Reliability and Validity of the Turkish Version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) Parent-Report

Yıl 2023, Cilt: 17 Sayı: 5, 354 - 362, 25.09.2023

Elif Akçay , Özge Parlak Gözükara , Büşra Bahadır , Funda Seher Özalp Ateş , Gülser Şenses Dinç , Eda Özaydın , Esra Çöp

https://doi.org/10.12956/tchd.1271162

Öz

Background and aims: The current study aimed to evaluate the psychometric properties of a Turkish version of The Nine Item Avoidant/Restrictive Food Intake Disorder Screen Parent Report (NIAS-PR), which measures the avoidant/restrictive food intake disorder (ARFID) symptoms by parents. NIAS-PR includes three subscales picky eating, poor appetite/limited interest in eating, and fear of aversive consequences from eating. Also, our secondary aim was to assess the relationship between ARFID-related eating behaviours and emotional-behavioural symptoms of children and parents' psychological status.
Methods: The NIAS-PR was translated into Turkish with standard procedures. Two hundred sixty-eight children (133 girls, 49.6%; mean age 8.62, age range from 2 to 18 years) and parents (175 mothers, 65.2%) were included in the study. The factor structure was confirmed using confirmatory factor analysis (CFA). The results were compared to the validated Turkish Children’s Eating Behavior Questionnaire (CEBQ) to determine the convergent validity. Internal consistency (Cronbach alpha coefficient) analysis was used to determine the reliability of the NIAS-PR.
Results: The current study provided evidence for the validity of the translated Turkish version of the NIAS-PR in the pediatric population. The three-factor structure of the NIAS—Picky eating, Appetite, and Fear—was replicated in the Turkish NIAS-PR. The NIAS-PR subscales showed the expected patterns of correlations with the CEBQ subscales. The reliability of the Turkish version of NIAS-PR proved to be satisfactory (total Cronbach's alpha=0.90) in the pediatric population (2-18 years).
Conclusions: This study demonstrated a good internal consistency of the Turkish version of the NIAS-PR. We confirmed the three-factor structure of the Turkish version of NIAS-PR. NIAS-PR is a brief, reliable instrument for ARFID research in Turkish children and adolescents. The NIAS-PR is developed as a screening questionnaire, so health professionals should use it to investigate ARFID-related eating behaviours further. It is worth mentioning that deepening these eating symptoms with clinical interviews is necessary.

Anahtar Kelimeler

ARFID, avoidant/restrictive food intake disorder, NIAS, validation, reliability

Teşekkür

We are extremely grateful to all children, and their parents for taking part. We would like to thank Neslihan Kayademir, Director of Pediatric Health Care at our hospital, for supporting our research.

Dokuz Maddeli Kaçıngan/Kısıtlayıcı Gıda Alım Bozukluğu Tarama Ölçeği (NIAS) Ebeveyn Bildirimi’nin Türkçe Versiyonunun Geçerlik ve Güvenirliği

