Parent–child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination

Abstract

Objective: The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. Method:The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports.Results: On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK 5 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC 5 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. Discussion:Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed. V C 2013 Wiley Periodicals, Inc.

Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting

“…DSM‐5 changes, fortunately, increase emphasis on collateral reporting (i.e., parent and teacher) and behavioral observations in assessment. A recent study by our group showed that standardized parent‐informant assessment can detect eating problems less readily apparent by the young person's report, particularly in cases of AN . A future research enquiry would be to evaluate the discriminant validity of the EDE among children with EDs, other mental illnesses, and healthy controls with respect to ED cognitions and to characterize its usefulness and limitations in a younger population.…”

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

“…Assessment should involve both children and their families or carers unless this is contraindicated due to safety concerns such as abuse or domestic violence (Mariano et al, 2013). At assessment, every child or adolescent suspected of having anorexia nervosa needs a comprehensive review of psychological and physiological signs and symptoms.…”

Identifying disordered eating behaviours in adolescents: how do parent and adolescent reports differ by sex and age?

“…For example, Mariano et al [11] found acceptable agreement for the presence of behavioural symptoms (e.g. binge eating, self-induced vomiting, and laxative/diuretic misuse), but poor agreement on frequency of behaviours and experience of disordered eating cognitions, with greater severity reported by young people compared to their parents.…”

“…Similarly, Salbach-Andrae et al [12] observed poor concordance between parent and adolescent reports, particularly for internalising behaviours. While several studies have observed good concordance for symptoms of AN [11], one study reported less concerns over weight and restraint in child reports (aged 6–12 years) compared to their parents [6], and another study revealed greater concordance for adolescents with BN compared to those with AN-Restrictive subtype [12]. In contrast, youths suffering from BN have been found to report greater severity of cognitions and frequency of behaviours [11], shape concerns and restraint [6] compared to their parents.…”