Heterogeneous Presentations at Admission But Similar Treatment Response Across Latent Profiles of ARFID Prototypes in Children and Adolescents.

Avoidant/restrictive food intake disorder (ARFID) is defined by any combination of three prototypic motivations for dietary restriction (sensory-based avoidance, lack of interest, fear of aversive consequences), resulting in heterogeneous presentations. Some work suggests overlap of prototypes, but little is known about how prototypes cluster together. Further, little research exists on how prototype influences outcome. We applied latent profile analysis (LPA) to 159 treatment-seeking children and adolescents (ages 9-18, 63% female, 78% White) with ARFID using items assessing ARFID prototype on the Eating Disorders in Youth-Questionnaire (EDY-Q). Resulting profiles were compared on clinical presentation and change in ARFID, anxiety, and depressive symptoms following evidence-based higher-level-of-care treatment. ARFID prototypes present heterogeneously. A 4-profile solution emerged from the LPA: ARFID-1 (with fear of aversive consequences; n = 26); ARFID-2 (with sensory-based avoidance and lack of interest; n = 43); ARFID-3 (with all three prototypes; n = 44); and Non-Endorsers (n = 53). While profiles differed on ARFID, anxiety, and depressive symptoms at admission, change in symptoms was similar across profiles. ARFID prototypes frequently overlap. Despite heterogeneity of ARFID prototypes, treatment outcome was similar across latent profiles, supporting continued categorisation of all these motivations for restrictive eating as ARFID. Future work is needed to further validate these profiles.