Assessment and Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents

doi:10.12114/j.issn.1007-9572.2023.0422

Abstract

Abstract:

Food intake disorders are costly to treat, with an increasing prevalence over the years, and a higher risk of mortality compared to other psychiatric disorders. Avoidant/restrictive food intake disorder (ARFID) , as a relatively new type of food intake disorder, is more prevalent in children and adolescents than in other age groups, affecting their normal growth and development, as well as psychosocial functioning. Currently, there are more foreign studies, while domestic studies are still in the initial stage. Therefore, this paper reviews assessment tools, influencing factors and treatment approaches for ARFID in children and adolescents, with the aim of providing a reference for related research in China.

Key words: Avoidant restrictive food intake disorder, Assessment tools, Influencing factors, Therapeutic measures, Children and adolescents, Review

摘要：

进食障碍治疗成本高，且发病率逐年增高，与其他精神障碍相比，死亡风险也较高。回避性/限制性摄食障碍作为较新的一类进食障碍，相比其他年龄群体在儿童青少年群体中更易出现，影响儿童青少年正常生长发育和社会心理功能。目前，国外研究较多，国内研究尚处于起始阶段。因此，本文对儿童青少年回避性/限制性摄食障碍评估工具、影响因素和治疗方式进行综述，以期为国内开展相关研究提供借鉴。

关键词: 回避限制性摄食障碍, 评估工具, 影响因素, 治疗措施, 儿童青少年, 综述

WANG Qingyu,LIN Zheng,LEI Yang, et al. Assessment and Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents[J]. Chinese General Practice, 2024, 27(09): 1028-1033. DOI: 10.12114/j.issn.1007-9572.2023.0422.
王清玉,林征,雷阳等. 儿童青少年回避性/限制性摄食障碍：评估与治疗[J]. 中国全科医学, 2024, 27(09): 1028-1033. DOI: 10.12114/j.issn.1007-9572.2023.0422.