Öz

Giriş ve amaçlar: Bu çalışma, ebeveynler tarafından kaçınan/kısıtlayıcı gıda alım bozukluğu (KKGAB) semptomlarını ölçen Dokuz Maddeli Kaçınan/Kısıtlayıcı Gıda Alım Bozukluğu Tarama Ölçeği’nin (NIAS-EÖ) Türkçe versiyonunun psikometrik özelliklerini değerlendirmeyi amaçlamıştır. NIAS-EÖ, seçici yeme, iştahsızlık/yemeye karşı sınırlı ilgi ve yemek yemenin tiksindirici sonuçlarından korkma olmak üzere üç alt ölçeğe sahiptir. Araştırmanın ikincil amacı ise, KKGAB ile ilişkili yeme davranışları ile çocukların duygusal-davranışsal belirtileri ve ebeveynlerin psikolojik durumları arasındaki ilişkiyi değerlendirmektir.
Yöntem: NIAS-EÖ standart prosedürlerle Türkçe'ye çevrilmiştir. Çalışmaya 268 çocuk (133 kız, %49.6; ort. yaş 8.62, yaş aralığı 2-18) ve ebeveynleri (175 anne, %65.2) dahil edilmiştir. Faktör yapısı, doğrulayıcı faktör analizi (DFA) kullanılarak doğrulanmıştır. Sonuçlar, yakınsak geçerliliği belirlemek için geçerli bir ölçek olan Türk Çocuklarının Yeme Davranışı Anketi (ÇYDA) alt testleri ile korelasyon analizleri yapılmıştır. NIAS-PR'nin güvenilirliğini belirlemek için iç tutarlılık (Cronbach alfa katsayısı) analizi kullanılmıştır.
Bulgular: Mevcut çalışma, NIAS-EÖ'nin çevrilmiş Türkçe versiyonunun pediatrik popülasyonda geçerli bir ölçek olduğunu göstermiştir. NIAS'ın üç faktörlü yapısı -Seçici yeme, İştah ve Korku- Türkçe versiyonu NIAS-EÖ için tekrarlanmıştır. NIAS-EÖ alt ölçekleri, CEBQ alt ölçekleri ile beklenen korelasyon modellerini göstermiştir. Pediyatrik popülasyonda (2-18 yaş) NIAS-EÖ Türkçe versiyonunun güvenilirliğinin yüksek olduğu (toplam Cronbach alfa=0.90) saptanmıştır.
Sonuçlar: Bu çalışma, NIAS-EÖ'nin Türkçe versiyonunun iyi bir iç tutarlılığı olduğunu göstermiştir. NIAS-EÖ'nin Türkçe versiyonunun üç faktörlü yapısı doğrulanmıştır. NIAS-EÖ, Türk çocuk ve ergenlerinde ARFID araştırması için kısa, güvenilir bir araçtır. NIAS-EÖ bir tarama ölçeği olarak geliştirilmiştir, bu nedenle sağlık profesyonelleri bu ölçeği KKGAB ile ilgili yeme davranışlarını daha fazla araştırmak için kullanabilir. Bu kısıtlı/kaçıngan yeme semptomlarının klinik görüşmeler ile derinleştirilmesi gerektiğini belirtmekte fayda vardır.

