Participants and Procedure
Our multidisciplinary intensive ED program is located in a Canadian tertiary care children’s hospital. Individuals meeting criteria for an intake assessment in the program are children and adolescents aged 9 to 17 years with severe EDs (as evidenced by concerns regarding medical stability, growth compromise, symptom-severity or acute safety concerns relating to ED presentation) who are referred by a physician. Data from all patients who were sequentially assessed in our program between April 1-October 31, 2019 and between April 1-October 31, 2020 were included in this study. A retrospective chart review was completed of initial multi-disciplinary assessment notes (completed by Adolescent Health physicians, psychiatrists, psychologists, and/or dieticians on the Eating Disorder team) and of accompanying self-report questionnaires collected as part of the intake process. Data gathered was de-identified and stored in an electronic database for analysis. Informed consent for use of this data was sought as part of the standardized intake process. This study was approved by the Research Ethics Board at the hospital where the research was conducted. The data that support the findings of this study are not publicly available due to privacy and ethical concerns, but can be provided upon request to the corresponding author.
Demographic and Clinical Characteristics
Data regarding various demographic, clinical, and treatment related characteristics were extracted from patients’ electronic charts based on information found in the clinician’s initial intake assessment notes, using both patient and caregiver reports. Details regarding body measurements were also recorded, and in all cases, patient’s premorbid growth trajectory (including available height, weight, and body mass index) was utilized to help determine the patient’s treatment goal weight (TGW) (Norris et al., 2018). Reliance on clinician-report for accounts of eating behaviours as well as ED symptoms was utilized.
Eating Behaviours and Cognitions
Eating Disorder Examination Questionnaire for Adolescents (EDEQ-A). The EDEQ-A is a self-report questionnaire with 36 items that examines eating related cognitions and behaviours. The scale produces a global score and four subscale scores (Restraint, Eating Concern, Shape Concern, and Weight Concern) along with asking questions related to frequency of common ED behaviours (vomiting, diuretic use, laxative use, compulsive exercise). The EDEQ-A has been found to have strong psychometric properties in adolescent samples (Carter et al., 2001).
Children’s Eating Attitudes Test (chEAT). Adapted from the Eating Attitudes Test (EAT; Garner & Garfinkel, 1979), the ChEAT is a 26-item measure featuring simpler language for use in children and adolescents aged 8 to 13 years. The chEAT has adequate internal reliability, good concurrent validity, and a factor structure that is similar to the original EAT (Smolak & Levine, 1994).
Clinical Impairment Assessment Questionnaire (CIA). The CIA is a brief, 16-item self-report measure that assesses the impact of ED psychopathology on an individual’s functioning. The CIA has high levels of internal consistency and test-retest reliability, and is positively correlated with scores on the EDE-Q, indicating good construct validity (Bohn et al., 2008).
Revised Children’s Anxiety and Depression Scale (RCADS). The RCADS is a 47-item self-report questionnaire that assesses anxiety and depression in youth. In addition to generating a Total Anxiety Score and Total Internalizing Score, the RCADS also produces total scores for separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and major depressive disorder. A t-score ≥65 indicates that a score is in the 93rd percentile of normative data (borderline clinical range), while a score ≥70 indicates that a score is in the 98th percentile (clinical range). The RCADS has been found to have good psychometric properties and a factor structure consistent with DSM-IV depression and anxiety disorders (Chorpita et al., 2000).
Descriptive and frequency statistics were performed to examine distributions and describe the clinical characteristics across all samples. Independent sample t-tests with a Welch correction were used when appropriate to compare characteristics across groups for continuous variables. Chi-square analyses were used to examine differences across categorical variables. Relationships with a relaxed p-value of less than 0.10 were also examined in this study given the clinical nature of this work and the small sample size available to start to explore these relationships (Thiese, Ronna, Ott, 2016). Cohen’s d was used to examine effect sizes, with 0.2 considered a small effect, 0.5 considered a moderate effect and 0.8 or greater a large effect (Cohen, 1988). All analyses were performed using IBM SPSS v.26.