Figures/Tables 1

References 55

[1]	ASSOCIATION A P. Diagnostic and Statistical Manual of Mental Disorders，Fourth Edition[M]. Washington DC：American Psychiatric Association Publishing，1994.
[2]	ASSOCIATION A P. Diagnostic And Statistical Manual Of Mental Disorders，Fifth Edition[M]. Washington DC：American Psychiatric Association Publishing，2013.
[3]	WHO. ICD-11死因和疾病统计（MMS）[EB/OL]. （2023-01）[2023-05-20].
[4]	THOMAS J J, LAWSON E A, MICALI N，et al. Avoidant/restrictive food intake disorder：a three-dimensional model of neurobiology with implications for etiology and treatment[J]. Curr Psychiatry Rep，2017,19(8):54. DOI：10.1007/s11920-017-0795-5.
[5]	NITSCH A, KNOPF E, MANWARING J，et al. Avoidant/restrictive food intake disorder（ARFID）：its medical complications and their treatment—an emerging area[J]. Curr Pediatr Rep，2021,9(2):21-29. DOI：10.1007/s40124-021-00239-8.
[6]	KAMBANIS P E, KUHNLE M C, WONS O B，et al. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder[J]. Int J Eat Disord，2020,53(2):256-265. DOI：10.1002/eat.23191.
[7]	SANCHEZ-CEREZO J, NAGULARAJ L, GLEDHILL J，et al. What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature[J]. Eur Eat Disord Rev，2023,31(2):226-246. DOI：10.1002/erv.2964.
[8]	CHEN Y L, CHEN W J, LIN K C，et al. Prevalence of DSM-5 mental disorders in a nationally representative sample of children in Taiwan：methodology and main findings[J]. Epidemiol Psychiatr Sci，2019,29:e15. DOI：10.1017/S2045796018000793.
[9]	VAN DYCK Z, BELLWALD L, KURZ S，et al. Essprobleme im kindesalter[J]. Zeitschrift für Gesundheitspsychologie，2013,21(2):91-100. DOI：10.1026/0943-8149/a000091.
[10]	SCHÖFFEL H, HIEMISCH A, KIESS W，et al. Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample[J]. Eur Eat Disord Rev，2021,29(1):60-73. DOI：10.1002/erv.2799.
[11]	HILBERT A, ZENGER M, EICHLER J，et al. Psychometric evaluation of the Eating Disorders in Youth-Questionnaire when used in adults：prevalence estimates for symptoms of avoidant/restrictive food intake disorder and population norms[J]. Int J Eat Disord，2021,54(3):399-408. DOI：10.1002/eat.23424.
[12]	KURZ S, VAN DYCK Z, DREMMEL D，et al. Early-onset restrictive eating disturbances in primary school boys and girls[J]. Eur Child Adolesc Psychiatry，2015,24(7):779-785. DOI：10.1007/s00787-014-0622-z.
[13]	ZICKGRAF H F, ELLIS J M. Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen（NIAS）：a measure of three restrictive eating patterns[J]. Appetite，2018,123:32-42. DOI：10.1016/j.appet.2017.11.111.
[14]	MEDINA-TEPAL K A, VAZQUEZ-AREVALO R, TRUJILLO-CHIVACUÁN E M，et al. Cross-cultural adaptation and validation of the Nine Item ARFID Screen（NIAS）in Mexican youths[J]. Int J Eat Disord，2023,56(4):721-726. DOI：10.1002/eat.23832.
[15]	BURTON MURRAY H, DREIER M J, ZICKGRAF H F，et al. Validation of the nine item ARFID screen（NIAS）subscales for distinguishing ARFID presentations and screening for ARFID[J]. Int J Eat Disord，2021,54(10):1782-1792. DOI：10.1002/eat.23520.
[16]	HE J B, ZICKGRAF H F, ELLIS J M，et al. Chinese version of the nine item ARFID screen：psychometric properties and cross-cultural measurement invariance[J]. Assessment，2021,28(2):537-550. DOI：10.1177/1073191120936359.
[17]	FINK M, SIMONS M, TOMASINO K，et al. When is patient behavior indicative of avoidant restrictive food intake disorder（ARFID）vs reasonable response to digestive disease?[J]. Clin Gastroenterol Hepatol，2022,20(6):1241-1250. DOI：10.1016/j.cgh.2021.07.045.
[18]	ZIÓŁKOWSKA B, OCALEWSKI J, ZICKGRAF H，et al. The Polish version of the avoidant/restrictive food intake disorder questionnaire-parents report（ARFID-Q-PR）and the nine items avoidant/restrictive food intake disorder screen-parents report（NIAS-PR）：maternal perspective[J]. Nutrients，2022,14(15):3175. DOI：10.3390/nu14153175.
[19]	BRYANT-WAUGH R, MICALI N, COOKE L，et al. Development of the Pica，ARFID，and Rumination Disorder Interview，a multi-informant，semi-structured interview of feeding disorders across the lifespan：a pilot study for ages 10-22[J]. Int J Eat Disord，2019,52(4):378-387. DOI：10.1002/eat.22958.