Anahtar Kelimeler

ARFID, kaçıngan/kısıtlayıcı gıda alımı bozukluğu, NIAS, geçerlilik, güvenilirlik

Kaynakça

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association Publishing; 2013.
• Call C, Walsh BT, Attia E. From DSM-IV to DSM-5: changes to eating disorder diagnoses. Curr Opin Psychiatry 2013;26:532-6.
• Murray HB, Rao FU, Baker C, Silvernale CJ, Staller K, Harshman SG, et al. Prevalence and Characteristics of Avoidant/Restrictive Food Intake Disorder in Pediatric Neurogastroenterology Patients. J Pediatr Gastroenterol Nutr 2022;74: 588-92.
• Goldberg HR, Katzman DK, Allen L, Martin S, Sheehan C, Kaiserman J, et al. The Prevalence of Children and Adolescents at Risk for Avoidant Restrictive Food Intake Disorder in a Pediatric and Adolescent Gynecology Clinic. J Pediatr Adolesc Gynecol 2020;33:466-9.
• Katzman DK, Spettigue W, Agostino H, Couturier J, Dominic A, Findlay SM, et al. Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder. JAMA pediatrics 2021;175:e213861-e.
• Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry 2015;24:779-85.
• Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, et al. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health 2014;55:49-52.
• Zickgraf HF, Ellis JM. Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns. Appetite 2018;123:32-42.
• Ziółkowska B, Ocalewski J, Zickgraf H, Brytek-Matera A. The Polish Version of the Avoidant/Restrictive Food Intake Disorder Questionnaire-Parents Report (ARFID-Q-PR) and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen-Parents Report (NIAS-PR): Maternal Perspective. Nutrients 2022;14:3175.
• Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the Children’s Eating Behaviour Questionnaire. J Child Psychol Psychiatry 2001;42:963-70.
• Yilmaz R, Esmeray H, Erkorkmaz U. Adaptation study of the Turkish children’s eating behavior questionnaire. Anatolian Journal of Psychiatry 2011;12:287-94.
• Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997;38:581-6.
• Güvenir T, Özbek A, Baykara B, Arkar H, Şentürk B, İncekaş S. Psychometric Properties of The Turkish Version of The Strengths and Difficulties Questionnaire (SDQ). Turk J Child Adolesc Ment Health 2008;15:65-74.
• Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-43.
• Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res 2018;7:19-30.
• R Core Team R. A language and environment for statistical computing. R foundation for statistical computing Vienna. Austria; 2013. http://www.r-project.org/ Access Date June 2022.
• Rosseel Y. lavaan: An R package for structural equation modeling. J Stat Soft 2012;48:1-36.
• Vandenberg RJ, Lance CE. A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational research methods 2000;3:4-70.
• Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015;7:280-93.
• He J, Zickgraf HF, Ellis JM, Lin Z, Fan X. Chinese Version of the Nine Item ARFID Screen: Psychometric Properties and Cross-Cultural Measurement Invariance. Assessment 2021;28:537-50.
• Medina-Tepal KA, Vazquez-Arevalo R, Trujillo-ChiVacuán EM, Zickgraf HF, Mancilla-Díaz JM. Cross-cultural adaptation and validation of the Nine Item ARFID Screen (NIAS) in Mexican youths. Int J Eat Disord 2023;56:721-6.
• Marchi M, Cohen P. Early childhood eating behaviors and adolescent eating disorders. J Am Acad Child Adolesc Psychiatry 1990;29:112-7.
• Cardona Cano S, Tiemeier H, Van Hoeken D, Tharner A, Jaddoe VWV, Hofman A, et al. Trajectories of picky eating during childhood: A general population study. Int J Eat Disord 2015;48:570-9.
• Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc 2004;104:57-64.
• Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: A longitudinal study to age 11years. Eating Behaviors 2010;11:253-7.
• Brown CL, Vander Schaaf EB, Cohen GM, Irby MB, Skelton JA. Association of Picky Eating and Food Neophobia with Weight: A Systematic Review. Child Obes 2016;12:247-62.
• Gibson EL, Cooke L. Understanding food fussiness and its implications for food choice, health, weight and interventions in young children: the impact of professor Jane Wardle. Current obesity reports 2017;6:46-56.
• Ekstein S, Laniado D, Glick B. Does picky eating affect weight-for-length measurements in young children? Clin Pediatr (Phila) 2010;49:217-20.
• Taylor CM, Steer CD, Hays NP, Emmett PM. Growth and body composition in children who are picky eaters: a longitudinal view. Eur J Clin Nutr 2019;73:869-78.
• Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite 2015;95:349-59.
• Dovey TM, Staples PA, Gibson EL, Halford JC. Food neophobia and ‘picky/fussy’ eating in children: a review. Appetite 2008;50:181-93.
• Jacobi C, Schmitz G, Agras WS. Is picky eating an eating disorder? Int J Eat Disord 2008;41:626-34.
• Machado BC, Dias P, Lima VS, Campos J, Gonçalves S. Prevalence and correlates of picky eating in preschool-aged children: A population-based study. Eating Behaviors 2016;22:16-21.
• Machado BC, Dias P, Lima VS, Carneiro A, Gonçalves S. Frequency and Correlates of Picky Eating And Overeating in School-aged Children: A Portuguese Population-based Study. J Child Fam Stud 2021;30:1198-213.
• Iron-Segev S, Best D, Arad-Rubinstein S, Efron M, Serur Y, Dickstein H, et al. Feeding, eating, and emotional disturbances in children with avoidant/restrictive food intake disorder (ARFID). Nutrients 2020;12:3385.
• Cole NC, An R, Lee SY, Donovan SM. Correlates of picky eating and food neophobia in young children: a systematic review and meta-analysis. Nutr Rev 2017;75:516-32.
• Mitchell GL, Farrow C, Haycraft E, Meyer C. Parental influences on children’s eating behaviour and characteristics of successful parent-focussed interventions. Appetite 2013;60:85-94.
• Tan CC, Holub SC. Children’s self-regulation in eating: associations with inhibitory control and parents’ feeding behavior. J Pediatr Psychol 2011;36:340-5.
• Jansen PW, de Barse LM, Jaddoe VWV, Verhulst FC, Franco OH, Tiemeier H. Bi-directional associations between child fussy eating and parents’ pressure to eat: Who influences whom? Physiol Behav 2017;176:101-6.
• Dovey TM, Staples PA, Gibson EL, Halford JCG. Food neophobia and ‘picky/fussy’ eating in children: A review. Appetite 2008;50:181-93.