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Sanchez-Cerezo J, Neale J, Julius N, Croudace T, Lynn RM, Hudson LD, Nicholls D. Subtypes of avoidant/restrictive food intake disorder in children and adolescents: a latent class analysis. EClinicalMedicine 2024; 68:102440. [PMID: 38333539 PMCID: PMC10850399 DOI: 10.1016/j.eclinm.2024.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary avoidant/restrictive food intake disorder (ARFID) subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes. Methods We carried out a surveillance study of ARFID in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS) in the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Paediatricians and child and adolescent psychiatrists were contacted monthly to report newly diagnosed cases of ARFID electronically and complete a detailed clinical questionnaire. Cases aged 5-18 years were included. LCA was performed specifying 1-6 classes and likelihood-based tests for model selection. The Bayesian Information Criterion (BIC), the Akaike Information Criterion (AIC) and the Sample-Size Adjusted BIC were used to determine the most parsimonious model. Analysis of variance (ANOVA) and χ2 tests were used to compare the characteristics of the identified classes. A multinomial logistic regression (MLR) was performed to investigate predicting factors for the latent classes. Findings We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as Fear subtype, Lack of Interest subtype, Sensory subtype, and Combined subtype. The probability of being classified as these were 7.2% (n = 23), 25.1% (n = 80), 29.5% (n = 94) and 38.2% (n = 122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership. Interpretation LCA identified four different classes in a sample of children and adolescents with ARFID. The Combined Subtype, a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions. Funding This study was funded by the Former EMS Ltd (charity number 1098725, registered October 9th 2017).
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Affiliation(s)
- Javier Sanchez-Cerezo
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Psychiatry, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Josephine Neale
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Priory Hospital Ticehurst House, Ticehurst, East Sussex, UK
| | - Nikita Julius
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard M. Lynn
- Institute of Child Health, University College London, London, UK
| | - Lee D. Hudson
- Institute of Child Health, University College London, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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Archibald T, Bryant‐Waugh R. Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions. JCPP ADVANCES 2023; 3:e12160. [PMID: 37753149 PMCID: PMC10519741 DOI: 10.1002/jcv2.12160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
Background ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well-recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice. Methods A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta-analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions. Results We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice-related research priorities are proposed for each of the four of the areas explored. Conclusion Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence-based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small-scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.
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Affiliation(s)
- Tanith Archibald
- Maudsley Centre for Child and Adolescent Eating DisordersMichael Rutter CentreMaudsley HospitalLondonUK
| | - Rachel Bryant‐Waugh
- Maudsley Centre for Child and Adolescent Eating DisordersMichael Rutter CentreMaudsley HospitalLondonUK
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKings College LondonLondonUK
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Costa CB, Xandre PE, Mathis KJ. Treating Individuals With Eating Disorders: Part 2. J Psychosoc Nurs Ment Health Serv 2020; 58:9-15. [DOI: 10.3928/02793695-20200310-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 2020; 8:4. [PMID: 32021688 PMCID: PMC6995106 DOI: 10.1186/s40337-020-0277-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, Canada
| | - Catherine Miller
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | | | | | | - Catherine Ford
- 9Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Kerry Bourret
- 10St. Joseph's Care Group - Thunder Bay, Thunder Bay, Canada
| | | | - Josie Geller
- 6The Univeristy of British Columbia, Vancouver, Canada
| | | | | | - Jennifer Scarborough
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
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Couturier J, Isserlin L, Spettigue W, Norris M. Psychotropic Medication for Children and Adolescents with Eating Disorders. Child Adolesc Psychiatr Clin N Am 2019; 28:583-592. [PMID: 31443877 DOI: 10.1016/j.chc.2019.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychotropic medications are commonly used in the treatment of eating disorders in children and adolescents. This article reviews the evidence base on psychotropic medications, including all randomized trials, uncontrolled trials, and case reports for the treatment of anorexia nervosa, bulimia nervosa, other specified feeding and eating disorders, binge-eating disorder, and avoidant/restrictive food intake disorder. Despite advances in the number of medication-based studies completed in young patients with eating disorders over the last 2 decades, significantly more work needs to be done in terms of identifying what role, if any, psychotropic medications can have on treatment outcomes.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Leanna Isserlin
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Wendy Spettigue
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Mark Norris
- University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
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Abstract
Avoidant restrictive food intake disorder (ARFID) is a rearticulated eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5), published in 2013. The purpose of this article is to review what is known about ARFID; specifically outline the DSM-5 diagnostic criteria; review the epidemiology; describe the clinical characteristics of patients with this disorder; and discuss evolving treatment approaches. Although this disorder occurs across the lifespan, the focus of recent research has been primarily in children and adolescents with ARFID. Therefore, most of this article is devoted to children and adolescents with ARFID.
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Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Mark L Norris
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Duke University, Duke Center for Eating Disorders, PO Box 3454, Durham, NC 27710, USA
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Abstract
Purpose of review Avoidant/restrictive food intake disorder (ARFID) was added to the psychiatric nomenclature in 2013. However, youth with ARFID often present first to medical- rather than psychiatric-settings, making its evaluation and treatment relevant to pediatricians. Recent findings ARFID is defined by limited volume or variety of food intake motivated by sensory sensitivity, fear of aversive consequences, or lack of interest in food or eating, and associated with medical, nutritional, and/or psychosocial impairment. It appears to be as common as anorexia nervosa and bulimia nervosa and can occur in individuals of all ages. ARFID is heterogeneous in presentation and may require both medical and psychological management. Summary Pediatricians should be aware of the diagnostic criteria for ARFID and the possibility that these patients may require medical intervention and referral for psychological treatment. The neurobiology underlying ARFID is unknown, and novel treatments are currently being tested.
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Hoşoğlu E, Akça ÖF. Escitalopram in the Treatment of a 3-Year-Old Child with Posttraumatic Feeding Disorder. J Child Adolesc Psychopharmacol 2018; 28:153-154. [PMID: 29315010 DOI: 10.1089/cap.2017.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Esra Hoşoğlu
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
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Tanıdır C, Hergüner S. Mirtazapine for Choking Phobia: Report of a Pediatric Case. J Child Adolesc Psychopharmacol 2015; 25:659-60. [PMID: 26485089 DOI: 10.1089/cap.2015.0145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Canan Tanıdır
- 1 Child and Adolescent Psychiatry Clinic, Bakirkoy State Hospital for Mental Health and Neurological Disorders , Istanbul, Turkey
| | - Sabri Hergüner
- 2 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University , Konya, Turkey
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