generalised anxiety (r=0.36, p=7.16 x 10-18). The sensory sensitivities (RR = 0.96; 95% CI, 0.85 to 1.09; P = .53), lack of interest (RR = 1.14; 95% CI, 1.03 to 1.28; P = .02) and concern about aversive consequences (RR = 1.27; 95% CI, 1.03 to 1.56; P = .03) drivers were independent of patient sex. Comorbid ASD was reported in 74 (28%) ARFID patients. Their parents reported higher rates of food-related sensory sensitivities (RR = 1.26; 95% CI, 1.09 to 1.45; P=0.002) and lack of interest (RR = 1.19; 95% CI, 1.05 to 1.34; P=0.006) driving their child's avoidant and restrictive eating than parents of ARFID patients without ASD (127 [49%]). Conclusions and Relevance Our study highlights that ARFID patients present with varying combinations and severity of food-related sensory sensitivities, lack of interest and concern about aversive consequences which drive their avoidant and restrictive eating. ARFID does not discriminate between male and female children and adolescents or those with or without ASD. Anxiety and ASD can co-occur with ARFID, and ASD may accentuate food-related sensory sensitivities and lack of interest. Healthcare professionals should be aware of the multi-faceted and heterogenous nature of ARFID; it is important that comprehensive multidisciplinary assessments are administered to sufficiently understand the drivers of the eating behaviour and associated physical health, nutritional, and psycho-social risk and impact.

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Section: Introductionmentioning

confidence: 99%

The clinical presentation of avoidant restrictive food intake disorder is largely independent of sex, autism spectrum disorder and anxiety traits

Watts

Archibald

Hembry

et al. 2023

Preprint

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“…20 Regarding the presentation of ARFID during the pandemic, the current report identified a small number of case reports linking the pandemic to presentation of cases with ARFID-like symptoms. 32,34,36,37 However, awareness of diagnostic criteria and management of ARFID in clinical practice has been recognised to be low, 43,44 highlighting the need for increased training. Therefore, developing and evaluating ARFID training could be a worthy area for future research.…”

Section: Arfid During Covid-19 and Clinical Implicationsmentioning

confidence: 99%

A systematic review of COVID-19 and the presentation of avoidant/restrictive food intake disorder and avoidant/restrictive food intake disorder-like symptoms

Maunder,

Markey,

Batchelor

et al. 2024

BJPsych open

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Background The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period. Aims To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic. Method Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used. Results Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted. Conclusions Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.

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“…In addition, there is hypotrophy, vitamin, micro- and macro-element deficiencies, weakness, dizziness, fainting, abdominal pain, constipation, hypothermia, dry and pale skin, and lanugo [ 3 , 4 ]. In the case of children, the consequence of significant nutritional deficiencies is also growth inhibition and abnormal general development [ 5 ]. ARFID also impairs a child’s psychosocial functioning, which makes them systematically avoid social gatherings (e.g., birthdays, holidays, school trips, outings to stores or restaurants) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Avoidant/Restrictive Food Intake Disorder among 2–10-Year-Old Children: The Significance of Maternal Feeding Style and Maternal Eating Disorders

2022

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The aim of the present study was to investigate whether the feeding style and core behavioral features of eating disorders of mothers are related to the symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) among their children. This study involved 207 mothers of children aged 2 to 10 years (Mage = 5.82 ± 2.59 years), of which 19.32% were children with neurodevelopmental disorders and 22.71% were children with chronic diseases (e.g., allergy, asthma, diabetes). The mothers were asked to complete the ARFID Parents Questionnaire–Parents Report (ARFID-Q-PR), the Parental Feeding Style Questionnaire (PFSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Our findings revealed that both the maternal feeding style and core behavioral features of eating disorders were associated with ARFID symptoms among their 2–10-year-old children. While biological factors increase the risk of feeding/nutrition difficulties, the maternal attitude towards feeding and eating behavior may play a relevant role in children’s eating behavior.

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Avoidant Restrictive Food Intake Disorder—What Are We Missing? What Are We Waiting for?

Abstract: Conflict of Interest Disclosures: None reported.12. Spettigue W, Norris ML, Santos A, Obeid N. Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.

Cited by 12 publications

References 13 publications

The clinical presentation of avoidant restrictive food intake disorder is largely independent of sex, autism spectrum disorder and anxiety traits

The clinical presentation of avoidant restrictive food intake disorder is largely independent of sex, autism spectrum disorder and anxiety traits

A systematic review of COVID-19 and the presentation of avoidant/restrictive food intake disorder and avoidant/restrictive food intake disorder-like symptoms

Symptoms of Avoidant/Restrictive Food Intake Disorder among 2–10-Year-Old Children: The Significance of Maternal Feeding Style and Maternal Eating Disorders

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