Skip to main content
SpringerLink
Log in

Neuropsychological Profiles and Clinical Correlates of Youths with Avoidant /Restrictive Food Intake Disorder and Anorexia Nervosa: an Exploratory Charter Investigation

  • Published:
Journal of Pediatric Neuropsychology Aims and scope Submit manuscript

Abstract

Neuropsychological sequelae have been reported in adults with anorexia nervosa (AN). However, there is dearth of investigations examining neuropsychological functioning in youths with eating disorders. More critically, as a result of its status as a new psychiatric diagnosis under DSM-5, there are no published empirical studies to date investigating the neuropsychological profiles of youths with avoidant/restrictive food intake disorder (ARFID). We examined neuropsychological similarities and differences in youth with AN and ARFID and their correlation with age, weight, comorbidities, and eating pathology. Children and adolescents with AN and ARFID from an eating disorders clinic (N = 28) participated in this cross-sectional, exploratory study. Independent sample t-tests, Pearson’s correlations, and Bonferroni corrections were used to investigate group differences and associations among variables under investigation. Participants with ARFID demonstrated lower intellectual ability and relatively greater set-shifting difficulties/cognitive inflexibility. Group differences did not emerge in visuospatial abilities, central coherence, processing speed, attention, or memory. Same age comparisons did not yield any gender differences in central coherence. Positive correlations between Full Scale IQ and some neuropsychological tasks were observed in the AN but not in the ARFID group. Weight and neuropsychological functioning were not correlated. Given the relative similarities in neuropsychological profiles between AN and ARFID, it is critical that future studies should evaluate the progression in neuropsychological profiles to identify risk factors for progression to AN across developmental stages and examine the impact of malnutrition rather than weight. Longitudinal studies combining neuropsychological assessment with functional neuroimaging are necessary to identify target brain regions that may hold promise for psychopharmacological and psychotherapeutic interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials. The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research further data is not available.

References

  • Abbate-Daga, G., Buzzichelli, S., Marzola, E., Aloi, M., Amianto, F., & Fassino, S. (2015). Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review. International Journal of Eating Disorders, 48(6), 736–745. https://doi.org/10.1002/eat.22399

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • Bailer, U. F., & Kaye, W. H. (2011). Serotonin: imaging findings in eating disorders. Current Topics in Behavioral Neurosciences, 6, 59–79. https://doi.org/10.1007/7854_2010_78

    Article  PubMed  PubMed Central  Google Scholar 

  • Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Development, 81, 1641–1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x

    Article  PubMed  PubMed Central  Google Scholar 

  • Billman, M. G., Forrest, L. N., Johnson, M., Quaill, M. A., King, S., Mausteller, K., Lane‐Loney, S. E., Essayli, J. H. (2022). Preliminary effectiveness of a cognitive‐behavioral, family‐centered partial hospitalization program for children and adolescents with avoidant/restrictive food intake disorder. International Journal of Eating Disorders. https://doi.org/10.1002/eat.23806

  • Bodell, L. P., Keel, P. K., Brumm, M. C., Akubuiro, A., Caballero, J., Tranel, D., Hodis, B., & McCormick, L. M. (2014). Longitudinal examination of decision-making performance in anorexia nervosa: Before and after weight restoration. Journal of Psychiatric Research, 56, 150–157. https://doi.org/10.1016/j.jpsychires.2014.05.015

    Article  PubMed  PubMed Central  Google Scholar 

  • Bryson, A. E., Scipioni, A. M., Essayli, J. H., Mahoney, J. R., & Ornstein, R. M. (2018). Outcomes of low-weight patients with avoidant/restrictive food intake disorder and anorexia nervosa at long-term follow-up after treatment in a partial hospitalization program for eating disorders. International Journal of Eating Disorders, 51(5), 470–474. https://doi.org/10.1002/eat.22853

    Article  PubMed  Google Scholar 

  • Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (1994). California verbal learning test, children’s version. Psychological Corporation.

    Google Scholar 

  • Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). The Delis-Kaplan executive function system: Examiner’s manual. Psychological Corporation.

    Google Scholar 

  • Dennis, M., Francis, D. J., Cirino, P. T., Schachar, R., Barnes, M. A., & Fletcher, J. M. (2009). Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. Journal of the International Neuropsychology Society, 15, 331–343. https://doi.org/10.1017/S1355617709090481

    Article  Google Scholar 

  • Filoteo, J. V., Paul, E. J., Ashby, F. G., Frank, G. K. W., Helie, S., Rockwell, R., Bischoff-Grethe, A., Wierenga, C., & Kaye, W. H. (2014). Simulating category learning and set shifting deficits in patients weight-restored from anorexia nervosa. Neuropsychology, 28(5), 741–751. https://doi.org/10.1037/neu0000055

    Article  PubMed  PubMed Central  Google Scholar 

  • Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013

    Article  Google Scholar 

  • Fox, C. F. (1982). Neuropsychological correlates of anorexia nervosa. The International Journal of Psychiatry in Medicine, 11(3), 285–290. https://doi.org/10.2190/9260-hl5e-1f5a-ry5u

