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Avoidant Restrictive Food Intake Disorder

Avoidant Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder characterized by a persistent failure to meet appropriate nutritional and/or energy needs.
Unlike other eating disorders, ARFID does not involve disturbances in body image or a fear of weight gain.
Indivduals with ARFID may avoid or restrict food intake due to sensory characteristics, fear of averse consequences, or lack of interest in eating.
This can lead to significant weight loss, nutritional deficiencies, and impaired psychosocial functioning.
ARFID is typically diagnosed in children, adolescents, and young adults, but can occur at any age.
Effective treatment often involves a multidisciplinary approach focusing on addressing the underlying reasons for food avoidance and restoring adequate nutrition.

Most cited protocols related to «Avoidant Restrictive Food Intake Disorder»

Children aged 4 to 5 years old in five classes at four London primary schools were recruited to a study of children's eating behaviour. Information sheets, consent forms and questionnaires were sent home to parents. Those who wished to participate completed consent forms and questionnaires and returned both to their child's class teacher. The questionnaire included the six-item version of the Child Food Neophobia Scale (CFNS; [10 (link)]) that we have used in previous research [7 (link),8 (link)]. The original CFNS is a 10-item scale to measure children's willingness to sample new foods, scores on which correlate highly with behavioural measures of neophobia. Four items were excluded on the basis that they were innapropriate for the age range of our sample (e.g. "My child likes to eat in ethnic restaurants). The six remaining items were: "My child does not trust new foods", "If my child doesn't know what's in a food, s/he won't try it", "My child is afraid to eat things s/he has never had before", "My child will eat almost anything" (reverse scored), "My child is very particular about the foods s/he will eat" and "My child is constantly sampling new and different foods" (reverse scored). Responses are on a 4 point scale from 'strongly disagree' to 'strongly agree'. Higher scores indicate higher neophobia. Cronbach's alpha for the 6-item version was 0.92 in this sample.
Children's food intake was recorded over 3 'test' lunchtime meals at school at weekly intervals. The study was part of a three-day repeated measures study of intake regulation, so on two out of the three days (Days 2 and 3), children were given a 200 ml orange squash drink prior to lunch. On one day this squash contained 5 kcal and on the other day the squash contained 174 kcal; drink conditions were counter-balanced across days. On Day 1 children received no preload drink, forming a control condition. Children participated in all conditions providing they were present on the day in question. Actions taken to account for the preload design are described in the Results section.
The test meal comprised weighed portions of chicken slices, cheese, bread roll with margarine, cheese crackers, chocolate biscuits, grapes and tomatoes or carrot sticks, served cold and presented to each child in an individual compartmented container. Tomatoes had been planned for all meals, but in the first class visited, a large number of children reported disliking tomatoes, so children in the remaining 4 classes were given sticks of raw carrot instead. To maintain consistency, children in the first class were given tomatoes at all subsequent meals. Children were not required to 'clean their plates, but were told to eat as much or as little of the meal as they wished.
Extra pre-weighed portions of bread rolls were offered when children had finished their original servings and unlimited water was provided. Children were observed throughout the meals in order to ensure that food was not shared. Children raised their hand to indicate when they had finished their meal and containers were then collected by researchers and sealed. Foods were subsequently weighed to establish intake in grammes of each food type. Energy content (kcal) of processed foods (chicken slices, cheese slices, cheese crackers, and chocolate biscuits) was calculated using manufacturers' information. McCance and Widdowson's 'The Composition of Foods' [11 ] was used to calculate energy content of the remaining foods (bread, grapes, tomatoes and carrots).
