Subtypes of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A Latent Class Analysis
Open accessAbstract
Background The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary avoidant/restrictive food intake disorder (ARFID) subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes. Methods We carried out a surveillance study of ARFID in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS) in the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Paediatricians and child and adolescent psychiatrists were contacted monthly to report newly diagnosed cases of ARFID electronically and complete a detailed clinical questionnaire. Cases aged 5–18 years were included. LCA was performed specifying 1–6 classes and likelihood-based tests for model selection. The Bayesian Information Criterion (BIC), the Akaike Information Criterion (AIC) and the Sample-Size Adjusted BIC were used to determine the most parsimonious model. Analysis of variance (ANOVA) and χ2 tests were used to compare the characteristics of the identified classes. A multinomial logistic regression (MLR) was performed to investigate predicting factors for the latent classes. Findings We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as Fear subtype , Lack of Interest subtype , Sensory subtype , and Combined subtype . The probability of being classified as these were 7.2% ( n = 23), 25.1% ( n = 80), 29.5% ( n = 94) and 38.2% ( n = 122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership. Interpretation LCA identified four different classes in a sample of children and adolescents with ARFID. The Combined Subtype , a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions. Funding This study was funded by the Former EMS Ltd (charity number 1098725, registered October 9th 2017).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In Sanchez-Cerezo et al.'s latent class analysis, the combined and sensory ARFID subtypes had significantly more ASD occurrences than the other classes.
“It is worth noting that analysis of the classes revealed that the combined and sensory subtypes had significantly more ASD occurrences than the other classes.”
From Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder (2025) · cites this paper as [32]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1080/10705510701575396 · Cited by 11,415 · see citing works
An entropy criterion for assessing the number of clusters in a mixture model
Celeux, G., & Soromenho, G. (1996) · Journal of Classification · doi:10.1007/bf01246098 · Cited by 2,448 · see citing works
Ten frequently asked questions about latent class analysis.
Nylund-Gibson, K. K., & Choi, A. Y. (2018) · Translational Issues in Psychological Science · doi:10.1037/tps0000176 · Cited by 2,362 · see citing works
Latent class analysis: a guide to best practice
Weller, B. E., Bowen, N. K., & Faubert, S. J. (2020) · Journal of Black Psychology · doi:10.1177/0095798420930932 · Cited by 2,223 · see citing works
Body mass index reference curves for the UK, 1990.
Cole, T. J., Freeman, J. V., & Preece, M. A. (1995) · Archives of Disease in Childhood · doi:10.1136/adc.73.1.25 · Cited by 2,063 · see citing works
Cross sectional stature and weight reference curves for the UK, 1990.
Freeman, J. V., Cole, T. J., Chinn, S., Jones, P. R., White, E. M., & Preece, M. A. (1995) · Archives of Disease in Childhood · doi:10.1136/adc.73.1.17 · Cited by 1,460 · see citing works
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0795-5 · Cited by 380 · see citing works
Bryant‐Waugh, R., Micali, N., Cooke, L. J., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22958 · Cited by 230 · see citing works
Early-onset restrictive eating disturbances in primary school boys and girls
Kurz, S., Dyck, Z. V., Dremmel, D., Munsch, S., & Hilbert, A. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0622-z · Cited by 205 · see citing works
Sanchez‐Cerezo, J., Nagularaj, L., Gledhill, J. A., & Nicholls, D. (2022) · European Eating Disorders Review · doi:10.1002/erv.2964 · Cited by 160 · see citing works
Self-citationNorris, M. L., Spettigue, W. J., Hammond, N. G., Katzman, D. K., Zucker, N. L., Yelle, K., Santos, A., Gray, M., & Obeid, N. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22814 · Cited by 156 · see citing works
Kambanis, P. E., Kuhnle, M. C., Wons, O. B., Jo, J. H., Keshishian, A. C., Hauser, K., Becker, K. R., Franko, D. L., Misra, M., Micali, N., et al. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23191 · Cited by 156 · see citing works
Zickgraf, H. F., Lane‐Loney, S. E., Essayli, J. H., & Ornstein, R. M. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23016 · Cited by 111 · see citing works
Bourne, L., Mandy, W., & Bryant‐Waugh, R. (2022) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15139 · Cited by 110 · see citing works
Reilly, E. E., Brown, T. A., Gray, E., Kaye, W. H., & Menzel, J. E. (2019) · European Eating Disorders Review · doi:10.1002/erv.2670 · Cited by 94 · see citing works
