The Polish Version of the Avoidant/Restrictive Food Intake Disorder Questionnaire—Parents Report (ARFID-Q-PR) and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen—Parents Report (NIAS-PR): Maternal Perspective

Assessing Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms Using the Nine Item ARFID Screen in >9000 Swedish Adults With and Without Eating Disorders

OBJECTIVE

The Nine Item ARFID Scale (NIAS) is a widely used measure assessing symptoms of avoidant/restrictive food intake disorder (ARFID). Previous studies suggest that individuals with eating disorders driven by shape/weight concerns also have elevated scores on the NIAS. To further describe NIAS scores among individuals with diverse current and previous eating disorders, we characterized NIAS scores in a large sample of individuals with eating disorders and evaluated overlap in symptoms measured by the NIAS and the Eating Disorder Examination-Questionnaire (EDE-Q) version 6.0.

METHOD

Our sample comprised 9148 participants from the Eating Disorders Genetics Initiative Sweden (EDGI-SE), who completed surveys including NIAS and EDE-Q. NIAS scores were calculated and compared by eating disorder diagnostic group using descriptive statistics and linear models.

RESULTS

Participants with current anorexia nervosa demonstrated the highest mean NIAS scores and had the greatest proportion (57.0%) of individuals scoring above a clinical cutoff on at least one of the NIAS subscales. Individuals with bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder also demonstrated elevated NIAS scores compared to individuals with no lifetime history of an eating disorder (ps < 0.05). All subscales of the NIAS showed small to moderate correlations with all subscales of the EDE-Q (rs = 0.26-0.40).

DISCUSSION

Our results substantiate that individuals with eating disorders other than ARFID demonstrate elevated scores on the NIAS, suggesting that this tool is inadequate on its own for differentiating ARFID from shape/weight-motivated eating disorders. Further research is needed to inform clinical interventions addressing the co-occurrence of ARFID-related drivers and shape/weight-related motivation for dietary restriction.

Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish adolescents

BACKGROUND

This study evaluates the psychometric properties of the Turkish version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a population of Turkish adolescents.

METHOD

The NIAS, designed to screen for ARFID symptoms, including picky eating, fear-related eating behaviors, and low appetite, was administered to secondary school students between 13 and 18 ages in Muğla, Turkiye.

RESULTS

Based on a sample of 268 adolescents, the NIAS's reliability and validity in this demographic are supported. The research utilized confirmatory factor analysis to verify its three-factor structure and various reliability tests, including Cronbach's alpha and test-retest reliability, confirming the scale's internal consistency and temporal stability. The descriptive analysis highlighted significant differences in NIAS scores across BMI categories, with underweight adolescents scoring higher, suggesting a potential link between ARFID symptoms and lower body weight. Criterion validity was supported by significant correlations between NIAS subscales and measures of anxiety, depression, and eating behaviors, indicating the scale's effectiveness in reflecting relevant psychopathological features.

CONCLUSION

Overall, the study establishes the Turkish NIAS as a useful tool for identifying ARFID in Turkish adolescents, aiding early detection and intervention in this at-risk age group. Further research is recommended to explore the scale's utility across different clinical settings and refine its diagnostic accuracy, enhancing our understanding of ARFID's impact on youth mental health and nutritional status.

Avoidant/Restrictive Food Intake Disorder: Review and Recent Advances

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder recently codified in DSM-5 that affects individuals of all ages. A proliferation of ARFID research has emerged over the years, and this review provides a brief overview of the current understanding of ARFID epidemiology, symptoms, comorbid conditions, assessment, and treatment. The review highlights recent research updates regarding ARFID among adults, putative neurobiological mechanisms underlying ARFID, and new treatment trials. Findings from this review demonstrate that ARFID is as prevalent as other eating disorders, even among adults, and is associated with significant medical and psychiatric comorbid conditions. New, promising treatments for children, adolescents, and adults are in the early stages of development. Several assessments are now available to aid in the screening and diagnosis of ARFID and have demonstrated cross-cultural validity. Areas for future research and clinical guidance, including unresolved questions regarding ARFID categorization and differential diagnosis, are discussed.

Autistic traits and ARFID-associated eating behaviors in preschoolers: Mediating effects of sensory processing patterns

OBJECTIVE

This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.

METHOD

A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4-6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.

RESULTS

The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.

DISCUSSION

Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.

Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish children

BACKGROUND

The nine item avoidant/restrictive food intake disorder screen (NIAS) is a short and practical assessment tool specific to ARFID with three ARFID phenotypes such as "Picky eating," "Fear," and "Appetite". This study aimed to evaluate the psychometric properties of the Turkish translation of the NIAS parent form and to investigate the relationship between ARFID symptoms and anxiety, depression symptoms, and eating behaviors in a sample of Turkish children.

