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Assessing Eating Disorder Symptoms in Adolescence: Is There a Role for Multiple Informants?
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    Epidemiologic studies of adolescent psychiatric disorders often collect information from adolescents and parents, yet most eating disorder epidemiologic studies rely only on adolescent report.


    We studied the eating disorder symptom reports provided by 7,968 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), and their parents, who were sent questionnaires at participants’ ages 14 and 16 years. Both adolescents and parents were asked questions about the adolescent's eating disorder symptoms, including binge eating, vomiting, laxative use, fasting, and thinness. We assessed the concordance of parent and adolescent report cross-sectionally using kappa coefficients, and further looked at how the symptom reports were predictive of adolescent body mass and composition measured at a clinical assessment at 17.5 years. Generalized estimating equations were used to model the symptom reports’ associations with risk factors and clinical outcomes.


    Parents and adolescents were largely discordant on symptom reports cross-sectionally (kappas<0.3), with the parent generally less likely to report bulimic symptoms than the adolescent but more likely to report thinness. Female adolescents were more likely to report bulimic symptoms than males (e.g., 2-4 times more likely to report binge eating), while prevalence estimates according to parent reports of female vs. male adolescents were similar. Both parent and adolescent symptom reports at ages 14 and 16 years were predictive of age-17.5 body mass and composition measures; parentally-reported binge eating was more strongly predictive of higher body mass and composition.


    Parent report of eating disorder symptoms seemed to measure different, but potentially important, aspects of these symptoms during adolescence. Epidemiologic eating disorder studies should consider the potential value added from incorporating parental reports. In particular, studies of male eating disorder presentations may be improved by using multiple sources of information.

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  • Funding:
    092731/Wellcome Trust/United Kingdom
    092731/Wellcome Trust/United Kingdom
    102215/Wellcome Trust/United Kingdom
    MN087786-01/MN/OMHHE CDC HHS/United States
    R01 MH087786/MH/NIMH NIH HHS/United States
    Medical Research Council/United Kingdom
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