Katzman, D. K., Spettigue, W. J., Agostino, H., Couturier, J. L., Dominic, A., Findlay, S. M., Lam, P., Lane, M. A., Maguire, B. R., Mawjee, K., et al. (2021) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2021.3861 · Cited by 90 · see citing works
Zickgraf, H. F., Murray, H. B., Kratz, H. E., & Franklin, M. E. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23013 · Cited by 84 · see citing works
Spettigue, W. J., Norris, M. L., Santos, A., & Obeid, N. (2018) · Journal of Eating Disorders · doi:10.1186/s40337-018-0205-3 · Cited by 77 · see citing works
Lowe, K. D., Barnes, T. L., Martell, C., Keery, H., Eckhardt, S., Peterson, C. B., Lesser, J., & Grange, D. L. (2019) · Nutrients · doi:10.3390/nu11081955 · Cited by 73 · see citing works
Stahl, D. R., & Sallis, H. (2012) · Wiley Interdisciplinary Reviews Computational Statistics · doi:10.1002/wics.1204 · Cited by 71 · see citing works
The central role of disgust in disorders of food avoidance
Harris, A., Romer, A. L., Hanna, E. K., Keeling, L. A., LaBar, K. S., Sinnott-Armstrong, W. P., Strauman, T. J., Wagner, H. R., Marcus, M. D., & Zucker, N. L. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23047 · Cited by 67 · see citing works
Dinkler, L., Wronski, M., Lichtenstein, P., Lundström, S., Larsson, H., Micali, N., Taylor, M. J., & Bulik, C. M. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.4612 · Cited by 60 · see citing works
Makhzoumi, S. H., Schreyer, C. C., Hansen, J. L., et al. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23049 · Cited by 54 · see citing works
Classification of Children and Adolescents With Avoidant/Restrictive Food Intake Disorder
Katzman, D. K., Guimond, T. H., Spettigue, W. J., Agostino, H., Couturier, J. L., & Norris, M. L. (2022) · PEDIATRICS · doi:10.1542/peds.2022-057494 · Cited by 45 · see citing works
Watts, R., Archibald, T., Hembry, P., Howard, M., Kelly, C., Loomes, R., Markham, L., Moss, H., Munuve, A., Oros, A., et al. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.102190 · Cited by 45 · see citing works
Nicholas, J. K., van Tilburg, M. A. L., Pilato, I. B., Erwin, S., Rivera‐Cancel, A. M., Ives, L. T., Marcus, M. D., & Zucker, N. L. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23536 · Cited by 44 · see citing works
Lorazepam in the Treatment of Posttraumatic Feeding Disorder
Kardas, M., Cermik, B. B., Ekmekçi, S., Uzuner, S., & Gökçe, S. (2014) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2013.0149 · Cited by 30 · see citing works
Kerem, L., Water, A. L. V. D., Kuhnle, M. C., Harshman, S. G., Hauser, K., Eddy, K. T., Becker, K. R., Misra, M., Micali, N., Thomas, J. J., et al. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1894944 · Cited by 30 · see citing works
Kennedy, H. L., Dinkler, L., Kennedy, M. A., Bulik, C. M., & Jordan, J. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00578-x · Cited by 29 · see citing works
Assessment of Patients With ARFID Presenting to Multi‐Disciplinary Tertiary Care Program
Richmond, T. K., Carmody, J. K., Freizinger, M., et al. (2023) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003774 · Cited by 19 · see citing works
Boerner, K. E., Coelho, J. S., Syal, F., Bajaj, D., Finner, N., & Dhariwal, A. K. (2021) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045211048170 · Cited by 13 · see citing works
Lynn, R., & Reading, R. (2019) · Archives of Disease in Childhood · doi:10.1136/archdischild-2019-317401 · Cited by 7 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [24]Long J.S. Freese J. Regression models for categorical dependent variables in stata 3rd ed. 2014 Stata Press
Cited by
Sorted by citations
Tomaszek, N., Urbaniak, A. D., Bałdyga, D., Chwesiuk, K., Modzelewski, S., & Waszkiewicz, N. (2025) · Nutrients · doi:10.3390/nu17030486 · Cited by 30 · see citing works
- Authors
- Sanchez-Cerezo, J., Neale, J., Julius, N., Croudace, T., Lynn, R. M., Hudson, L. D., & Nicholls, D.
- Affiliations
- East Sussex Healthcare NHS Trust (GB)
- Imperial College London (GB)
- University of Dundee (GB)
- University College London (GB)
- ORCID
- Venue
- EClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2024-02
- Volume
- 68
- Pages
- 102440
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC10850399
- OpenAlex
- W4391424864
- Cited by
- 56
- References
- 35
- Citations by year
- 2026: 18 · 2025: 26 · 2024: 11 · 2023: 1
- FWCI
- 27.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by)
- SSRN Electronic Journal (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- Discovery Research Portal (University of Dundee) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fundación Alicia Koplowitz
- National Institute for Health and Care Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- avoidant/restrictive food intake disorder, children and adolescents, latent class analysis, sensory sensitivity, autism spectrum disorder, eating disorders, paediatric surveillance, DSM-5 diagnostic criteria, weight loss, clinical intervention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
