Determining the Feeding, Eating, and Emotional Disturbances in Children with Avoidant/Restrictive Food Intake Disorder

The diagnosis of avoidant/restrictive food intake disorder (ARFID) is relatively new. We wanted to see if the Stanford Feeding Questionnaire (SFQ), a picky eating assessment tool, can distinguish children with ARFID from control children, and if children with ARFID have more non-feeding/eating emotional difficulties than controls. Fifty children with ARFID were compared to 98 controls. Parents completed the SFQ, Screen for Child Anxiety Related Emotional Disorders (SCARED), Strength and Difficulties Questionnaire (SDQ), and Sensory Responsiveness Questionnaire (SRQ). Twelve items within the SFQ represented the child problematic eating-related behaviors (SFQ-ARFID Scale), and another 15 items represented parental feeding problems (SFQ-PFP Scale). These two subscales underwent validation for use as screening tools to identify the severity of the children’s eating behaviors (the SFQ-ARFID Scale) and the degree of parental feeding problems (the SFQ-PFP Scale). The findings revealed that the SFQ-ARFID and SFQ-PFP Scale scores were significantly higher in children with ARFID vs. controls. When compared to controls, children with ARFID had higher SDQ-Total-Difficulties, higher SDQ-Internalizing-Difficulties, and lower SRQ-Hedonic scores. Of all parameters, the SFQ-ARFID Scale best differentiated children with ARFID from control children (area under receiver operating characteristics curve = 0.939, 95% CI, 0.895–0.983, p < 0.001). These findings suggest, based on parental report, that there are more eating-related problems and emotional disturbances in children with ARFID vs. controls, alongside increased parental feeding problems.

Study objectives: This work was designed to evaluate whether the use of the SFQ subscales assessing children’s problematic eating (SFQ-ARFID Scale) and parental problematic feeding behaviors (SFQ-PFP Scale), have the potential to support a clinical diagnosis of ARFID. It also sought to determine whether children with ARFID would differ from control children in their overall psychiatric status including several specific domains (anxiety, sensory modulation), previously shown to be more severe in children with ARFID.