Pica, ARFID, and Rumination Disorder Interview

Reviewed by Deborah M. Michel, PhD, CEDS-S

Bryant‐Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Development of the Pica, ARFID, and Rumination Disorder Interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378-387.

https://doi.org/10.1002/eat.22958

In this article, Bryant-Waugh and colleagues explain the development of a comprehensive, multi-informant, structured interview called the Pica, Avoidant Restrictive Food Intake Disorder, and Rumination Disorder Interview (PARDI).  The measure allows for diagnosis of these disorders across the lifespan, which is consistent with the new “Feeding and Eating Disorders” chapter in DSM-5.  It also captures relevant clinical features as well as the severity of the conditions with focus among various ARFID clinical presentations.

Test development included a multi-step process to generate an initial item pool drawn from existing tests evaluating similar constructs.  The workgroup’s collective clinical expertise was utilized to identify additional items missing from existing measures.  The PARDI includes a screen to rule out other eating disorders, and an introduction to assess developmental, physical, and mental health conditions which would preclude a feeding disorder diagnosis.  The final segments assess diagnostic criteria and the severity of symptoms on a 7-point Likert scale.  Three ARFID profiles described in DSM 5 are measured.  These include sensory sensitivity, lack of interest in eating, and fear of aversive consequences.  The dimensional rating chosen by the authors facilitate multiple symptom evaluation within one clinical profile.  In addition, four parallel Parent/Carer interview versions are available based on subject age to yield multi-informant data.

Psychometric properties of the PARDI were evaluated in a study of 57 males and females ages 10-22, 10 of whom were healthy controls.  Preliminary data indicated adequate acceptability and feasibility (measured by interview length) by those interviewed.  Internal consistency for the profiles ranged from adequate to good and moderate for ARFID diagnosis.  Validity results demonstrated that those with ARFID scored higher than controls on all clinical profiles and on severity of symptoms.  Limitations of the study included small sample size, lack of sample diversity, focus on ARFID, and narrow focus on age groups, all of which need to be addressed in future studies.

Why is this important?

Overall, the PARDI has tremendous promise in filling the need to comprehensively assess Pica, ARFID, and Rumination Disorder over the lifespan from a multi-informant perspective.  Implications include improved evaluations resulting in more accurate diagnosis, enhanced treatment planning, and increased clinical communication on the various dimensions of the profiles.  The fact that the authors generously permit free access to the PARDI allows for wider dissemination of the tool with subsequent research on these disorders as well as the tool itself.