Validation of the youth‐nine item avoidant/restrictive food intake disorder screen

Abstract

ObjectiveThis study assessed the factorial, divergent, and criterion‐related validity of the Youth‐Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y‐NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED).MethodParticipants included 310 patients (82.9% female, 77.4% White, Age M = 14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three‐factor of the Y‐NIAS. One‐way analysis of variance compared Y‐NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion‐related validity of the obtained Y‐NIAS cut‐scores.ResultsCFA supported the original three‐factor structure of the Y‐NIAS. Clinically‐elevated scores were observed in all diagnostic groups except for binge‐eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE‐Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%).DiscussionThe Y‐NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y‐NIAS for identifying clinically‐significant ARFID presentations from other ED diagnoses.

Assessing avoidant/restrictive food intake disorder symptoms using the Nine Item ARFID Screen in >9,000 Swedish adults with and without eating disorders

“…The results of this study replicate previous findings suggesting that the NIAS alone is insufficient for differentiating ARFID from other eating disorder presentations (Billman Miller et al, 2024; Burton Murray et al, 2021). Our findings quantify this problem and contribute new insight into the relative elevation of individual NIAS subscale scores among individuals with different types of eating disorders, highlighting that individuals with AN are more likely than individuals with other current eating disorders to have elevated scores on the NIAS, especially the Appetite subscale.…”

“…The NIAS has been widely used in a number of settings with diverse clinical and non-clinical populations (Zickgraf et al, 2023) and norms for the general population have been established (Zickgraf & Ellis, 2018). A large number of translations and adaptations of the NIAS have been made (e.g., Billman Miller et al, 2024; Fekih-Romdhane et al, 2023; He et al, 2021; Medina-Tepal et al, 2023; Van Ouytsel et al, 2024; Ziolkowska et al, 2022), including development of a parent-report version (Ziolkowska et al, 2022). The NIAS has also been used to examine the potential comorbidity of ARFID in individuals with gastrointestinal disorders, including gastroparesis, functional dyspepsia, achalasia, celiac disease, eosinophilic esophagitis, and inflammatory bowel disease (Burton Murray et al, 2020; Fink et al, 2022; Kaul et al, 2024; Robelin et al, 2021; Yelencich et al, 2022).…”

“…However, several smaller clinical studies have now shown that the NIAS does not seem to differentiate well between ARFID and eating disorders driven by shape/weight concerns, because individuals with other eating disorders also have elevated scores on the NIAS (Billman Miller et al, 2024; Burton Murray et al, 2021). These studies found that the NIAS alone was insufficient to distinguish accurately between individuals with ARFID and individuals with other eating disorders, suggesting that the NIAS may capture both ARFID-related eating disturbances and eating behaviors associated with weight/shape driven eating disorders (Billman Miller et al, 2024; Burton Murray et al, 2021). Accordingly, findings from these studies have yielded recommendations to combine the NIAS with additional eating disorder questionnaires as exclusion measures when assessing ARFID symptoms.…”

Avoidant/restrictive food intake disorder prevalence is high in children with gastroparesis and functional dyspepsia

“…The NIAS uses three subscales assessing the three motivations behind ARFID restriction: “Picky Eating” (sensory sensitivity presentation), “Appetite” (lack of interest presentation), and “Fear” (fear of aversive consequences) (rated 0‐Strongly Disagree to 5‐Strongly Agree). Cutoffs for a positive NIAS ARFID screen were validated in a study that included participants ≥10 years of age (in combination with a negative screen on the Eating Disorder Examination‐Questionnaire 16,18 ). We also employed the ARFID‐checklist which has been used in combination with the NIAS to align with DSM‐5 criteria assessing for the presence of psychosocial impairment and/or medical consequences 19 .…”

Picky eating or something more? Differentiating ARFID from typical childhood development

“…This underscores the importance of screening for PPE behaviors associated with an increased risk of ARFID, particularly given the potential health consequences. Although no singular validated screening tool exists for ARFID specifically, the following tools may help to identify behaviors that confer risk for this diagnosis: Eating Disturbances in Youth-Questionnaire (EDY-Q), a self-report tool consisting of four subcategories (food avoidance, selective eating, functional dysphagia, and weight problems); Pica, ARFID, and Rumination Disorder Interview (PARDI), which contains parent and child reports and is aligned with DSM-5 criteria for ARFID; and the Youth-Nine Item ARFID Screen 19,21,22…”