METHOD

Parents were asked to provide their children's sociodemographic data and to complete the NIAS, Eating Disorder Examination Questionnaire-Short (EDE-QS), Children's Eating Behavior Questionnaire (CEBQ), and Revised Child Anxiety and Depression Scale (RCADS) scales.

RESULTS

The sample included 440 participants between 6 and 12 ages. Turkish NIAS demonstrated good internal consistency. The three-factor model of the Turkish NIAS was in an acceptable structure. The Turkish NIAS scale was shown to be valid and reliable. NIAS scores were shown to be higher in underweight participants. The NIAS-parent version subscales showed expected convergent and divergent validity with the CEBQ, EDEQ-S, and RCADS scales in children, except CEBQ emotional overeating and desire to drink subscales were correlated with NIAS.

CONCLUSION

The Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children.

ARFID Genes and Environment (ARFID-GEN): study protocol

BACKGROUND

The Avoidant Restrictive Food Intake Disorder - Genes and Environment (ARFID-GEN) study is a study of genetic and environmental factors that contribute to risk for developing ARFID in children and adults.

METHODS

A total of 3,000 children and adults with ARFID from the United States will be included. Parents/guardians and their children with ARFID (ages 7 to 17) and adults with ARFID (ages 18 +) will complete comprehensive online consent, parent verification of child assent (when applicable), and phenotyping. Enrolled participants with ARFID will submit a saliva sample for genotyping. A genome-wide association study of ARFID will be conducted.

DISCUSSION

ARFID-GEN, a large-scale genetic study of ARFID, is designed to rapidly advance the study of the genetics of eating disorders. We will explicate the genetic architecture of ARFID relative to other eating disorders and to other psychiatric, neurodevelopmental, and metabolic disorders and traits. Our goal is for ARFID to deliver "actionable" findings that can be transformed into clinically meaningful insights.

TRIAL REGISTRATION

ARFID-GEN is a registered clinical trial: clinicaltrials.gov NCT05605067.

Arfid Genes and Environment (ARFID-GEN): Study Protocol

Background

The Avoidant Restrictive Food Intake Disorder Genes and Environment (ARFID-GEN) study is a study of genetic and environmental factors that contribute to risk for developing ARFID in children and adults.

Methods

A total of 3,000 children and adults with ARFID from the United States will be included. Parents/guardians and their children with ARFID (ages 7 to 17) and adults with ARFID (ages 18+) will complete comprehensive online consent, parent verification of child assent (when applicable), and phenotyping. Enrolled participants with ARFID will submit a saliva sample for genotyping. A genome-wide association study of ARFID will be conducted.

Discussion

ARFID-GEN, a large-scale genetic study of ARFID, is designed to rapidly advance the study of the genetics of eating disorders. We will explicate the genetic architecture of ARFID relative to other eating disorders and to other psychiatric, neurodevelopmental, and metabolic disorders and traits. Our goal is for ARFID to deliver "actionable" findings that can be transformed into clinically meaningful insights.

Trial registration

ARFID-GEN is a registered clinical trial: clinicaltrials.gov NCT05605067.

Avoidant/Restrictive Food Disorder (ARFID), Food Neophobia, Other Eating-Related Behaviours and Feeding Practices among Children with Autism Spectrum Disorder and in Non-Clinical Sample: A Preliminary Study

Previous research shows that children with autism spectrum disorder (ASD) may experience several difficulties-including those related to eating-and this area of research needs to be explored further. This study had two main objectives: (1) comparison of the clinical (autism spectrum disorder) and non-clinical sample of children in terms of avoidant/restrictive food disorder, food neophobia, other eating-related behaviours and feeding practices; (2) assessment of selected predictors of food neophobia. The final sample included 54 children and parents from the clinical sample (ASD) and 51 from the non-clinical sample. Parents completed: the autism spectrum rating scales (ASRS), the eating disorders in youth questionnaire (EDY-Q), the children food neophobia scale (CFNS), the child eating behaviour questionnaire (CEBQ), the child feeding questionnaire (CFQ), and a socio-demographic survey. Our analysis allowed us to partially confirm the first hypothesis since the clinical sample (vs. the non-clinical group) had significantly higher scores in such variables as (a) avoidant/restrictive food disorder (ARFID), (b) food neophobia, (c) other eating-related behaviours: emotional under-eating, desire to drink, food fussiness, (d) feeding practices: pressure to eat. Moreover, our analysis of predictors of food neophobia in the clinical and non-clinical samples also allowed us to partially confirm the second hypothesis because it turned out that only in the clinical sample (vs. the non-clinical sample) were the predictors significantly associated with food neophobia, but only two of them (food fussiness and selective eating). In conclusion, our study showed that children with ASD (compared to children without this diagnosis) experience increased difficulties in eating behaviours, and their parents present a stronger intensity of the feeding practice based on pressure to eat. This study showed that feeding problems for children in the ASD sample are a significant problem, and it is still worth exploring this area in research.

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

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.