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Publication 2006
Avoidant Restrictive Food Intake Disorder Bread Carrots Cheese Chickens Child Chocolate Common Cold Craniofrontonasal dysplasia Daucus carota Eating Fear Food Food, Processed Grapes Margarine Parent Squashes Tomatoes
Participants in the initial pilot study were 57 males and females aged 10–22 years who completed either the Child (n = 26) or Young person/Adult (n = 31) version of the PARDI as part of an ongoing study of the neurobiology of ARFID in Boston. To test the hypotheses of the ongoing larger study of neurobiology, we recruited both healthy controls (n = 10) as well as individuals with clinically significant avoidant/restrictive eating, including those with ARFID (n = 47). We further divided the avoidant/restrictive eating group into participants with ARFID (n = 39) versus without ARFID (n = 8) using DSM-5 criteria as assessed via the PARDI diagnostic items. As a result, individuals in the ARFID group endorsed not only restricting their food intake by volume or variety, but also met one or more of the four components of Criterion A for ARFID, including objectively low weight or faltering growth; a vitamin deficiency as diagnosed by a medical professional; dependence on tube feeding or high-energy supplement drinks to meet a large proportion of calorie needs; and/or psychosocial impairment. Of note, to meet PARDI criteria for psychosocial impairment, participants needed to endorse that their eating problem caused at least moderate levels of impairment in eating with others, eating outside of the home, and/or daily functioning at school or work. In contrast, individuals in the avoidant/restrictive eating group endorsed restricting their intake by volume and/or variety, but did not meet any of the components of criterion A for ARFID. Of note, the PARDI diagnostic items (which we used to divide the avoidant/restrictive eating group into those with versus without ARFID) have little overlap with the much larger pool of severity and frequency items that comprise the overall severity and profile scores on which we compared the groups.
Individuals were eligible to participate as healthy controls if they reported no eating difficulties and did not meet criteria for any psychiatric disorders—including feeding or eating disorders—on the Kiddie Schedule for Affective Disorders (Kaufman et al., 2013 ). In contrast, in order to be eligible for the avoidant/restrictive eating group, participants needed to (1) endorse avoidant and/or restrictive eating symptoms on the KSADS that did not meet diagnostic criteria for AN, BN, BED, or a related OSFED; and (2) score below the clinical cut-off of 4.0 on the EDE-Q (Fairburn & Beglin, 2008 ), and (3) deny on the EDE-Q and KSADS any self-induced vomiting, laxatives, diuretics, fasting, or compensatory exercise for the past 28 days, and (4) not have a medical condition that could fully account for avoidant/restrictive eating symptoms. Due to the procedures required for the neurobiology study, self-reported history of a developmental disability was an exclusion criterion for both groups.
Publication 2018
Avoidant Restrictive Food Intake Disorder Child Developmental Disabilities Diagnosis Dietary Supplements Diuretics Eating Disorders Females Laxatives Males Mental Disorders Mood Disorders Vitamin Deficiency Young Adult
The PARDI includes a screen, an introduction, and diagnostic and severity items for pica, ARFID, and RD. The purpose of the screen is to rule out the presence of other eating disorders (specifically, AN, bulimia nervosa [BN], binge eating disorder [BED], or a related form of other specified feeding or eating disorder [OSFED]) that would preclude a diagnosis of pica, ARFID, or RD per DSM-5 trumping rules (APA, 2013 ). The introduction includes items assessing growth and development, and physical and/or mental health conditions that would rule out a feeding disorder diagnosis, as well as the current pattern of feeding and/or eating. The remaining items are intended to inform the diagnostic algorithm (i.e., the combination of items that determine whether the participant meets criteria for pica, ARFID, or RD by DSM-5 criteria) and provide severity ratings for pica, ARFID, and RD. To assess the heterogeneity of ARFID specifically, the PARDI also contains three profiles with continuous ratings of severity for sensory sensitivity, lack of interest in eating, and fear of aversive consequences. These three PARDI profiles correspond with the three ARFID presentations described in DSM-5, which have been replicated in both clinical (Norris et al., 2018 (link)) and community (Kurz et al., 2016 (link)) samples. Based on our clinical experience that severity varies even within profiles, and that some patients with ARFID exhibit symptoms of more than one profile (Thomas et al., 2017 (link)), we opted for a dimensional rather than categorical approach to profile assessment.
Similar to the Eating Disorder Examination (EDE; Fairburn, Cooper, & O’Connor 2008 ), the majority of PARDI items are scored on a 7-point scale ranging from 0 (no symptoms) to 6 (severe symptoms). Like the EDE, the PARDI includes items assessing both the frequency and severity of relevant constructs. The remaining items invite responses that are either qualitative (e.g., “I would like to ask you about a typical day of eating and drinking. Starting with when you wake up, can you tell me about what you typically eat and drink throughout the day?”), or categorical (“Are you currently receiving any tube feeding?” with response options of yes or no). Table 2 provides an example item from each PARDI profile.
