Parent-child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination

Sociodemographic correlates of parent and youth-reported eating disorder symptoms in the Adolescent Brain Cognitive Development Study

PURPOSE

Eating Disorders (EDs) often start in adolescence, though ED-related concerns in diverse youth samples remain understudied. We leveraged data from the Adolescent Brain Cognitive Development (ABCD) Study to identify the prevalence of parent- and youth-reported ED symptoms and their sociodemographic characteristics.

METHODS

Data were drawn from baseline (ages 9-11 years, n=11,868) and 2-year follow-up (ages 11-14 years; n=10,908) from the ABCD Study. A tetrachoric factor analysis summarized clusters of ED symptoms, which were compared between parent and youth reports and across sociodemographic variables.

RESULTS

Three factors emerged reflecting "weight distress", "weight control", and "binge eating" (prevalence range: 1.5-7.3%). Symptoms loaded onto similar factors between reporters. Rates of symptom endorsement were similar between sexes, with disproportionately higher endorsement rates for youth who self-identified as sexual minority, Hispanic, Black, or Mixed race participants, and those from a disadvantaged socioeconomic background, compared to the reference ABCD sample. Youth and parent reports at 2-year showed ~12% overlap.

CONCLUSIONS

ED-related concerns among historically understudied racial and sexual minority groups call for greater attention to the detection and treatment of these symptoms in these groups. Applying a transdiagnostic approach to ED symptoms can inform effective detection and intervention efforts.

Reliability and validity of a parent-reported screening tool for disordered eating in children and young people with type 1 diabetes

BACKGROUND

There is a high prevalence and complex overlap between type 1 diabetes (T1D) and disordered eating. However, screening for disordered eating in children and young people (CYP) with T1D is not routinely conducted, with reluctance reported by both professionals and parents. This study aimed to validate a parent-reported version of a validated disordered eating screening tool for CYP with T1D (the Diabetes Eating Problems Survey-Revised; DEPS-R).

METHODS

The existing DEPS-R was adapted for parental use. Eighty-nine parents of CYP with T1D aged 11-14 years completed the parent-reported DEPS-R and other questionnaires related to demographics, child eating behaviours and parental well-being. CYP of parents were invited to participate, with 51 CYP completing the validated CYP-reported DEPS-R for comparison.

RESULTS

The parent-reported DEPS-R demonstrated good internal consistency (Cronbach's α = 0.89). Moderate to good inter-rater reliability was found between the parent-reported DEPS-R and CYP-reported DEPS-R (ICC 0.746, 95% CI = 0.554-0.855, p < 0.001), indicating good convergent validity. Construct validity with hypothesised variables, including specific eating behaviours, diabetes-related distress, well-being, CYP BMI, gender and parental worry about CYP disordered eating, suggested validity of the measure. However, some hypothesised variables did not significantly correlate with the parent-reported DEPS-R as expected.

CONCLUSIONS

The parent-reported DEPS-R has demonstrated good reliability and validity, and it may provide clinical benefit by increasing screening and early detection of disordered eating in CYP with T1D. Whilst novel and providing stepped increase in our knowledge, these findings would benefit from further validation (e.g. in a larger sample and responsiveness).

A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children

Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.

Preliminary Validation of The Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P)

OBJECTIVE

There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P).

METHOD

The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6-18, N = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9).

RESULTS

After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q (r = .69), and moderate convergent validity with child scores on the GAD-7 (r = .37) and PHQ-9 (r = .46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns.

DISCUSSION

The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents.

Psychometric properties of the Parent Eating Disorder Examination Questionnaire

OBJECTIVE

To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE-Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants.

METHODS

A multi-site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE-Q) and their parents completed the PEDE-Q.

