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Estrem HH, Pederson JL, Dodrill P, Romeo C, Thompson K, Thomas JJ, Zucker N, Noel R, Zickgraf H, Menzel J, Lukens CT, Goday PS, MacLaughlin S, Sharp WG. A US-Based Consensus on Diagnostic Overlap and Distinction for Pediatric Feeding Disorder and Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2024. [PMID: 39679744 DOI: 10.1002/eat.24349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 11/15/2024] [Accepted: 11/16/2024] [Indexed: 12/17/2024]
Abstract
OBJECTIVE As diagnoses covering dysfunctional feeding and eating in pediatrics, avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) contain inherent areas of overlap in their diagnostic criteria. Areas of overlap include criteria regarding nutritional consequences associated with feeding/eating dysfunction and shared emphasis on possible psychosocial impairment associated with restricted food intake. Complicating the differential diagnosis process is a lack of guidance regarding when the two conditions occur independently, co-qualify, and/or transition into the other. Feeding Matters' Research Initiatives Task Force planned and hosted a PFD-ARFID consensus meeting, with the aim of reaching a consensus regarding diagnostic clarity on PFD and ARFID. METHOD Criteria for participation focused on US residents who either: (a) served as an author on the ARFID workgroup or PFD consensus papers, or (b) provided community representation via board or committee roles. The consensus process followed three stages: prework, the meeting, and post-work/writing. Twelve participants were present for the meeting, with 14 involved in pre- and post-work/writing. RESULTS The final panel included four psychologists representing the ARFID community and seven multidisciplinary members representing PFD's four domains (medical, nutrition, skill, and psychosocial) plus a Zero-to-Three community representative and two representatives from Feeding Matters. Results yielded 10 consensus statements and visuals to support the consensus statements. DISCUSSION The consensus process and results underscore an ongoing need to improve diagnostic systems and reinforce calls for strengthening healthcare expertise for both PFD and ARFID. Community-based participatory research is recommended to advance both diagnoses and reduce ambiguity in practice settings.
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Affiliation(s)
- Hayley H Estrem
- School of Nursing, University of North Carolina at Wilmington, Wilmington, North Carolina, USA
| | | | - Pamela Dodrill
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cuyler Romeo
- Banner-University Medical Center South, Tucson, Arizona, USA
| | - Kelsey Thompson
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Nancy Zucker
- Duke University Health Center, Durham, North Carolina, USA
| | - Richard Noel
- Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Hana Zickgraf
- Rogers Behavioral Health Oconomowoc Main Campus, Atlanta, Georgia, USA
| | | | - Colleen T Lukens
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - William G Sharp
- Emory Medical School, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Guessoum SB, Loisel A, Fabrizio B, Barry C, Albertelli T, Moro MR, Blanchet C. Does multimodal inpatient treatment help some adolescents with severe ARFID? L'ENCEPHALE 2024:S0013-7006(24)00208-2. [PMID: 39580318 DOI: 10.1016/j.encep.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/04/2024] [Accepted: 10/10/2024] [Indexed: 11/25/2024]
Abstract
INTRODUCTION Avoidant Restrictive Food Intake Disorder (ARFID) is a recently described disorder. Data on inpatient treatment is still scarce, ARFID mainly being an outpatient condition. The purpose of this study is to describe a rare population of adolescents with severe ARFID receiving full-time multimodal inpatient care by examining their clinical characteristics, management, and evolution. METHODS We conducted a retrospective study on a series of patients diagnosed with ARFID who were hospitalised from 2005 to 2022. This study was carried out at the Adolescent Medicine department of a University Hospital in Paris, France, specialising in the treatment of eating disorders. RESULTS Sixteen adolescents aged 12 to 17 were hospitalised for severe ARFID associated with malnutrition, growth retardation, pubertal delay, and/or psychiatric comorbidities. All but one had body mass indexes less than -2 standard deviations. Mean BMI upon admission was 14,1 [standard deviation=1,8]. They benefited from multimodal treatment plans supported by a multidisciplinary team, including nutritional, somatic and psychiatric transdisciplinary assessment and care, residential care, and family involvement. Length of stay was five months on average, and 50% had achieved normal body mass index at discharge. CONCLUSIONS Full-time inpatient care with multimodal and multidisciplinary interventions and tailored management can help restore normal weight for some adolescents. These interventions are aimed at patients with severe ARFID with major complications such as stunted growth and delayed puberty, and/or comorbidities such as depression. Specific subtypes of patients with severe ARFID need to be identified to delineate their characteristics, prognosis, and treatments effective for this group.
