Parent–child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination

Authors

  • Paige Mariano BPsych,

    1. School of Psychology, Murdoch University, Perth, Australia
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  • Hunna J. Watson PhD, MPsych(Clin),

    Corresponding author
    1. Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
    2. Centre for Clinical Interventions, Department of Health in Western Australia, Perth, Australia
    3. School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
    4. School of Psychology and Speech Pathology, Curtin University, Perth, Australia
    • Correspondence to: Dr. Hunna Watson, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, Australia, 6840. E-mail: hunna.watson@health.wa.gov.au

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  • David J. Leach MEPsych,

    1. School of Psychology, Murdoch University, Perth, Australia
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  • Julie McCormack MSc(Psych),

    1. Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
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  • David A. Forbes MBBS, FRACP

    1. Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
    2. School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
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ABSTRACT

Objective

The aim of this study was to examine parent–youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample.

Method

The sample comprised 619 parent-youth dyads of youth (8–18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports.

Results

On the whole, parent–youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48–0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07–0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents.

Discussion

Results support the utility of parent–youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:617–625)

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