To support multi-informant assessment, there are four parallel versions of the PARDI: (1) Parent/Carer (2–3) (for the parents of 2–3-year-olds); (2) Parent/Carer (4+) (for the parents of 4-year-olds and up); (3) Child (for 8–13 year olds); and (4) Young person/Adult (for 14 year olds and up). Each version assesses the same constructs and contains similar items. However, the wording and response options have been adapted to include developmentally appropriate scenarios, vocabulary, and content. For example, only individuals less than 20 years old are asked about faltering growth. Specifically, both the Parent/Carer (2–3) and the Parent/Carer (4+) ask “Over the past 3 months has there been concern (e.g. from doctors, family etc.) that your child is not growing taller as he/she should?” In the contrast, the Child version asks “Over the past 3 months has your doctor or anyone in your family worried that you are not growing taller?” The Young/Person adult version asks the question in the same with as the Child version, with instructions from the interviewer to skip this item if the individual is 20 years or older.
When two versions of the interview are required, separate administration to parents and children is recommended. The PARDI rating sheet, as well as the Child and Young Person/Adult versions of the interview are freely available as an online supplement to the current article. Copies of the two Parent/Carer versions are available upon request from the first author (RBW).
Following administration of the PARDI, the diagnostic algorithms can be applied to the responses to generate diagnoses of pica, ARFID and RD. Similar to the EDE, the interview is designed as a semi-structured, investigator-based assessment tool, so that training in its use is recommended to maximize reliability.
Publication 2018
Avoidant Restrictive Food Intake Disorder Bulimia Nervosa Child Diagnosis Dietary Supplements Disorder, Binge-Eating Eating Disorders Fear Feeding Disorders Genetic Heterogeneity Hypersensitivity Interviewers Mental Health Parent Patients Physical Examination Physicians Pica Young Adult
The following describe the constructs and associated survey items. A full copy of the FAB Survey and associated materials can be found at http://cancercontrol.cancer.gov/brp/fab/.
Psychosocial Constructs and Single Items on the FAB Survey. Conventional psychosocial constructs included self-efficacy, social support, perceived barriers and benefits of eating FVs, and FV purchasing behaviors (Table 1). These constructs have been shown in prior studies to be strong correlates of FVI [15 (link)]. Self-efficacy (7 items) measured confidence to consume FVs. Social support (5 items) asked about family/friends support and encouragement in eating FVs. Perceived benefits (7 items) asked about perceptions of health benefits of FVs. Perceived barriers (14 items) included: access, high cost, and short shelf-life of FVs.
Novel psychosocial constructs included views on vegetarianism (6 items), autonomous (11 items) and controlled motivation (7 items), preference for FVs (36 items), and food neophobia (3 items) (Table 2). The development of items was exploratory and based on emerging evidence or in the case of motivation, had previously been explored with other behaviors (e.g., smoking). Autonomous motivation was defined as motivations for performing behaviors for which the rewards were internal to the individual, while controlled motivation were those that were based on the receipt of external rewards or punishment [25 (link),26 ,35 (link)]. Food neophobia asked about reluctance to try new foods.
Single items on the survey were either other behaviors or items that did not fit within a scale (i.e., low alphas) and included: physical activity (participation/non-participation for ≥30 minutes daily); smoking (never/former/current smoker); awareness and knowledge of FV recommendation; and two out of three items from the original food neophobia scale (see Table 2). Additional single items asked about “worry” (how much has worrying about your health led you to change the way you ate in the past year), and seasonality (do you tend to eat the same types of FVs all year round or tend to eat different types of FVs depending on the season?). Finally, respondents were asked about the amount (cups) of water they consumed daily, and how often they ate FVs while growing up.
Fruit and Vegetable Intake. The main outcome variable on the survey was FVI during the past month. This was assessed with an eight-item FV screener that was modified from the NCI FV screener [36 ], and validated using multiple 24-hour dietary recalls (adjusted correlation coefficients ranged from 0.39–0.57 for fruit, vegetable, and FV combined) [37 (link)]. Responses included ten frequency categories ranging from never to ≥5 times/day, and four portion size categories ranging from about ¼ cup to more than 2 cups. Responses were converted into servings, as defined by the MyPyramid 1992 dietary guidelines [36 ]. Total FVI was calculated as the sum of all items on the screener, excluding fried potatoes.