    Article  Google Scholar 

  • Fuglset, T. S. (2021). Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review. BMC Psychiatry, 21, 137. https://doi.org/10.1186/s12888-021-03120-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Holliday, J., Tchanturia, K., Landau, S., Collier, D., & Treasure, J. (2005). Is impaired set-shifting an endophenotype of anorexia nervosa? American Journal of Psychiatry, 162(12), 2269–2275. https://doi.org/10.1176/appi.ajp.162.12.2269

    Article  PubMed  Google Scholar 

  • IBM Corp. (2017). IBM SPSS Statistics for Windows, Version 25.0 Armonk. IBM Corp.

    Google Scholar 

  • Kaye, W. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology & Behavior, 94(1), 121–135. https://doi.org/10.1016/j.physbeh.2007.11.037

    Article  Google Scholar 

  • Kingston, K., Szmukler, G., Andrewes, D., Tress, B., & Desmond, P. (1996). Neuropsychological and structural brain changes in anorexia nervosa before and after refeeding. Psychological Medicine, 26(1), 15–28. https://doi.org/10.1017/S0033291700033687

    Article  PubMed  Google Scholar 

  • Kovacs, M. (2015). Children’s depression inventory (CDI and CDI 2). The Encyclopedia of Clinical Psychology, pp. 1–5. https://doi.org/10.1002/9781118625392.wbecp419.

  • Lane-Loney, S. E., Zickgraf, H. F., Ornstein, R. M., Mahr, F., Essayli, J. H. (2020). A cognitive-behavioral family-based protocol for the primary presentations of avoidant/restrictive food intake disorder (ARFID): Case examples and clinical research findings. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2020.06.010

  • Lang, K., Lopez, C., Stahl, D., Tchanturia, K., & Treasure, J. (2014). Central coherence in eating disorders: An updated systematic review and meta-analysis. The World Journal of Biological Psychiatry: the Official Journal of the World Federation of Societies of Biological Psychiatry, 15(8), 586–598. https://doi.org/10.3109/15622975.2014.909606

    Article  PubMed  Google Scholar 

  • Lang, K., Tchanturia, K. (2014). A systematic review of central coherence in young people with anorexia nervosa. Journal of Child and Adolescent Behaviour, 02(03). https://doi.org/10.4172/2375-4494.1000140.

  • Llorente, A. M., Voigt, R. G., Williams, J., Frailey, J. K., Satz, P., & D'Elia, L. F. (2009). Children's color trails test 1 & 2: Professional manual. PAR Inc.

    Google Scholar 

  • Lopez, C., Tchanturia, K., Stahl, D., & Treasure, J. (2008). Central coherence in eating disorders: A systematic review. Psychological Medicine, 38(10), 1393–1404. 10.

    Article  PubMed  Google Scholar 

  • Lopez, C., Stahl, D., Tchanturia, K. (2010). Estimated intelligence quotient in anorexia nervosa: A systematic review and meta-analysis of the literature. Annals of General Psychiatry, 9(1). https://doi.org/10.1186/1744-859x-9-40

  • Lozano-Serra, E., Andrés-Perpiña, S., Lázaro-García, L., & Castro-Fornieles, J. (2014). Adolescent anorexia nervosa: Cognitive performance after weight recovery. Journal of Psychosomatic Research, 76(1), 6–11. https://doi.org/10.1016/j.jpsychores.2013.10.009

    Article  PubMed  Google Scholar 

  • Maloney, M., Bell, J., McGuire, S., & Daniels, R. (1988). Reliability testing of a Children’s version of the Eating Attitude Test. Journal of the American Academy of Child & Adolescent Psychiatry, 27(5), 541–543.

    Article  Google Scholar 

  • Miller, M. R., Giesbrecht, G. F., Müller, U., McInerney, R. J., & Kerns, K. A. (2012). A latent variable approach to determining the structure of executive function in preschool children. Journal of Cognition and Development, 13, 395–423. https://doi.org/10.1080/15248372.2011.585478

    Article  Google Scholar 

  • Nicely, T. A., Lane-Loney, S., Masciulli, E., et al. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2, 21. https://doi.org/10.1186/s40337-014-0021-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Norris, M. L., & Katzman, D. K. (2015). Change is never easy, but it is possible: Reflections on avoidant/restrictive food intake disorder two years after its introduction in the DSM-5. Journal of Adolescent Health, 57(1), 8–9.

    Article  Google Scholar 

  • Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213–218. https://doi.org/10.2147/NDT.S82538

    Article  PubMed  PubMed Central  Google Scholar 

  • Norris, M. L., Spettigue, W., Hammond, N. G., Katzman, D. K., Zucker, N., Yelle, K., Santos, A., Gray, M., & Obeid, N. (2018). Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. The International Journal of Eating Disorders, 51(2), 170–173. https://doi.org/10.1002/eat.22814

    Article  PubMed  Google Scholar 

  • Ornstein, R. M., Lane-Loney, S. E., Hollenbeak, C. S. (2012). Clinical outcomes of a novel, family-centered partial hospitalization program for young patients with eating disorders. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 17(3). https://doi.org/10.1007/bf03325344.

