Secondary outcomes
Biological and radiological outcomes will be collected. Nutritional status will be assessed with prealbumin, leptin, total ghrelin and IGF1. Body composition and bone mineralisation will be estimated by using dual-energy X-ray absorptiometry (DEXA, GE Lunar ProdigyCorp., Madison. WI). Bone mineral measurements will be expressed as standard deviation score according to age and sex (SDS). Bone maturation will be assessed from an en face radiograph of the left wrist, interpreted using the Greulich and Pyle atlas.
Global clinical and psychological evaluation will be assessed with the
Clinical Global Impression (CGI) [
20] scale. CGI is scored on a two-part 7 response levels evaluating illness severity (CGI-S) and improvement (CGI-I) from 1 (“not ill”/ “very much improved”) to 7 (“extremely ill”/ “much worse”).
Eating disorder symptomatology will be assessed with the
Morgan and Russell scale (MRS) [
21] and the
Children Eating Disorders Inventory (EDI-c) [
22,
23]. The MRS is a questionnaire designed to evaluate the long-term evolution of the eating disorder and is used to assess the main aspects of anorexia nervosa over a six-month period. A version has been adapted for younger children, with deletion of non-appropriated items as "menstruation", "psychosexual functioning" and "emancipation". The assessment of the adapted procedure has 8 subscales divided into 3 groups: Eating; Mental status; Socioeconomic Status.
The EDI-c is adapted form of the EDI for children from 8 years of age onwards [
22,
23]. This is a multidimensional self-questionnaire that assesses different psychological, behavioural and emotional characteristics associated with eating disorder symptoms. It comprises 91 items divided into 11 factors: Drive for Thinness, Bulimia, Body Dissatisfaction, Low Self-Esteem, Personal Alienation, Interpersonal Insecurity, Interpersonal Alienation, Interoceptive Deficits, Emotional Dysregulation, Perfectionism, Asceticism, and Maturity Fears. Each of the 91 items is rated from 'never' to 'always', respectively from 0 to 3 for direct items and from 3 to 0 for indirect items.
Depressive and anxiety symptomatology will be respectively assessed by the Children Depression Inventory (CDI) [
24], the
State –Trait Anxiety Inventory for Children (STAIC) [
25]. The CDI is a self-adapted Beck Depression Inventory for children aged 7 to 17 years, with 27 items scored from 0 (absent or normal behaviour for age) to 2 (severe). The total score, calculated as the sum of all the items, varies from 0 to 54 with a pathological threshold of 15. It is a widely used tool in the international literature to assess the intensity of depression.
The STAIC is a self-questionnaire and comprises two 20-item subscales, the Trait Anxiety and the State Anxiety. The scores observed for the two subscales range from 20 to 80, with a score of 35 or less corresponding to very low anxiety and a score of over 65 corresponding to very high anxiety.
Self-esteem will be assess by the Rosenberg Self-esteem Scale [
26]
is a self-questionnaire with a 10-items measure of global self-esteem, widely used in general and clinical populations. The higher the scores, the better the self-esteem. It can be used from the age of 8 years.
Therapeutic alliance/perception of treatment benefit and Motivation to change will be assessed by the
Helping Alliance Questionnaire-11 (HAQ-11S) [
27], the
Consumer Satisfaction Questionnaire (CSQ-8) [
27] and the
Motivation Questionnaire [
28].
The CSQ-8 is a self -"satisfaction"-questionnaire, defined here as a concept tending to assess whether the needs of the consumer of a service are being met or not. In medical terms, patient satisfaction is an internationally recognized measure for the evaluation of the perception of quality of care; this dimension can have an influence on the outcome and adherence to the proposed treatment and thus on the acceptability of the treatment. It consists of eight questions, each with four response options ranging from one "not at all satisfied" to four "completely satisfied".
The HAQ-11S is a self-questionnaire of 11 items measuring the strength of the collaboration between the patient and the healthcare team.
The Motivation Questionnaire will assess the importance of change and the perceived ability to change. It consists of two questions: "How important is it for you to change" and "How confident are you in your ability to change". Both questions are rated on a Likert scale from 0: "Not at all" to 10: "Completely".
Quality of life will be assessed by the
Short-Form 12-Item Health Survey (SF-12) [
29,
30]. The SF-12 is a generic self-assessment scale of quality of life and a shortened version of the SF-36 validated in France. It contains 12 questions. It provides two scores: a physical health and a mental health summary scores. These two scores were constructed so that their average in the general population is 50 and range from 0 to 100, 100 indicating the highest level of quality of life.
Social functioning will be particularly evaluated based on the subscales of the MRS assessing the socioeconomic status: relationship with family, social contacts outside family, social activities and scolarity.
Direct and indirect costs will be calculated from resources consumption: all hospital admissions will be recorded as ambulatory consultations, complementary examinations, medical transport and number of non-working days for parents due to medical care for their child for control and experimental groups will be recorded.