RESULTS

The internal consistencies of the PEDE-Q subscales were on par with established EDE-Q ranges (.73 to .90), both when examined using the original four-factor EDE-Q subscales and the seven-item, three-factor subscales of the brief EDE-Q. Statistically significant medium- to large-sized correlations and poor to moderate levels of agreement were found between the corresponding EDE-Q and PEDE-Q subscales. Receiver-operator characteristic (ROC) curves showed that the PEDE-Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full-syndrome AN, whereas the EDE-Q did not. Based on chi-square analyses, the PEDE-Q identified a statistically significantly greater number of AN cases than the EDE-Q. The EDE-Q yielded a BN diagnosis more frequently than the PEDE-Q, although this difference was not statistically significant.

DISCUSSION

Results suggest that the PEDE-Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN.

PUBLIC SIGNIFICANCE

There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE-Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE-Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.

The prospective relationship between weight-based discrimination and eating pathology among youth

Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (M_age at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94-4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.

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

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.

Recognition and duration of illness in adolescent eating disorders: Parental perceptions of symptom onset

AIM

To understand the earliest parent reported signs suggesting their child may have an eating disorder (ED), and to quantify time from symptom onset to specialist assessment.

METHODS

This is a secondary analysis of data derived from parents of 78 young people presenting to a British community ED service who completed a questionnaire asking when they first noticed their child displaying (a) a change in eating pattern, (b) weight concerns, (c) shape concerns. Parents were also asked to describe the first thing they noticed in terms of possible ED symptoms.

RESULTS

Mean age was 14.9 (SD: 1.58), 94% were female with diagnoses of anorexia nervosa (n = 50), bulimia nervosa (n = 10) and atypical anorexia nervosa (n = 18). Weight and shape concerns were most often noticed over a year prior to assessment (mean 12.7 months [SD: 12.8] and 13.3 months [SD: 13.2], respectively), with eating pattern change observed a mean of 9.7 months (SD: 7.6) before referral to specialist care. Seven main themes were developed from parents' descriptions of their child's symptoms: (1) eating pattern change, (2) shape concern, (3) weight concern, (4) observed weight loss, (5) binge eating/compensatory behaviours, (6) other mental health concerns and (7) physical symptoms.

CONCLUSIONS

The most common parental concerns were eating pattern change, specifically their child becoming more rigid/rule-bound with regard to eating and dietary restraint. Such external changes are likely observed before physical changes such as weight loss, offering potential for early identification by parents, primary care and other professionals, with implications for improved prognosis.

Psychiatric comorbidity of eating disorders in children between the ages of 9 and 10

BACKGROUND

Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study.

METHODS

The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression.

RESULTS

Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research.

CONCLUSIONS

This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.

Psychiatric comorbidity associated with weight status in 9 to 10 year old children

BACKGROUND

Paediatric overweight and obesity (OW/OB) constitute a serious public health concern. Given that psychological problems may be key contributors to the onset and maintenance of paediatric obesity, the present study examined past and current psychiatric comorbidities across the weight spectrum during middle childhood among a nationally representative sample.

METHODS

Participants were 11 708 9- to 10-year-old children (31.6% with OW/OB) and their caregivers who participated in the first wave of data collection in the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions were used to examine the association between weight status (i.e., underweight, healthy weight, OW, OB) and likelihood of current/past psychiatric diagnoses.

RESULTS

Compared to healthy weight children, those with OW/OB were more likely to have current/past major depressive disorder and binge eating disorder. Relative to healthy weight children, those with OB were more likely to have prior separation anxiety disorder, current specific phobia and oppositional defiant disorder; those with OW were more likely to have PTSD; and those with underweight were more likely to have ADHD.

CONCLUSIONS

Results suggest cross-sectional associations among negative emotionality, binge eating, and OW/OB, and highlight the need for ongoing prospective research to investigate directionality of associations and mechanisms of effects.

Concordance between youth and caregiver report of eating disorder psychopathology: Development and psychometric properties of the Eating Disorder-15 for Parents/Caregivers (ED-15-P)

OBJECTIVE

Outcome measurement in youth with eating disorders relies heavily on self-report, which is problematic in a population that may deny or minimize symptoms. Caregiver-report measures are lacking. This study examined the psychometric and clinical properties of a newly-developed measure designed to assess short-term change in eating disorder symptomatology as observed by caregivers-the Eating Disorder-15 for Parents/Caregivers (ED-15-P).

