title: Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network.
abstract: OBJECTIVE
  Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM-5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter-rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample.
  
  
  METHODS
  We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8-18 years) to 19 Boston-area pediatric gastroenterology clinics for evidence of DSM-5 ARFID.
  
  
  RESULTS
  We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding (n = 19) or limited diet due to sensory features of the food (n = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems.
  
  
  CONCLUSIONS
  In a pediatric treatment-seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over-inclusive even in a population where eating/feeding difficulties are expected.
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hastings
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Katherine
authors.initials: K
authors.lastname: Edkins
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Evan
authors.initials: E
authors.lastname: Lamont
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Nevins
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Patterson
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Helen B
authors.initials: HB
authors.lastname: Murray
authors.affiliation: Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bryant-Waugh
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.|Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000175:diagnosis; D001007:Anxiety / Q000175:diagnosis; D002648:Child; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: DSM-5; avoidant/restrictive food intake disorder; feeding disorder