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Subtypes of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A Latent Class Analysis
19 Pages Posted: 1 Sep 2023
More...Abstract
Background:The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary ARFID subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes. We used multinomial logistic regression to identify predictors of class membership.
Methods: We carried out a surveillance study in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS). Newly diagnosed cases of ARFID aged 5 to 18 years were ascertained across the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Fit indices were used to identify the best LCA model.
Findings: We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as Fear subtype, Lack of Interest subtype, Sensory subtype, and Combined subtype. The probability of being classified as these were 7.2% (n=23), 25.1% (n=80), 29.5% (n=94) and 38.2% (n=122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership.
Interpretation:LCA identified four different classes in a sample of children and adolescents with ARFID. The Combined Subtype, a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions.
Funding: This study was funded by the Former EMS Ltd (charity number 1098725, registered Oct. 9th 2017). JSC is supported by a Fellowship funded by the Fundación Alicia Koplowitz. DN is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration Northwest London and NIHR Imperial Biomedical Research Collaboration.
Declaration of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Ethical Approval: The study protocol was approved by both BPSU and CAPSS Executive Committees. Ethical approval was obtained from West Midlands – Black Country Research Ethics Committee (Integrated Research Application System ID 273665; REC 20/WM/0256). Due to the nature of the study, patient and parental consent was not required. Data were collected in England and Wales following Section 251 advice from the Confidentiality Advisory Group of the Health Research Authority (20/CAG/0120). Data were collected in Scotland following advice from the Public Benefit and Privacy Panel for Health and Social Care (HSC-PBPP) (2021-0113). Northern Ireland Privacy Advisory Committee requirements were met to collect data.
Keywords: Child and Adolescent Psychiatry, ARFID, Restrictive Eating, Eating and Feeding Disorders, Latent Class Analysis, ASD, Nutrition
Suggested Citation: Suggested Citation