Children and adolescents with avoidant/restrictive food intake disorder (ARFID) are likely to present with a variety of symptoms depending on their age and sex, according to a report published Monday in JAMA Pediatrics. For example, older youth with ARFID were more likely to report not eating enough and a loss of appetite, whereas younger children were more likely to report a lack of interest in food, avoidance of certain foods, and refusal based on sensory characteristics. Similarly, the study revealed that boys were more likely to refuse food based on sensory characteristics while girls were more likely to eat but not enough.
Avoidant/restrictive food intake disorder is characterized by a lack of interest in or avoidance of food that leads to significant weight loss, nutritional deficiency, dependence on nutritional supplements, and/or marked interference with psychosocial functioning.
“A better understanding of children and adolescents with ARFID could aid in its earlier recognition, development of effective treatment strategies, and reduction of lifelong medical and psychological complications,” wrote Debra K. Katzman, M.D., of the University of Toronto and colleagues.
Katzman and colleagues surveyed Canadian pediatricians in community settings monthly for 24 months to identify youth aged 5 to 18 years who met the DSM-5 diagnostic criteria for avoidant/restrictive food intake disorder. They then mailed questionnaires to these youth/their families to establish the presence of avoidant/restrictive food intake disorder criteria; associated eating behaviors; medical, psychiatric, family, and social history; and more. In total, 207 children and adolescents were included in this analysis.
The incidence of ARFID in the sample was 2.02 per 100,000 patients; the incidence was the highest among girls and boys aged 10 to 14 years (3.43 per 100,000 patients). In general, the researchers found that older patients were more likely to have weight and growth issues (such as significant weight loss and faltering growth) compared with younger patients. Although girls were more likely than boys to meet the criteria for weight and growth issues, older boys had greater mean weight loss than girls, the researchers reported.
Nearly 49% of the children and adolescents with ARFID had comorbid anxiety, and just over 10% had comorbid depression. The rate of depression and anxiety was higher in the older patients compared with the younger patients, the researchers noted.
“These findings affirm the heterogeneity of the clinical presentations noted in this pediatric population. This study also illustrates substantial medical and psychological complications associated with ARFID, underscoring the need for pediatric health care professionals to be familiar with the identification and clinical management of this disorder,” Katzman and colleagues concluded.
“In this issue, Katzman et al offer one of the largest, most comprehensive, and nuanced community-based prospective studies on ARFID demographic characteristics,” wrote Laura K. Grubb, M.D., M.P.H., of Tufts Children’s Hospital in Boston in an accompanying editorial. “The study … provides crucial information to allow better early disease recognition and intervention, which may improve outcomes for patients with ARFID.”
For related information, see the Psychiatric News article “Eating Disorders: Current Knowledge and Treatment Update,” by B. Timothy Walsh, M.D.
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