[20]	BRYANT-WAUGH R, STERN C M, DREIER M J，et al. Preliminary validation of the pica，ARFID and rumination disorder interview ARFID questionnaire（PARDI-AR-Q）[J]. J Eat Disord，2022,10(1):179. DOI：10.1186/s40337-022-00706-7.
[21]	FARAG F, SIMS A, STRUDWICK K，et al. Avoidant/restrictive food intake disorder and autism spectrum disorder：clinical implications for assessment and management[J]. Dev Med Child Neurol，2022,64(2):176-182. DOI：10.1111/dmcn.14977.
[22]	KATZMAN D K, SPETTIGUE W, AGOSTINO H，et al. Incidence and age- and sex-specific differences in the clinical presentation of children and adolescents with avoidant restrictive food intake disorder[J]. JAMA Pediatr，2021,175(12):e213861. DOI：10.1001/jamapediatrics.2021.3861.
[23]	DALY A N, O'SULLIVAN E J, KEARNEY J M. Considerations for health and food choice in adolescents[J]. Proc Nutr Soc，2022,81(1):75-86. DOI：10.1017/S0029665121003827.
[24]	CAÑAS L, PALMA C, MOLANO A M，et al. Avoidant/restrictive food intake disorder：psychopathological similarities and differences in comparison to anorexia nervosa and the general population[J]. Eur Eat Disord Rev，2021,29(2):245-256. DOI：10.1002/erv.2815.
[25]	NORRIS M L, ROBINSON A, OBEID N，et al. Exploring avoidant/restrictive food intake disorder in eating disordered patients：a descriptive study[J]. Int J Eat Disord，2014,47(5):495-499. DOI：10.1002/eat.22217.
[26]	VARÌ R, SILENZI A, D'AMORE A，et al. MaestraNatura reveals its effectiveness in acquiring nutritional knowledge and skills：bridging the gap between girls and boys from primary school[J]. Nutrients，2023,15(6):1357. DOI：10.3390/nu15061357.
[27]	SMITH K R, MORAN T H. Gastrointestinal peptides in eating-related disorders[J]. Physiol Behav，2021,238:113456. DOI：10.1016/j.physbeh.2021.113456.
[28]	BECKER K R, MANCUSO C, DREIER M J，et al. Ghrelin and PYY in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls[J]. Psychoneuroendocrinology，2021,129:105243. DOI：10.1016/j.psyneuen.2021.105243.
[29]	BURTON MURRAY H, BECKER K R, HARSHMAN S，et al. Elevated fasting satiety-promoting cholecystokinin（CCK）in avoidant/restrictive food intake disorder compared to healthy controls[J]. J Clin Psychiatry，2022,83(5):21m14111. DOI：10.4088/JCP.21m14111.
[30]	KOOMAR T, THOMAS T R, POTTSCHMIDT N R，et al. Estimating the prevalence and genetic risk mechanisms of ARFID in a large autism cohort[J]. Front Psychiatry，2021,12:668297. DOI：10.3389/fpsyt.2021.668297.
[31]	KENNEDY H L, DINKLER L, KENNEDY M A，et al. How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder（ARFID）[J]. J Eat Disord，2022,10(1):53. DOI：10.1186/s40337-022-00578-x.
[32]	DINKLER L, WRONSKI M L, LICHTENSTEIN P，et al. Etiology of the broad avoidant restrictive food intake disorder phenotype in Swedish twins aged 6 to 12 years[J]. JAMA Psychiatry，2023,80(3):260-269. DOI：10.1001/jamapsychiatry.2022.4612.
[33]	MCCLELLAND J, ROBINSON L, POTTERTON R，et al. Symptom trajectories into eating disorders：a systematic review of longitudinal，nonclinical studies in children/adolescents[J]. Eur Psychiatry，2020,63(1):e60. DOI：10.1192/j.eurpsy.2020.55.
[34]	DINKLER L, YASUMITSU-LOVELL K, EITOKU M，et al. Early neurodevelopmental problems and risk for avoidant/restrictive food intake disorder（ARFID）in 4-7-year-old children：a Japanese birth cohort study[J]. JCPP Adv，2022,2(3):e12094. DOI：10.1002/jcv2.12094.
[35]	MURRAY H B, BAILEY A P, KESHISHIAN A C，et al. Prevalence and characteristics of avoidant/restrictive food intake disorder in adult neurogastroenterology patients[J]. Clin Gastroenterol Hepatol，2020,18(9):1995-2002.e1. DOI：10.1016/j.cgh.2019.10.030.
[36]	MURRAY H B, RAO F U, BAKER C，et al. Prevalence and characteristics of avoidant/restrictive food intake disorder in pediatric neurogastroenterology patients[J]. J Pediatr Gastroenterol Nutr，2022,74(5):588-592. DOI：10.1097/MPG.0000000000003369.
[37]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders，fifth edition，text revision（DSM-5-TR）[EB/OL]. [2023-05-20].
[38]	CHAPMAN L, CARTWRIGHT-HATTON S, THOMSON A，et al. Parental eating disorders：a systematic review of parenting attitudes，behaviours，and parent-child interactions[J]. Clin Psychol Rev，2021,88:102031. DOI：10.1016/j.cpr.2021.102031.
