ARFID Test: NIAS (Nine Item ARFID Screen) Scoring and Cutoffs

The NIAS (Nine Item ARFID Screen) is a 9-item self-report questionnaire that scores three ARFID eating patterns, picky eating, appetite and fear, on separate 0 to 15 subscales ¹.

What does the NIAS measure?

The NIAS measures the eating behaviours behind avoidant/restrictive food intake disorder (ARFID). DSM-5 describes three patterns that can lead to ARFID, and the NIAS gives each its own subscale ¹:

• Picky eating. Avoiding foods because of their sensory properties, such as taste, texture or smell ².
• Appetite. Low appetite or little interest in eating, so that even liked foods are hard to eat in large enough amounts ².
• Fear. Avoiding or putting off eating because of fear of choking, vomiting or gut discomfort ².

It is a behaviour measure. It does not ask about the consequences that define ARFID, such as weight loss, nutritional deficiency, dependence on supplements or impact on daily life ¹.

How do you give the NIAS?

• Format. Nine statements, three per subscale, each rated on a 6-point scale from 0 (strongly disagree) to 5 (strongly agree) ².
• Who completes it. The client, on paper or on screen. It was first validated in adults ¹; a youth version (Y-NIAS) has been tested in young people seen at an eating disorder clinic ³.
• Parent report. Self-reports from adults and adolescents, and parent reports about adolescents, appear to be read the same way; parent reports about younger children did not match parent reports about adolescents ⁵.
• Pairing. Give it with a measure of shape- and weight-driven eating disorders, such as the EDE-Q, so a high NIAS score can be read in context ².

How do you score and interpret the NIAS?

1. Add the three items of each subscale. Each subscale runs 0 to 15; higher scores mean more picky eating, less interest in eating or more fear ².
2. If useful, add all nine items for a total of 0 to 45, a broad index of avoidant/restrictive eating ².
3. Compare each subscale with the cutoffs proposed by Burton Murray and colleagues ²:

4. Treat a score at or above any subscale cutoff as a positive screen for that ARFID pattern. The NIAS is read as a profile of three subscales, so this page shows no single total band.
5. Read a positive screen together with an EDE-Q. In the 2021 study, NIAS cutoffs alone flagged many people with other eating disorders; adding an EDE-Q global score below 2.3 was what separated ARFID from other eating disorders ².

Psychometric properties

• Development. In three adult samples (455 online workers, 505 adults from a nationally representative panel and 311 undergraduates), factor analyses supported three factors. The subscales showed high internal consistency and test-retest reliability, and correlated with other measures of picky eating, appetite and fear ¹.
• Clinical validation. In 166 people (49 outpatients with ARFID, 77 with other eating disorders and 40 non-clinical participants), Cronbach's α was 0.86 for picky eating, 0.91 for appetite and 0.90 for fear. Each subscale identified its matching ARFID presentation well, but only the picky eating subscale separated ARFID from other eating disorders ².
• Young people. In 310 young people (mean age 14.7) at a tertiary eating disorder clinic, the three-factor structure was supported. Cut scores emerged for picky eating (10) and fear (9) but not appetite. Combined with the EDE-Q, 62.7% of ARFID cases and 89.4% of other eating disorder cases were classified correctly ³.
• Large eating disorder sample. Among 9,148 Swedish adults, 57.0% of those with current anorexia nervosa scored above a cutoff on at least one subscale. NIAS subscales correlated only modestly with EDE-Q subscales (r 0.26 to 0.40) ⁴.

Limitations

• Not a diagnosis. The NIAS measures eating patterns, not the medical and psychosocial consequences that ARFID requires.
• Overlaps with other eating disorders. People with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorders also score high, so the NIAS alone cannot tell ARFID apart from shape- or weight-driven restriction ⁴.
• Cutoffs are early. The adult cutoffs come from one clinical sample of 166 people ², and the youth study found no cutoff for appetite ³.
• Specificity varies by subscale. The picky eating cutoff catches nearly all cases but also flags many people without that presentation ².
• Other screens miss ARFID. Broad eating disorder screens such as the SCOFF and EDDS were not built to detect ARFID, which is why a dedicated measure is useful alongside them.