Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidant/restrictive food intake disorder phenotype

Abstract

Background

Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by extremely restricted dietary variety and/or quantity resulting in serious consequences for physical health and psychosocial functioning. ARFID often co-occurs with neurodevelopmental conditions (NDCs) and psychiatric conditions, but previous data are mostly limited to small clinical samples examining a narrow range of conditions. Here, we examined NDCs and psychiatric conditions in a large, population-based group of children with ARFID.

Methods

In 30,795 children born 1992–2008 in Sweden, ARFID was assessed using parent reports and clinical diagnoses from national health registers. Parents further reported symptoms of NDCs and psychiatric conditions at child age 9 or 12 years. Validated cutoffs were applied to the resulting symptoms scores to identify above-threshold conditions. We then examined whether ARFID was associated with higher symptom scores (19 outcomes) and higher likelihood of above-threshold conditions (15 outcomes) using linear and logistic regressions.

Results

Most prevalent in children with ARFID were separation anxiety (29.0%), oppositional defiant disorder (19.4%), attention deficit hyperactivity disorder (ADHD, 16.9%), panic disorder (15.3%), and tic disorders (14.8%). For all measured co-occurring conditions, ARFID was associated with significantly higher symptom scores (standardized beta range: 0.6–1.5) and higher odds of above-threshold conditions (odds ratio [OR] range: 3.3–13.7). The conditions with the highest increase in odds were autism (OR = 13.7) and ADHD (OR = 9.4). We did not find any sex-specific differences in co-occurring conditions.

Conclusions

This study highlights the co-occurrence of a broad range of NDCs and psychiatric conditions with ARFID in a large, non-clinical cohort. Our findings underscore that children with ARFID face significant burden from multiple co-existing conditions which should be considered during assessment and treatment.