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

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.