Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study
Abstract Background Despite its common early onset, little is known about the prevalence and clinical presentation of avoidant restrictive food intake disorder (ARFID) in very young children, hindering early identification and intervention. Differentiating ARFID from normative selective eating is pa...
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BMC
2025-08-01
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| Series: | Journal of Eating Disorders |
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| Online Access: | https://doi.org/10.1186/s40337-025-01369-w |
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| author | Lisa Dinkler Katarzyna Brimo Helena Holmäng Kahoko Yasumitsu-Lovell Ralf Kuja-Halkola Anne-Katrin Kantzer Zerina Omanovic Narufumi Suganuma Masamitsu Eitoku Mikiya Fujieda Elisabeth Fernell Per Möllborg Rachel Bryant-Waugh Christopher Gillberg Maria Råstam |
| author_facet | Lisa Dinkler Katarzyna Brimo Helena Holmäng Kahoko Yasumitsu-Lovell Ralf Kuja-Halkola Anne-Katrin Kantzer Zerina Omanovic Narufumi Suganuma Masamitsu Eitoku Mikiya Fujieda Elisabeth Fernell Per Möllborg Rachel Bryant-Waugh Christopher Gillberg Maria Råstam |
| author_sort | Lisa Dinkler |
| collection | DOAJ |
| description | Abstract Background Despite its common early onset, little is known about the prevalence and clinical presentation of avoidant restrictive food intake disorder (ARFID) in very young children, hindering early identification and intervention. Differentiating ARFID from normative selective eating is particularly challenging, yet validated parent-reported screening tools are lacking. This study aimed to estimate the point prevalence and describe the clinical characteristics of ARFID in preschoolers. It also evaluated the psychometric properties of the parent-reported ARFID-Brief Screener by assessing its agreement with a diagnostic interview for ARFID. Methods Parents of 645 children (50.5% male, mean age 3.2 years) completed the ARFID-Brief Screener and a neurodevelopmental screener during 2.5- and 4-year routine check-ups at 21 child health centers in West Sweden. Parents of all screen-positive and of randomly selected screen-negative children were invited to a follow-up diagnostic interview via phone. Additional clinical data were extracted from health records. Results Of the 42 children (6.5%) who screened positive for ARFID, 29 were followed up via diagnostic interview, and 21 received an ARFID diagnosis, yielding a positive predictive value of 72%. Negative predictive value, sensitivity, specificity, and overall accuracy of the ARFID-Brief Screener were 94%, 91%, 79%, and 84%, respectively. The estimated point prevalence of ARFID was 5.9%. All diagnosed children exhibited both sensory-based avoidance and low interest in eating. Only 13.5% met ARFID criteria based on weight- or nutrition-related impairment (DSM-5 Criteria A1-A3). Two fifths (39.1%) of children with ARFID exhibited early language delays compared to 13.5% of children without ARFID. More extensive neurodevelopmental problems were associated with greater ARFID severity and with higher scores on the sensory and concern profiles. Conclusions ARFID is not uncommon among preschoolers, though prevalence may be slightly overestimated in this study. It is primarily characterized by sensory-based avoidance and low interest in eating, and by psychosocial impairment instead of physical health consequences, underscoring the need to assess impact beyond weight, growth, and nutrition. Early neurodevelopmental difficulties are overrepresented, highlighting their relevance for early detection and intervention. The ARFID–Brief Screener demonstrated promising psychometric properties and may be a valuable tool for routine screening, though follow-up assessments remain necessary to confirm a diagnoses. |
| format | Article |
| id | doaj-art-bd9e2bfc2ec04ffeb1d3bd222a983b26 |
| institution | Kabale University |