METHOD

At initial presentation to an outpatient eating disorders assessment, 206 families (primary caregiver and their child up to 18 years old) completed psychological measures.

RESULTS

The ED-15-P demonstrated excellent reliability, preliminary evidence of discriminant and concurrent validity, and good sensitivity to change early in treatment (first 8 weeks). Agreement between primary caregivers and children on eating disorder psychopathology was moderate, while agreement between pairs of caregivers was relatively strong. Level of agreement varied across behaviors and informants, with poorer caregiver-child agreement on dieting and driven exercise.

DISCUSSION

Agreement was stronger within caregiver pairs than caregiver-child pairs, indicating that caregivers and their children have related but unique perspectives on eating disorder symptoms, highlighting the importance of multi-informant assessment. The ED-15-P complements a parallel youth report measure to more comprehensively assess eating disorder psychopathology, with high utility for measuring change over time.

A systematic review of neural correlates of dysregulated eating associated with obesity risk in youth

Dysregulated eating among children and adolescents is associated with a wide range of negative mental and physical health outcomes, including obesity. However, less is known regarding underlying neural mechanisms underlying such behaviors. Therefore, the present manuscript systematically reviewed neuroimaging research examining dysregulated eating behavior linked to excess weight in children and adolescents. A systematic literature search identified 23 eligible studies, the majority of which were cross-sectional functional magnetic resonance imaging (fMRI) studies and excluded participants with psychiatric disorders. Dysregulated eating was captured by measures of eating styles and eating self-regulation, eating disorder behaviors, food addiction, objective measures of non-homeostatic eating and caloric restriction. While preliminary, findings suggested eating dysregulation was related to aberrant functioning within the frontostriatal and frontoparietal regions involved in self-regulatory processes, as well as regions involved in satiety signaling and interoception. This heterogeneous body of research is continually growing and may have potential to inform future prevention and intervention approaches. Results also identified several important limitations to consider and highlight key areas for future research.

Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study

This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT00418977.

Do parents perceive the abnormal eating attitudes of their adolescent children with anorexia nervosa?

Parents are often the first to detect the initial signs of anorexia nervosa (AN) and take necessary measures to ensure that their children receive appropriate treatment. The evaluation of AN in adolescence is complicated by taking into account the tendency to minimize and deny the symptoms by adolescents, and the difficulty of parents in detecting the main symptoms. We compared the adolescent and parent scores on measures of disordered eating at initial presentation. The sample consisted of 62 adolescents diagnosed with AN, who attended an eating disorder children's unit. Adolescents completed the Eating Attitudes Test (EAT-40) and their parents the Anorectic Behavior Observation Scale (ABOS). The questionnaire data were collected as part of the routine clinical practice and were obtained from clinical notes. The findings indicate no significant correlations between the EAT-40 and ABOS scores, or between AN subtypes according to parent observation of symptoms. There were significant differences between parents, with mothers reporting higher scores than fathers. This study highlights the importance of psychoeducation for parents on the early signs of AN, in order to improve recognition and diagnosis at initial assessment of their adolescent children in the early phases.

Convergence in maternal and child reports of impulsivity, depressive symptoms, and trait anxiety, and their predictive utility for binge-eating behaviors

OBJECTIVE

Early detection of binge-eating (BE) behaviors and their risk factors is associated with better outcomes. A multi-informant approach for assessing BE psychopathology and risk factors has been emphasized to increase the probability and accuracy of early detection. Impulsivity (particularly negative and positive urgency), trait anxiety, and depressive symptoms are associated with BE behaviors. The present study examined maternal-child convergence of reports of child BE, impulsivity, trait anxiety, and depressive symptoms and examined the predictive power of maternal reports for child-reported BE behaviors.

METHOD

Participants included 927 female twins (aged 8-16 years) and 468 mothers from the Michigan State University Twin Registry. Risk factors and BE were assessed with self-report questionnaires.

