Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management

TY - JOUR

T1 - Avoidant/restrictive food intake disorder and autism spectrum disorder

T2 - clinical implications for assessment and management

AU - Farag, Fadila

AU - Sims, Annemarie

AU - Strudwick, Katy

AU - Carrasco, Janette

AU - Waters, Amy

AU - Ford, Vicki

AU - Hopkins, Julia

AU - Whitlingum, Gabriel

AU - Absoud, Michael

AU - Kelly, Veronica B

N1 - Funding Information: We would like to thank the tertiary feeding team for their contributions to this research, as well as all patients and their families for agreeing to take part in this study. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2021 Mac Keith Press

PY - 2022/2

Y1 - 2022/2

N2 - AIM: We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management.METHOD: Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records.RESULTS: Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy.INTERPRETATION: Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.

AB - AIM: We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management.METHOD: Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records.RESULTS: Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy.INTERPRETATION: Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.

KW - Adolescent

KW - Adult

KW - Autism Spectrum Disorder/diagnosis

KW - Avoidant Restrictive Food Intake Disorder/diagnosis

KW - Case-Control Studies

KW - Child

KW - Child, Preschool

KW - Comorbidity

KW - Female

KW - Hospitals, Pediatric

KW - Humans

KW - Infant

KW - London/epidemiology

KW - Male

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85112717999&partnerID=8YFLogxK

U2 - 10.1111/dmcn.14977

DO - 10.1111/dmcn.14977

M3 - Article

C2 - 34405406

SN - 0012-1622

VL - 64

SP - 176

EP - 182

JO - Developmental Medicine and Child Neurology

JF - Developmental Medicine and Child Neurology

IS - 2

ER -