Validation study on the child, adult, and parent version of the ARFID module 2.0 for the Eating Disorder Examination

Abstract

Objective This study presents a psychometric evaluation of the avoidant/restrictive food intake disorder (ARFID) module 2.0 for the Eating Disorder Examination (EDE), its child (ChEDE), and parent version. Within a pediatric sample seeking treatment for restrictive feeding or eating disorders and non‐treatment‐seeking controls, the module's interrater reliability, parent–child agreement, and its convergent, divergent, and discriminant validity were examined. Method The child, adult, and/or parent version of the German ARFID module was administered to N = 176 children and adolescents (0–17 years) and their parents, as were the (Ch)EDE, well‐established measures on food‐avoidance behaviors, food variety, and body esteem, and objective anthropometric measures. Results Across all versions of the ARFID module, substantial to almost perfect interrater reliability was shown. Parent–child agreement for ARFID diagnosis was substantial. Based on medium‐to‐large associations between interview‐assessed avoidant/restrictive food intake and questionnaire‐assessed food‐avoidance behaviors, food variety, and objective weight status, the module showed high convergent validity, especially for the child and parent version. Low associations of avoidant/restrictive food intake with weight and shape concern demonstrated divergent validity. Individuals with ARFID differed significantly from those with anorexia nervosa and individually matched controls in a range of clinical characteristics, indicating discriminant validity. Discussion This comprehensive validation supports the EDE ARFID module to be a valuable measure for the assessment and diagnosis of ARFID in 0–17‐year‐olds based on self‐ and parent‐report. Validation of the ARFID module against other interview‐based measures on ARFID and its evaluation in an adult sample are pending. Public Significance Based on good reliability and validity of the avoidant/restrictive food intake disorder (ARFID) module for the Eating Disorder Examination (EDE) in its child, adult, and parent version, the present study paves the way for the clinical and research use of the interview‐based EDE ARFID module for assessing ARFID across childhood and adolescence.

Distribution and clinical comparison of restrictive feeding and eating disorders using ICD‐10 and ICD‐11 criteria

“…Contrary to our hypothesis, no significant differences were found for sex, which might be due to the small sample size of the present study. Patients reclassified to ICD‐11 ARFID or ICD‐11 AN did not show equivalent BMI‐SDS, when considering equivalence boundaries of medium effect size, contrasting expectations and previous evidence (Schmidt et al, 2022). Previous literature showed either nonsignificantly different (e.g., Nicely et al, 2014; Norris et al, 2014; Ornstein et al, 2017) or higher body weight status (e.g., Becker et al, 2019; Cañas et al, 2021; Zanna et al, 2021) for patients with ARFID versus AN.…”

“…If interested, appointments for diagnostic interviews were scheduled separately for children and parents and self‐report questionnaires were sent to families. The German version of the Eating Disorder Examination (EDE; Fairburn et al, 2014; Hilbert & Tuschen‐Caffier, 2016) or its child adapted version (ChEDE; Bryant‐Waugh et al, 1996; Hilbert, 2016) and the child, adult, and parent version of the ARFID module for the EDE (Schmidt et al, 2019; Schmidt et al, 2022) were administered by trained research assistants. Because the COVID‐19 pandemic precluded in‐person diagnostic interviews, out of 130 interviews, n = 30 (23.0%) were completed via telephone, mostly ( n = 27, 90.0%) with parents.…”

“…2.3.1 | Avoidant/restrictive food intake disorder and feeding disorder of infancy and childhood diagnoses ARFID module for the Eating Disorder Examination. To elicit diagnoses of ARFID and FD, the ARFID module (Schmidt et al, 2019) for the ChEDE (Bryant-Waugh et al, 1996;Hilbert, 2016), EDE (Fairburn et al, 2014;Hilbert & Tuschen-Caffier, 2016) and P-EDE (Loeb, 2016) was used; a semistructured clinical interview with established reliability and validity (Schmidt et al, 2019;Schmidt et al, 2022). The child and adolescent version of the ARFID module was integrated at the end of the (Ch)EDE, while the parent version was used stand-alone.…”

“…Individuals with AN and ARFID are both characterized by a highly restrictive food intake, which can go along with significant weight loss or growth delay, or other physical or psychosocial impairment. Nevertheless, recent evidence indicated higher levels of food avoidance and restrictive eating behaviors, including food fussiness, emotional undereating, and satiety responsiveness, for patients with ARFID than for patients with AN (Schmidt et al, 2022). In comparison to AN, other reasons than concerns about weight and shape and weight‐loss intentions drive food intake in ARFID, such as an apparent lack of interest in eating, sensory sensitivities toward food, or concerns about the aversive consequences of eating (APA, 2013).…”

Self‐reported expertise and confidence in diagnosing and treating avoidant restrictive food intake disorder among Swedish clinicians

“…ARFID is associated with severe nutritional, developmental, and social impairment caused by clinically significant avoidance or restriction of food intake (Box 1). Although much remains unknown about its aetiology, maintenance, and treatment (Bourne et al, 2020), the ARFID literature is expanding rapidly, with screening, diagnostic, and treatment measures being developed and tested in diverse patient populations (Breiner et al, 2021;Cooper-Vince et al, 2022;Dinkler & Bryant-Waugh, 2021;Lock et al, 2019;Schmidt et al, 2022;Shimshoni & Lebowitz, 2020;Thomas et al, 2020Thomas et al, , 2021). Yet, Sweden, along with many other countries, lacks national diagnostic and treatment guidelines for ARFID, and many afflicted individuals do not receive treatment (Lumell Associates, 2018).…”