Demographic Characteristics. Demographic characteristics that were assessed included sex, age, race/ethnicity, highest level of education completed, income, and geographic region of residence.
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Publication 2015
Avoidant Restrictive Food Intake Disorder Awareness Diet Ethnicity Food Friend Fruit Malignant Neoplasms Mental Recall Motivation Potato Vegetables Vegetarianism
This is an observational study of current practices on the Medical Behavioral Unit (MBU) at Rady Children’s Hospital San Diego (RCHSD)/UCSD. A retrospective chart review was conducted among patients admitted between January 2015 and March 2016. RCHSD is the only children’s hospital in San Diego County, serving several neighboring counties in Southern California. The MBU is an inpatient unit at RCHSD with 10 medical-surgical beds for patients with medical complications of malnutrition.
Patients were included if they were diagnosed with AN, Other Specified Eating Disorder or Avoidant Restrictive Food Intake Disorder (ARFID) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [19 ], and met medical criteria for hospitalization. Hospitalization criteria were based on those recommended by the Society for Adolescent Health and Medicine [8 ] and include: weight <75% of the expected body weight (EBW); resting heart rate (HR) < 45 beats per minute (bpm) while asleep or <50 bpm while awake; hypotension (<90/45 mmHg); body temperature < 35.6° Celsius; orthostatic change in systolic blood pressure (SBP) > 20 mmHg or diastolic blood pressure (DBP) > 10 mmHg; orthostatic change in HR > 30 bpm; syncope, arrhythmia, heart failure, or symptomatic pericardial effusion related to malnutrition or refeeding; dehydration; electrolyte disturbance related to malnutrition, refeeding, vomiting, or laxative/diuretic abuse; or acute food refusal necessitating tube-feeding or non-enteric feeding.
Patients were between the ages of 8 and 20 years old and were included in the analysis if this was their first or second admission to the (MBU), with no previous admission to the MBU in the preceding 30 days. Patients were excluded if they had a diagnosis of bulimia nervosa (n = 1), left the hospital against medical advice (n = 3), or were transferred to another medical or psychiatric facility (n = 2). Human subjects approval was obtained from the UCSD Human Research Protections Program Institutional Review Board.
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Publication 2017
Avoidant Restrictive Food Intake Disorder Body Temperature Body Weight Bulimia Nervosa Cardiac Arrhythmia Child Congestive Heart Failure Dehydration Diagnosis Diuretics Drug Abuse Eating Disorders Effusion, Pericardial Electrolytes Ethics Committees, Research Food Homo sapiens Hospitalization Inpatient Laxatives Malnutrition Patients Pharmaceutical Preparations Pressure, Diastolic Protective Agents Rate, Heart Syncope Systolic Pressure

Most recents protocols related to «Avoidant Restrictive Food Intake Disorder»

All information from CATSS used in this study was reported by parents, either at twin age 9 years (27 492 of 33 902 children [81.1%]) or at twin age 12 years (6410 of 33 902 children [18.9%]). To match this age range, we included diagnostic and procedure codes from the NPR and prescribed drugs from the PDR to assess DSM-5 ARFID criterion A (avoidant/restrictive eating with clinically significant consequences of the eating behavior, eg, low weight/failure to thrive, nutritional deficiency, dependence on nutritional supplements, or psychosocial impairment) between age 6 and 12 years. We chose age 6 years to increase sensitivity for potential consequences of the eating disturbance diagnosed earlier than age 9 years, which is the lower age bound for the parent reports from CATSS.
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Publication 2023
Avoidant Restrictive Food Intake Disorder Child Dietary Supplements Failure to Thrive Feeding Behaviors Hypersensitivity Malnutrition Parent Pharmaceutical Preparations Twins
Criterion B (eating disturbance is not better explained by lack of available food or an associated culturally sanctioned practice) could not be considered, as such information was not available; however, the clinical feeding and eating disorder diagnoses and the specific CATSS items used to identify the ARFID phenotype are unlikely to reflect lack of available food or cultural practices causing the eating disturbance (eTable 1 in Supplement 1).