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Affiliation(s)
- Sélim Benjamin Guessoum
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; PCPP, University of Paris, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, University Paris-Saclay, 94807 Villejuif, France.
| | - Alexandra Loisel
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; PCPP, University of Paris, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, University Paris-Saclay, 94807 Villejuif, France
| | - Brunella Fabrizio
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; University of Pavia, Pavia, Italy
| | - Caroline Barry
- Inserm, UVSQ, CESP, Team DevPsy, University Paris-Saclay, 94807 Villejuif, France
| | - Tancrède Albertelli
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; PCPP, University of Paris, 92100 Boulogne-Billancourt, France
| | - Marie Rose Moro
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; PCPP, University of Paris, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, University Paris-Saclay, 94807 Villejuif, France
| | - Corinne Blanchet
- Maison des adolescents - Youth Department, Cochin Hospital, AP-HP, 75014 Paris, France; PCPP, University of Paris, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, University Paris-Saclay, 94807 Villejuif, France
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Breiner CE, Miller ML, Hormes JM. ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2024; 57:2306-2317. [PMID: 39031449 DOI: 10.1002/eat.24269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP"). METHOD Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up. RESULTS Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (M CEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average. DISCUSSION ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04913194.
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Affiliation(s)
- Courtney E Breiner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - McKenzie L Miller
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
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Sharp WG, Malugen E, Pederson J, Martin-Halpine L, Dempster R, Baranwal N, Hodges A, Raol N, Volkert VM. Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape. J Pediatr 2024; 272:114126. [PMID: 38815739 DOI: 10.1016/j.jpeds.2024.114126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.
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Affiliation(s)
- William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Atlanta, GA.
| | | | | | - Loretta Martin-Halpine
- Children's Hospital of Philadelphia Philadelphia, PA; International Association of Pediatric Feeding and Swallowing, Pittsburgh, PA
| | - Robert Dempster
- International Association of Pediatric Feeding and Swallowing, Pittsburgh, PA; Nationwide Children's Hospital Columbus, OH
| | - Navya Baranwal
- The Warren Alpert Medical School of Brown University Providence, RI
| | | | - Nikhila Raol
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Valerie M Volkert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta Atlanta, GA
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5
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James RM, O'Shea J, Micali N, Russell SJ, Hudson LD. Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis. BMJ Paediatr Open 2024; 8:e002595. [PMID: 38977355 PMCID: PMC11261741 DOI: 10.1136/bmjpo-2024-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder with known acute and longstanding physical health complications in children and young people (CYP) and commonly presents to paediatricians. OBJECTIVE To systematically review the published literature on physical health complications in CYP with ARFID using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A systematic search of PubMed, Embase, Web of Science, PsycINFO and Cochrane Library was performed on 14 February 2024. Studies reporting physical health complications in CYP ≤25 years with ARFID were included. We pooled studies for meta-analysis comparing ARFID with healthy controls or anorexia nervosa (AN). RESULTS Of 9058 studies found in searches, we included 132 studies. We found evidence for low weight, nutritional deficiencies and low bone mineral density. CYP with ARFID can present across the weight spectrum; however, the majority of CYP with ARFID were within the healthy weight to underweight range. Most studies reported normal range heart rates and blood pressures in ARFID, but some CYP with ARFID do experience bradycardia and hypotension. CYP with ARFID had higher heart rates than AN (weighted mean difference: 12.93 bpm; 95% CI: 8.65 to 17.21; n=685); heterogeneity was high (I2: 81.33%). CONCLUSION There is a broad range of physical health complications associated with ARFID requiring clinical consideration. Many CYP with ARFID are not underweight yet still have complications. Less cardiovascular complications found in ARFID compared with AN may be related to chronicity. PROSPERO REGISTRATION NUMBER CRD42022376866.