[39]	DINKLER L, YASUMITSU-LOVELL K, EITOKU M，et al. Development of a parent-reported screening tool for avoidant/restrictive food intake disorder（ARFID）：initial validation and prevalence in 4-7-year-old Japanese children[J]. Appetite，2022,168:105735. DOI：10.1016/j.appet.2021.105735.
[40]	SCHMIDT R, VOGEL M, HIEMISCH A，et al. Pathological and non-pathological variants of restrictive eating behaviors in middle childhood：a latent class analysis[J]. Appetite，2018,127:257-265. DOI：10.1016/j.appet.2018.04.030.
[41]	BRYTEK-MATERA A, ZIÓŁKOWSKA B, OCALEWSKI J. Symptoms of avoidant/restrictive food intake disorder among 2-10-year-old children：the significance of maternal feeding style and maternal eating disorders[J]. Nutrients，2022,14(21):4527. DOI：10.3390/nu14214527.
[42]	RIENECKE R D, JOHNSON C, MEHLER P S，et al. Adverse childhood experiences among a treatment-seeking sample of adults with eating disorders[J]. Eur Eat Disord Rev，2022,30(2):156-167. DOI：10.1002/erv.2880.
[43]	TSANG K K, HAYES L C, BUJOREANU S，et al. Characterization study of patients presenting to an acute care pediatric hospital identified with avoidant/restrictive food intake disorder[J]. Hosp Pediatr，2020,10(7):600-607. DOI：10.1542/hpeds.2020-0010.
[44]	TAYLOR T, HABERLIN A. Treatment for younger siblings of participants in a home-based intensive paediatric feeding programme in Australia[J]. Behav Change，2020,37(4):206-218. DOI：10.1017/bec.2020.14.
[45]	TAYLOR T, HABERLIN A, HABERLIN J. Treatment of avoidant/restrictive food intake disorder for a teenager with typical development within the home setting[J]. J Adolesc，2019,77:11-20. DOI：10.1016/j.adolescence.2019.09.007.
[46]	MULKENS S, WALLER G. New developments in cognitive-behavioural therapy for eating disorders（CBT-ED）[J]. Curr Opin Psychiatry，2021,34(6):576-583. DOI：10.1097/YCO.0000000000000745.
[47]	THOMAS J J, BECKER K R, KUHNLE M C，et al. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder：feasibility，acceptability，and proof-of-concept for children and adolescents[J]. Int J Eat Disord，2020,53(10):1636-1646. DOI：10.1002/eat.23355.
[48]	LOCK J, ROBINSON A, SADEH-SHARVIT S，et al. Applying family-based treatment（FBT）to three clinical presentations of avoidant/restrictive food intake disorder：similarities and differences from FBT for anorexia nervosa[J]. Int J Eat Disord，2019,52(4):439-446. DOI：10.1002/eat.22994.
[49]	LOCK J, SADEH-SHARVIT S, L'INSALATA A. Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder[J]. Int J Eat Disord，2019,52(6):746-751. DOI：10.1002/eat.23077.
[50]	BREWERTON T D, D'AGOSTINO M. Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program[J]. J Child Adolesc Psychopharmacol，2017,27(10):920-922. DOI：10.1089/cap.2017.0133.
[51]	GRAY E, CHEN T, MENZEL J，et al. Mirtazapine and weight gain in avoidant and restrictive food intake disorder[J]. J Am Acad Child Adolesc Psychiatry，2018,57(4):288-289. DOI：10.1016/j.jaac.2018.01.011.
[52]	MAHR F, BILLMAN M, ESSAYLI J H，et al. Selective serotonin reuptake inhibitors and hydroxyzine in the treatment of avoidant/restrictive food intake disorder in children and adolescents：rationale and evidence[J]. J Child Adolesc Psychopharmacol，2022,32(2):117-121. DOI：10.1089/cap.2021.0038.
[53]	LESSER A D, MATHIS E S, MELICOSTA M E. Avoidant and restrictive food intake disorder：outcomes for 16 inpatient cases to target oral consumption using a medical and behavioral treatment model[J]. Clin Pediatr，2022,61(4):362-369. DOI：10.1177/00099228221078419.
[54]	KUROTORI I, SHIODA K, ABE T，et al. An inpatient observational study：characteristics and outcomes of avoidant/restrictive food intake disorder（ARFID）in children and adolescents in Japan[J]. Neuropsychiatr Dis Treat，2019,15:3313-3321. DOI：10.2147/NDT.S218354.
[55]	BILLMAN M G, FORREST L N, JOHNSON M，et al. Preliminary effectiveness of a cognitive-behavioral，family-centered partial hospitalization program for children and adolescents with avoidant/restrictive food intake disorder[J]. Int J Eat Disord，2022,55(11):1621-1626. DOI：10.1002/eat.23806.