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Publication 2023
Avoidant Restrictive Food Intake Disorder Diagnosis Dietary Supplements Eating Disorders Food Phenotype
To identify children with the ARFID phenotype, we extracted all information relevant to the DSM-5 criteria for ARFID from CATSS, NPR, and PDR and developed a composite measure (Figure). eTable 1 in Supplement 1 provides a full list of CATSS items, NPR diagnostic and procedure codes, and PDR ATC codes used to evaluate the DSM-5 ARFID criteria.
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Publication 2023
Avoidant Restrictive Food Intake Disorder Child Diagnosis Dietary Supplements Phenotype
To assess criterion D (eating disturbance not attributable to a concurrent medical condition or another mental disorder), we selected a range of medical conditions at any time before age 12 years that could potentially explain the eating disturbance. Furthermore, we wanted to ascertain that genetic and environmental influences on the ARFID phenotype are not only due to autism, which is highly heritable28 (link) and often cooccurs with ARFID.29 (link),30 (link) Therefore, we identified children with an NPR diagnosis of autism at any point in their life (ICD-9 code 299A; ICD-10 codes F84.0, F84.1, F84.5, F84.8, and F84.9) as well as children scoring above the cutoff (8.5 or more points) on the autism scale of the Autism-Tics, AD/HD, and Other Comorbidities Inventory (A-TAC), which has been well-validated for autism.31 (link),32 (link),33 (link)
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Publication 2023
Autistic Disorder Avoidant Restrictive Food Intake Disorder Child Diagnosis Mental Disorders Phenotype Reproduction Tic Disorder
In summary, we identified 4 different case definitions (Figure): (1) children who met DSM-5 ARFID criterion A, (2) children who met DSM-5 ARFID criteria A and C, (3) children who met DSM-5 ARFID criteria A, C, and partially D excluding children with comorbid medical conditions that could potentially explain the eating disturbance, and (4) children who met both DSM-5 ARFID criteria A, C, and partially D excluding children with comorbid autism. However, medical conditions and autism are common comorbidities of ARFID,29 (link),30 (link),34 (link) and in this epidemiological context, it is impossible to determine whether, in each specific case, the selected medical conditions are cause, comorbidity, or consequence of ARFID. Hence, we deemed case definitions 3 and 4 too conversative definitions of ARFID, whereas the case definition 1 was too broad, as it did not exclude children with fear of weight gain. We therefore considered case definition 2 (criteria A and C) to best reflect children with the ARFID phenotype and conducted sensitivity analyses for the other 3 case definitions.
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Publication 2023
Autistic Disorder Avoidant Restrictive Food Intake Disorder Child Hypersensitivity Obesophobia Phenotype

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More about "Avoidant Restrictive Food Intake Disorder"

Avoidant Restrictive Food Intake Disorder (ARFID) is a complex feeding and eating condition characterized by a persistent failure to meet appropriate nutritional and/or energy needs.
Unlike other eating disorders, ARFID does not involve disturbances in body image or a fear of weight gain.
Individuals with ARFID may avoid or restrict food intake due to sensory characteristics, fear of adverse consequences, or lack of interest in eating.
This can lead to significant weight loss, nutritional deficiencies, and impaired psychosocial functioning.
ARFID is typically diagnosed in children, adolescents, and young adults, but can occur at any age.
Effective treatment often involves a multidisciplinary approach focusing on addressing the underlying reasons for food avoidance and restoring adequate nutrition.
Researchers have utilized statistical software like Stata/SE, SPSS, and R to analyze data and understand the complex factors contributing to ARFID.
Sucrose pellets and other experimental methods have been employed in animal studies to investigate the neurobiological mechanisms involved in feeding behaviors related to ARFID.
The Prism v8 software has been used to visualize and analyze data from these studies.
ARFID, also known as 'selective eating disorder' or 'food avoidance emotional disorder,' is a dsytinct condition from other eating disorders like anorexia nervosa and bulimia nervosa.
It's important to recognize and address ARFID early to prevent further complications and support optimal nutritional and psychosocial functioning.
PubCompare.ai can help researchers identify the most effective protocols for studying and treating ARFID, enhancing the reproducibility and accuracy of their work.