Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder

Abstract

Objective The current study explored the experience and familiarity of pediatric health professionals with avoidant/restrictive food intake disorder (ARFID), and assessed the application of diagnostic criteria in a series of clinical vignettes. Method Pediatric health professionals were invited to complete an online survey. Data from 93 health professionals from medical and allied health roles who completed the survey were analyzed. Results Respondents providing care for pediatric feeding/eating disorders were more likely to report familiarity with ARFID than those not typically providing care for feeding/eating disorders. Clinicians who had provided care for pediatric ARFID reported more confidence in clinical management of ARFID than did those who had not yet provided care for ARFID, though there were overall relatively low levels of confidence in providing care for ARFID. Respondents to the clinical vignettes were more likely to confer a diagnosis of ARFID when there were symptoms of both psychosocial impairment and weight loss than when there was psychosocial impairment alone. Discussion The results suggest variability in current application of diagnostic criteria for ARFID, low confidence in clinical management of ARFID, and ambiguity in clinicians' judgments regarding whether psychosocial impairment is sufficient to meet a diagnosis of ARFID.

What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature

“…Another survey of multi‐disciplinary health professionals working across a range of treatment settings, showed that knowledge about this disorder has improved in recent years, with 78.5% of participants reporting familiarity with ARFID. However, participants reported a lack of confidence in treating this group of patients (Coelho et al., 2021 ), with a recent study from France reporting that only 18% of children with ARFID in their sample were receiving professional care (Bertrand et al., 2021 ). Following the publication of DSM‐5, the diagnostic specificity of eating disorders in young people has improved.…”

Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder

“…Pediatricians seem to have become skilled at using all the DSM-5 criteria to make their diagnosis. 38 The most cited ARFID criterion was A1 (186 [89.9%]). The CIPs also identified criterion A4 in 67.1% of the patients, highlighting the substantial toll that a feeding disturbance can have on both individual and family functioning.…”

“…In contrast, only 13% of patients in this study were excluded for inappropriate application of the diagnostic criteria. Pediatricians seem to have become skilled at using all the DSM-5 criteria to make their diagnosis . The most cited ARFID criterion was A1 (186 [89.9%]).…”

A diagnostic subgroup comparison of health care utilization patterns in individuals with eating disorders diagnosed in childhood and/or adolescence

“…In terms of treatment needs, those with ARFID have been identified as having high rates of comorbidity of mood and anxiety disorders, and needing multi‐disciplinary and specialized resources (Norris et al, 2021). Other authors have commented that those health professionals working outside of eating disorder programs may not have familiarity and experience diagnosing ARFID (Coelho et al, 2021). These challenges suggest that more training and specialized services be developed for those with ARFID as utilization is similar to those with other eating disorders.…”