| issn | 2050-2974 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj-art-bd9e2bfc2ec04ffeb1d3bd222a983b262025-08-24T11:03:29ZengBMCJournal of Eating Disorders2050-29742025-08-0113111610.1186/s40337-025-01369-wAvoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening studyLisa Dinkler0Katarzyna Brimo1Helena Holmäng2Kahoko Yasumitsu-Lovell3Ralf Kuja-Halkola4Anne-Katrin Kantzer5Zerina Omanovic6Narufumi Suganuma7Masamitsu Eitoku8Mikiya Fujieda9Elisabeth Fernell10Per Möllborg11Rachel Bryant-Waugh12Christopher Gillberg13Maria Råstam14Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetChild and Adolescent Psychiatry, NU Hospital GroupGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgDepartment of Environmental Medicine, Kochi Medical School, Kochi UniversityDepartment of Environmental Medicine, Kochi Medical School, Kochi UniversityDepartment of Pediatrics, Kochi Medical School, Kochi UniversityGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgDepartment of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgMaudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation TrustGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgGillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of GothenburgAbstract Background Despite its common early onset, little is known about the prevalence and clinical presentation of avoidant restrictive food intake disorder (ARFID) in very young children, hindering early identification and intervention. Differentiating ARFID from normative selective eating is particularly challenging, yet validated parent-reported screening tools are lacking. This study aimed to estimate the point prevalence and describe the clinical characteristics of ARFID in preschoolers. It also evaluated the psychometric properties of the parent-reported ARFID-Brief Screener by assessing its agreement with a diagnostic interview for ARFID. Methods Parents of 645 children (50.5% male, mean age 3.2 years) completed the ARFID-Brief Screener and a neurodevelopmental screener during 2.5- and 4-year routine check-ups at 21 child health centers in West Sweden. Parents of all screen-positive and of randomly selected screen-negative children were invited to a follow-up diagnostic interview via phone. Additional clinical data were extracted from health records. Results Of the 42 children (6.5%) who screened positive for ARFID, 29 were followed up via diagnostic interview, and 21 received an ARFID diagnosis, yielding a positive predictive value of 72%. Negative predictive value, sensitivity, specificity, and overall accuracy of the ARFID-Brief Screener were 94%, 91%, 79%, and 84%, respectively. The estimated point prevalence of ARFID was 5.9%. All diagnosed children exhibited both sensory-based avoidance and low interest in eating. Only 13.5% met ARFID criteria based on weight- or nutrition-related impairment (DSM-5 Criteria A1-A3). Two fifths (39.1%) of children with ARFID exhibited early language delays compared to 13.5% of children without ARFID. More extensive neurodevelopmental problems were associated with greater ARFID severity and with higher scores on the sensory and concern profiles. Conclusions ARFID is not uncommon among preschoolers, though prevalence may be slightly overestimated in this study. It is primarily characterized by sensory-based avoidance and low interest in eating, and by psychosocial impairment instead of physical health consequences, underscoring the need to assess impact beyond weight, growth, and nutrition. Early neurodevelopmental difficulties are overrepresented, highlighting their relevance for early detection and intervention. The ARFID–Brief Screener demonstrated promising psychometric properties and may be a valuable tool for routine screening, though follow-up assessments remain necessary to confirm a diagnoses.https://doi.org/10.1186/s40337-025-01369-wFeeding disordersEating disordersChildrenGeneral populationComorbidityEpidemiology |
| spellingShingle | Lisa Dinkler Katarzyna Brimo Helena Holmäng Kahoko Yasumitsu-Lovell Ralf Kuja-Halkola Anne-Katrin Kantzer Zerina Omanovic Narufumi Suganuma Masamitsu Eitoku Mikiya Fujieda Elisabeth Fernell Per Möllborg Rachel Bryant-Waugh Christopher Gillberg Maria Råstam Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study Journal of Eating Disorders Feeding disorders Eating disorders Children General population Comorbidity Epidemiology |
| title | Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study |
| title_full | Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study |
| title_fullStr | Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study |
| title_full_unstemmed | Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study |
| title_short | Avoidant restrictive food intake disorder (ARFID) in Swedish preschool children: a screening study |
| title_sort | avoidant restrictive food intake disorder arfid in swedish preschool children a screening study |
| topic | Feeding disorders Eating disorders Children General population Comorbidity Epidemiology |
| url | https://doi.org/10.1186/s40337-025-01369-w |
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