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Affiliation(s)
| | | | - Nadia Micali
- UCL GOS Institute of Child Health, London, UK
- Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
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6
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Proctor KB, Mansoura M, Rodrick E, Volkert V, Sharp WG, Kindler JM. The relationship between food selectivity and stature in pediatric patients with avoidant-restrictive food intake disorder - an electronic medical record review. J Eat Disord 2024; 12:64. [PMID: 38773584 PMCID: PMC11110304 DOI: 10.1186/s40337-024-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND We aimed to characterize stature in pediatric patients with avoidant/restrictive food intake disorder (ARFID), including associations between body size and nutrient intake and height. METHODS We conducted a secondary analysis of pre-treatment data from 60 patients diagnosed with ARFID that were collected from the electronic medical record. Anthropometric measurements were converted to age- and sex-specific Z-scores using pediatric CDC growth charts. Spearman correlations were performed to test the relationship between height and weight/BMI Z-scores as well as height Z-score and diet variables. RESULTS On average, height (-0.35 ± 1.38), weight (-0.58 ± 1.56), and BMI (-0.56 ± 1.48) Z-scores tended to be lower than what would be expected in a generally healthy pediatric population. Percent of individuals with height, weight, or BMI Z-score < -2.0 was 8%, 20%, and 17%, respectively. BMI (P < 0.05) and weight (P < 0.05) were positively associated with height Z-score. Further, intake of some nutrients (e.g., calcium, vitamin D) correlated positively with height Z-score (all P < 0.05). CONCLUSIONS The cross-sectional relationships reported in this study suggest that in children with ARFID, body weight and consumption of bone-augmenting nutrients such as calcium and vitamin D correlated with height. A thorough understanding of the clinical manifestations of malnutrition and longitudinal effects of restrictive eating in patients with ARFID is critical.
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Affiliation(s)
- Kaitlin B Proctor
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maryam Mansoura
- Medical College of Georgia, Augusta University, University of Georgia Medical Partnership, Augusta, GA, USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Valerie Volkert
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - William G Sharp
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA.
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7
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Milliren CE, Crowley M, Carmody JK, Bern EM, Eldredge O, Richmond TK. Pediatric hospital utilization for patients with avoidant restrictive food intake disorder. J Eat Disord 2024; 12:42. [PMID: 38528642 DOI: 10.1186/s40337-024-00996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States. METHODS Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions. RESULTS Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit. CONCLUSIONS Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.
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Affiliation(s)
- Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - McGreggor Crowley
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Julia K Carmody
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elana M Bern
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Olivia Eldredge
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Tracy K Richmond
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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8
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Parent MB, Whitley KE, Zafar U, Zickgraf HF, Sharp WG. Systematic review of pharmacological treatments that reduce conditioned taste aversions in rodents: A potential animal model of pediatric feeding disorder and avoidant/restrictive food intake disorder (ARFID). Appetite 2024; 194:107172. [PMID: 38135183 DOI: 10.1016/j.appet.2023.107172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Avoidant/restrictive food intake disorder (ARFID) is diagnosed when food avoidance leads to clinically significant nutritional, weight/growth, or psychosocial impairment. As many as 81.5% of children and adolescents diagnosed with ARFID have a history of a medical condition associated with pain, fatigue, or malaise. ARFID is diagnosed and treatment begins after the medical condition is resolved but food avoidance remains. Effective treatment involves repeated exposure to eating food and related stimuli aimed at creating inhibitory learning to counteract learned fears and aversions. Treatment usually involves positive reinforcement of food approach behavior and escape extinction/response prevention to eliminate food avoidant behavior. To shed light on the neural mechanisms that may maintain ARFID and to identify candidate pharmacological treatments for adjuncts to behavioral interventions, this paper systematically reviews research on drug treatments that successfully reduce conditioned taste aversions (CTA) in animal models by disrupting reconsolidation or promoting extinction. The mechanism of action of these treatments, brain areas involved, and whether these CTA findings have been used to understand human eating behavior are assessed. Collectively, the results provide insight into possible neural mechanisms associated with resuming oral intake following CTA akin to the therapeutic goals of ARFID treatment and suggest that CTA animal models hold promise to facilitate the development of interventions to prevent feeding problems. The findings also reveal the need to investigate CTA reduction in juvenile and female animals and show that CTA is rarely studied to understand disordered human feeding even though CTA has been observed in humans and parallels many of the characteristics of rodent CTA.
