The factor structure and validity of a diagnostic interview for avoidant/restrictive food intake disorder in a sample of children, adolescents, and young adults

Abstract

Objective There is a paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID) to aid identification and classification of cases for both clinical and research purposes. To evaluate the factor structure, construct validity, and criterion validity of the Pica ARFID and Rumination Disorder Interview (PARDI; ARFID module), we administered the PARDI to 129 children and adolescents ages 9–23 years (M = 16.1) with ARFID (n = 84), subclinical ARFID (n = 11), and healthy controls (n = 34). Method We used exploratory factor analysis to examine the factor structure of the PARDI in children, adolescents, and young adults with an ARFID diagnosis, the Kruskal‐Wallis analysis of variance and Spearman correlations to test the construct validity of the measure, and non‐parametric receiver operating characteristic curves to evaluate the criterion validity of the PARDI. Results Exploratory factor analysis yielded a 3‐factor structure: (1) concern about aversive consequences of eating, (2) low appetite/low interest in food, and (3) sensory sensitivity. Participants with ARFID demonstrated significantly higher levels of sensory sensitivity, low appetite/low‐food interest, and concern about aversive consequences of eating symptoms relative to control participants. The construct validity for each PARDI subscale was supported and clinical cutoffs for the low appetite/low interest in food (1.1) and sensory sensitivity subscales (0.6) were established. Discussion These data present evidence for the factor structure and validity of the PARDI diagnostic interview for diagnosing ARFID in children, adolescents, and young adults, supporting the use of this tool to facilitate ARFID clinical assessment and research. Public Significance Due to the paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID), we evaluated the factor structure and validity of the Pica ARFID and Rumination Disorder Interview (ARFID module). Findings suggest that the interview assesses 3 components of ARFID: concern about aversive consequences of eating, low‐appetite, and sensory sensitivity, and that clinical threshold scores on the latter two subscales can be used to advance ARFID assessment.

Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder: A proof‐of‐concept for mechanisms of change and target engagement

“…We used the four‐item AEBQ Satiety Responsiveness (AEBQ‐SR) subscale as a measure of low appetite (e.g., “I get full easily”), which has been shown to moderately correlate with an interview measure of lack of interest in eating/food in children, adolescents, and young adults with ARFID (Cooper‐Vince et al, 2022). Items are rated on a 5‐point Likert scale from 1 (“strongly disagree”) to 5 (“strongly agree”) and averaged.…”

“…At pre‐ and posttreatment assessment visits, the Pica, ARFID, and Rumination Disorder Interview (PARDI) was administered by an independent, trained evaluator who did not serve as a study therapist. The PARDI is a semi‐structured interview that evaluates ARFID psychopathology (Bryant‐Waugh et al, 2019; Cooper‐Vince et al, 2022). The PARDI severity scale assesses severity of psychosocial impairment, health consequences, and nutritional compromise due to avoidant/restrictive eating.…”

Recent Advances in Cognitive-Behavioural Therapy for Eating Disorders (CBT-ED)

“…There are also suggestions of approach-specific outcomes when using CBT-ED with different ARFID presentations [ 62 ], but we are still awaiting the outcome of more definitive studies in the field of CBT-ED for ARFID. However, there is now a set of validated measures to support the evaluation of ARFID and the use of CBT-ED in such cases, rather than relying on other, less relevant eating disorder measures [ 63 , 64 ].…”

Obtaining an Avoidant Restrictive Food Intake Disorder diagnosis in The UK for Individuals with Intellectual and Developmental Disabilities: A Qualitative Study of Families’ Experiences

“…The diagnostic assessment tool was effective, demonstrating moderate inter-rater reliability and signi cantly scoring higher on severity and pro le for individuals with ARFID compared to healthy controls [5]. More recently, research has revealed the strong factor structure and validity of PARDI, indicating that a strong assessment tool for ARFID [9]. Some researchers have indicated that obtaining a diagnosis for ARFID may be in uenced by other neurodevelopmental conditions, like Intellectual and Developmental Disabilities (IDD) [10].…”