  • Pender, S., Gilbert, S. J., Serpell, L. (2014). The neuropsychology of starvation: Set-shifting and central coherence in a fasted nonclinical sample. PLoS ONE, 9(10). https://doi.org/10.1371/journal.pone.0110743.

  • Rey, A. (1941). L’examen psychologique dans les cas d’encephalopathie traumatique [The psychological examination of cases of traumatic encephalopathy]. Archives de Psychologie, 37, 126–139.

    Google Scholar 

  • Reynolds, C. R., & Richmond, B. O. (2008). Revised Children’s Manifest Anxiety Scale–Second Edition (RCMAS-2): Manual. Western Psychological Services.

    Google Scholar 

  • Roid, G. H., Miller, L. J., Pomplun, M., & Koch, C. (2013). Leiter international performance scale-third edition. Stoelting Company.

    Google Scholar 

  • Stedal, K., Landrø, N. I., & Lask, B. (2013). Verbal fluency in anorexia nervosa. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 18(2), 151–156. https://doi.org/10.1007/s40519-013-0024-0

    Article  Google Scholar 

  • Stedal, K., Broomfield, C., Hay, P., Touyz, S., & Scherer, R. (2021). Neuropsychological functioning in adult anorexia nervosa: A meta-analysis. Neuroscience & Biobehavioral Reviews, 130, 214–226. https://doi.org/10.1016/j.neubiorev.2021.08.021

    Article  Google Scholar 

  • Stedal, K., Scherer, R., Touyz, S., Hay, P., & Broomfield, C. (2021). Research review: Neuropsychological functioning in young anorexia nervosa: A meta-analysis. Journal of Child Psychology and Psychiatry, 63(6), 616–625. https://doi.org/10.1111/jcpp.13562

    Article  PubMed  Google Scholar 

  • Steward, T., Mestre-Bach, G., Agüera, Z., Granero, R., Martín, V., Sánchez-Diaz, I., Riesco, N., Jiménez-Murcia, S., Fernández-Aranda, F. (2016). Enduring changes in decision making in patients with full remission from anorexia nervosa. European Neuropsychopharmacology, 27. https://doi.org/10.1016/s0924-977x(17)30135-9.

  • Tchanturia, K., Morris, R. G., Anderluh, M. B., Collier, D. A., Nikolaou, V., & Treasure, J. (2004). Set shifting in anorexia nervosa: An examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits. Journal of Psychiatric Research, 38(5), 545–552. https://doi.org/10.1016/j.jpsychires.2004.03.001

    Article  PubMed  Google Scholar 

  • van Noort, B.M., Lohmar, S.K., Pfeiffer, E, Lehmkuhl, U., Winter, S.M. Kappel V. (2016). Clinical characteristics of early onset anorexia nervosa. European Eating Disorders Review. https://doi.org/10.1002/erv.2614

  • Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence-Second Edition (WASI-II). NCS Pearson.

    Google Scholar 

  • Weider, S., Indredavik, M., Lydersen, S., & Hestad, K. (2016). Central coherence, visuoconstruction and visual memory in patients with eating disorders as measured by different scoring methods of the Rey complex figure test. European Eating Disorders Review, 24, 106–113. https://doi.org/10.1002/erv.2385

    Article  PubMed  Google Scholar 

  • Zanna, V., Criscuolo, M., Mereu, A., Cinelli, G., Marchetto, C., Pasqualetti, P., Tozzi, A. E., Castiglioni, M. C., Chianello, I., & Vicari, S. (2020). Restrictive eating disorders in children and adolescents: A comparison between clinical and psychopathological profiles. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 26(5), 1491–1501. https://doi.org/10.1007/s40519-020-00962-z

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA

    Fauzia Mahr, Susan E. Lane-Loney & Antolin M. Llorente

  2. Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA

    Fauzia Mahr, Marley G. Billman Miller, Susan E. Lane-Loney, Sheryl A. Ryan & Antolin M. Llorente

  3. Barry University, Miami, FL, USA

    Marlana A. Quaill

Authors
  1. Fauzia Mahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marley G. Billman Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marlana A. Quaill
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan E. Lane-Loney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sheryl A. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antolin M. Llorente
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antolin M. Llorente.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of the Penn State College of Medicine.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahr, F., Miller, M.G.B., Quaill, M.A. et al. Neuropsychological Profiles and Clinical Correlates of Youths with Avoidant /Restrictive Food Intake Disorder and Anorexia Nervosa: an Exploratory Charter Investigation. J Pediatr Neuropsychol 9, 200–213 (2023). https://doi.org/10.1007/s40817-023-00147-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40817-023-00147-3

Keywords

Search

Navigation