评估工具	时间（年）	测评形式	适用人群	Cronbach's α系数	汉化版	优点	缺点
青少年饮食紊乱调查问卷（EDY-Q）^[9]	2013	自陈量表	≥14岁	0.62	无	①简单快捷 ②可以区分其他进食障碍	①信度较低
九项回避性/限制性摄食障碍筛查量表（NIAS）^[13]	2017	自陈量表	≥12岁	多样本检验为0.79~0.90	有	①简单快捷 ②信效度较好	①需结合其他量表进行区分 ②不适合胃肠道疾病患者筛查
回避性/限制性摄食障碍父母报告版问卷（ARFID-Q-PR）^[18]	2022	他评量表	2~10岁儿童	0.84	无	①可以区分其他进食障碍 ②信效度较好	①有待在多样本人群推广验证
异食癖、回避性/限制性摄食障碍和反刍障碍访谈（PARDI）^[19]	2019	半结构化访谈	全年龄段使用	评估ARFID分量表各维度为0.83~0.93	无	①可用于诊断 ②信效度较好	①需要心理医生指导使用 ②大规模筛查人力成本较高

评估工具	时间（年）	测评形式	适用人群	Cronbach's α系数	汉化版	优点	缺点
青少年饮食紊乱调查问卷（EDY-Q）^[9]	2013	自陈量表	≥14岁	0.62	无	①简单快捷 ②可以区分其他进食障碍	①信度较低
九项回避性/限制性摄食障碍筛查量表（NIAS）^[13]	2017	自陈量表	≥12岁	多样本检验为0.79~0.90	有	①简单快捷 ②信效度较好	①需结合其他量表进行区分 ②不适合胃肠道疾病患者筛查
回避性/限制性摄食障碍父母报告版问卷（ARFID-Q-PR）^[18]	2022	他评量表	2~10岁儿童	0.84	无	①可以区分其他进食障碍 ②信效度较好	①有待在多样本人群推广验证
异食癖、回避性/限制性摄食障碍和反刍障碍访谈（PARDI）^[19]	2019	半结构化访谈	全年龄段使用	评估ARFID分量表各维度为0.83~0.93	无	①可用于诊断 ②信效度较好	①需要心理医生指导使用 ②大规模筛查人力成本较高