LETTERS TO THE EDITORS

Good news for Brazilian eating disorders researchers

Boas novas para os pesquisadores de transtornos alimentares no Brasil

Dear Editor,

We would like to congratulate the Revista Brasileira de Psiquiatria for the publication of the paper The Eating Disorders Section of the Development and Well Being Assessment (DAWBA): development and validation, by Dr. Tatiana Moya et al from PROTAD, USP, Brazil.

The paper describes a well-controlled study of the validation and test-retest reliability of the Portuguese version of the Eating Disorders (ED) section of the DAWBA.¹ The DAWBA is an assessment package designed for the psychiatric evaluation of children and adolescents.

Results from Dr. Moya's study demonstrate that DAWBA eating disorders diagnoses have high levels of agreement with expert clinical assessment and yield high sensitivity, specificity, positive and negative predictive values for the discrimination between ED diagnoses (irrespective of type) and its absence, when compared to independent clinical interview. Test-retest reliability of the DAWBA final ED diagnoses is also very good. One important advantage of the DAWBA system is that it can also generate preliminary computer diagnoses. The computer program can be used when experts are not available or when financial resources are scarce.

This publication represents a major advance for eating disorders researchers in Brazil, where there is a lack of well-validated, easily-administered and cost-effective diagnostic instruments suitable for the use with younger populations. The DAWBA has good psychometric properties and also combines the advantages of respondent-based (structured) interviews with clinician-based (semi-structured) interviews and, therefore, can be adapted to different settings and needs.

Eating disorders are known to have a peak age of incidence during adolescence and specialized ED centers have witnessed, in the last five years, an increase in the number of patients below 18 years of age seeking help for eating problems. In our ED program (PROATA), at UNIFESP, referrals of children and adolescents have not been uncommon, with patients as young as 12 years old being treated by our team.²

Mean age of Dr. Moya's sample was 16 years. It would be interesting to know the minimum age of her subjects and to verify the psychometric performance of DAWBA's ED section with prepubertal patients. It is somewhat surprising that the assessment of children with less than 11 years of age is restricted to the parent-interview, which is how the DAWBA as a whole was originally designed. Even though the inclusion of a parent interview has major advantages because of the tendency of ED patients to deny their symptoms,³ restricting the assessment to parents excludes the possibility of detecting secretive behaviors, particularly purging behaviors and eating in secret. To help clarifying this issue, studies could be accomplished comparing parent and child interviews of subjects in the lower age range covered by the instrument.

Finally, we would like to recommend a visit to the fascinating and user-friendly site of the DAWBA (www.dawba.com). The ED section has already been incorporated to online and text Portuguese versions of the DAWBA, which were validated by Fletlich-Bilyk and Goodman, both available at no cost.⁴

Christina Marcondes Morgan,

Angélica de Medeiros Claudino

Program for Orientation and Assistance to Eating Disorders Patients (PROATA),

Department of Psychiatry, Universidade Federal de São Paulo

(UNIFESP), São Paulo (SP), Brazil

References

1. Moya T, Fleitilich-Bilyk B, Goodman R, Nogueira FC, Focchi PS, Nicoletti M, et al. The Eating Disorders Section of the Development and Well-Being Assessment (DAWBA): development and validation. Rev Bras Psiquiatr. 2005;27(1):25-31.

2. Tirico PP, Morgan CM, Palavras MA, Lucena C, Alvarenga ML, Guizo VLS, et al. Características do Programa de Orientação e Assistência a Pacientes com Transtornos Alimentares (PROATA) do Departamento de Psiquiatria, UNIFESP. [poster]. In: Simpósio Internacional de Transtornos Alimentares, PROATA 10 anos; 2004 nov 19-20. São Paulo: UNIFESP/EPM; 2004.

3. Bryant-Waugh RJ, Cooper PJ, Taylor CL, Lask BD. The use of the eating disorder examination with children: a pilot study. Int J Eat Disord. 1996;19(4):391-7.

4. Fleitilich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43(6):727-34.

Financing: None

Conflict of interests: None

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