RESULTS

Intraclass correlation coefficients showed fair-to-moderate inter-rater agreement (ICCs = .31-.41) between maternal and child reports of risk factors and low-to-fair agreement for BE (ICCs = .05-.29). Controlling for the effects of age, pubertal status, body mass index, and family relatedness, multilevel models showed that maternal reports of child impulsivity, anxiety, and depressive symptoms did not add predictive power above and beyond child reports.

DISCUSSION

Results call into question the utility and practical implications of using maternal reports to supplement child reports for BE and its risk factors.

Interview-based assessment of avoidant/restrictive food intake disorder (ARFID): A pilot study evaluating an ARFID module for the Eating Disorder Examination

OBJECTIVE

Although avoidant/restrictive food intake disorder (ARFID) has been included as a new diagnostic entity of childhood feeding and eating disorders, there is a lack of measures to reliably and validly assess ARFID. In addition, virtually nothing is known about clinical characteristics of ARFID in nonclinical samples.

METHOD

The present study presents the development and validation of an ARFID module for the child and parent version of the Eating Disorder Examination (EDE) in a nonclinical sample of N = 39 children between 8 and 13 years with underweight and/or restrictive eating behaviors. For evaluating the ARFID module's reliability, the convergence of diagnoses between two independent raters and between the child and parent module was determined. The module's validity was evaluated based on the full-length child version of the EDE, a 24 h food record, parent-reported psychosocial functioning and self-reported quality of life, and objective anthropometric measures.

RESULTS

In total, n = 7 children received an ARFID diagnosis. The ARFID module showed high interrater reliability, especially for the parent version, and high convergence between child and parent report. Evidence for the module's convergent, divergent, and discriminant validity was provided. Specifically, children with versus without ARFID reported significantly less macro- and micronutrient intake and were more likely to be underweight.

DISCUSSION

This pilot study indicates the child and parent version of the EDE ARFID module to be promising for diagnosing ARFID in a structured way but still necessitates a validation in a larger clinical and community-based sample.

Identifying disordered eating behaviours in adolescents: how do parent and adolescent reports differ by sex and age?

This study investigated the prevalence of disordered eating cognitions and behaviours across mid-adolescence in a large European sample, and explored the extent to which prevalence ratings were affected by informant (parent/adolescent), or the sex or age of the adolescent. The Development and Well-Being Assessment was completed by parent-adolescent dyads at age 14 (n = 2225) and again at age 16 (n = 1607) to explore the prevalence of 7 eating disorder symptoms (binge eating, purging, fear of weight gain, distress over shape/weight, avoidance of fattening foods, food restriction, and exercise for weight loss). Informant agreement was assessed using kappa coefficients. Generalised estimating equations were performed to explore the impact of age, sex and informant on symptom prevalence. Slight to fair agreement was observed between parent and adolescent reports (kappa estimates between 0.045 and 0.318); however, this was largely driven by agreement on the absence of behaviours. Disordered eating behaviours were more consistently endorsed amongst girls compared to boys (odds ratios: 2.96-5.90) and by adolescents compared to their parents (odds ratios: 2.71-9.05). Our data are consistent with previous findings in epidemiological studies. The findings suggest that sex-related differences in the prevalence of disordered eating behaviour are established by mid-adolescence. The greater prevalence rates obtained from adolescent compared to parent reports may be due to the secretive nature of the behaviours and/or lack of awareness by parents. If adolescent reports are overlooked, the disordered behaviour may have a greater opportunity to become more entrenched.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

OBJECTIVES

This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014.

METHODS

The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified.

RESULTS

In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice.

CONCLUSIONS

Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management.

EXPERT REVIEWERS

Associate Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis.

Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting

OBJECTIVE

To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program.

METHOD

This study compared cognitive, behavioral, and physical and medical features of children (≤ 12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8-18 years; 94% female).

RESULTS

Significant differences were found between the groups. Children were more commonly male (p < .001), had lower eating pathology scores (p < .001), were less likely to binge eat (p = .02), purge (p < .001) or exercise for shape and weight control (p < .001), and lost weight at a faster rate than adolescents (p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders (p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise (p > .05).

DISCUSSION

The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.