Validation of the nine item ARFID screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID

• Published in: The International journal of eating disorders Vol. 54; no. 10; pp. 1782 - 1792
• Main Authors: Burton Murray, Helen, Dreier, Melissa J., Zickgraf, Hana F., Becker, Kendra R., Breithaupt, Lauren, Eddy, Kamryn T., Thomas, Jennifer J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2021; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Avoidant Restrictive Food Intake Disorder; Child; diagnosis; Eating disorders; feeding and eating disorders; Feeding and Eating Disorders - diagnosis; Female; Humans; Male; Middle Aged; Outpatients; surveys and questionnaires; Young Adult; avoidant/restrictive food intake disorder; diagnosis; surveys and questionnaires; feeding and eating disorders
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.23520

Objective The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) has three subscales aligned with ARFID presentations but clinically validated cutoff scores have not been identified. We aimed to examine NIAS subscale (picky eating, appetite, fear) validity to: (1) capture clinically‐diagnosed ARFID presentations; (2) differentiate ARFID from other eating disorders (other‐ED); and (3) capture ARFID symptoms among individuals with ARFID, individuals with other‐ED, and nonclinical participants. Method Participants included outpatients (ages 10–76 years; 75% female) diagnosed with ARFID (n = 49) or other‐ED (n = 77), and nonclinical participants (ages 22–68 years; 38% female, n = 40). We evaluated criterion‐related concurrent validity by conducting receiver operating curve (ROC) analyses to identify potential subscale cutoffs and by testing if cutoffs could capture ARFID with and without use of the Eating Disorder Examination‐Questionnaire (EDE‐Q). Results Each NIAS subscale had high AUC for capturing those who fit versus do not fit each ARFID presentation, resulting in proposed cutoffs of ≥10 (sensitivity = .97, specificity = .63), ≥9 (sensitivity = .86, specificity = .70), and ≥ 10 (sensitivity = .68, specificity = .89) on the NIAS‐picky eating, NIAS‐appetite, and NIAS‐fear subscales, respectively. ARFID versus other‐ED had high AUC on the NIAS‐picky eating (≥10 proposed cutoff), but not NIAS‐appetite or NIAS‐fear subscales. NIAS subscale cutoffs had a high association with ARFID diagnosis, but only correctly classified other‐ED in combination with EDE‐Q Global <2.3. Discussion To screen for ARFID, we recommend using a screening tool for other‐ED (e.g., EDE‐Q) in combination with a positive score on any NIAS subscale (i.e., ≥10, ≥9, and/or ≥10 on the NIAS‐picky eating, NIAS‐appetite, and NIAS‐fear subscales, respectively).