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Affiliation(s)
- Marise B Parent
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA; Department of Psychology, Georgia State University, Atlanta, GA, USA.
| | | | - Usama Zafar
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Hana F Zickgraf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
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9
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Galai T, Friedman G, Kalmintzky N, Shemer K, Gal DL, Cohen S, Moran‐Lev H. Factors associated with age of presentation of pediatric feeding disorder. Brain Behav 2024; 14:e3461. [PMID: 38468461 PMCID: PMC10928322 DOI: 10.1002/brb3.3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
AIM Understanding the association between pediatric feeding disorder (PFD) and age of presentation is limited. We aimed to investigate factors associated with PFD among different age groups. METHODS Retrospective analysis of medical records of infants and toddlers diagnosed with PFD, according to the World Health Organization-based definition. We compared children aged 1-12 months to those aged 13-72 months. RESULTS Included were 253 children with PFD (median [interquartile range] age 16.4 [9.5-33] months at diagnosis, 56% boys). Significantly more children in the younger age group were girls (52.6% vs. 34.4%, respectively, p = .03) and preterm (25% vs. 14%, p = .03). They had more hospitalizations (34% vs. 23%, p = .03) and needed more prescription medications (36% vs. 17%, p < .01). Additionally, disturbances in oral intake were primarily linked to feeding skills dysfunction in the younger group and nutritional dysfunction in the older group (39.6% vs. 23.7% and 55% vs. 38%, respectively, p = .02). CONCLUSIONS Infants under 1 year old with PFD represent a distinct patient group with unique characteristics and outcomes. The age of presentation plays a significant role in children with PFD, necessitating tailored treatment strategies.
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Affiliation(s)
- Tut Galai
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
| | - Gal Friedman
- PediatricsDana Dwek Children's Hospital, Affiliated to the Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Nataly Kalmintzky
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
| | - Kim Shemer
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
| | - Dana L Gal
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
| | - Shlomi Cohen
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
| | - Hadar Moran‐Lev
- Pediatric GastroenterologyDana Dwek Children's Hospital, Affiliated to the Faculty of MedicineTel AvivIsrael
- PediatricsDana Dwek Children's Hospital, Affiliated to the Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
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10
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Vincent LB, Stone-Heaberlin M, Kandarpa K, McIntire H, Turner K, Krebs K. Clinical Outcomes from an Interdisciplinary Outpatient Feeding Treatment Pilot Program. J Clin Psychol Med Settings 2024; 31:208-223. [PMID: 37178340 PMCID: PMC10182748 DOI: 10.1007/s10880-023-09963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Many children with developmental disabilities experience feeding challenges, including food refusal and food selectivity. Feeding concerns are often multifaceted and, therefore, an interdisciplinary approach to treatment is needed. A pilot of an interdisciplinary outpatient feeding program was conducted in a hospital medical center by psychologists and occupational therapists. The pilot program focused on caregiver training and improvements in targeted feeding goals in both the clinic and home settings. Treatment outcomes from this pilot program found increases in bite acceptance, decreases in inappropriate mealtime behaviors, increases in caregiver-reported number of foods consumed, and mastery of most individualized feeding goals for children who participated in the treatment program. Additionally, caregivers reported decreased concerns related to feeding and increased confidence in addressing their child's feeding concerns after participation in the treatment. Caregivers also reported high levels of satisfaction with this pilot program and reported the intervention to be feasible.
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Affiliation(s)
- Lori B Vincent
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA.
| | - Meg Stone-Heaberlin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kavya Kandarpa
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA
| | - Hannah McIntire
- School of Human Services, School Psychology Programs, University of Cincinnati, 450B Teacher-Dyer Complex, Cincinnati, OH, 45221, USA
| | - Krystin Turner
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathy Krebs
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Willmott E, Dickinson R, Hall C, Sadikovic K, Wadhera E, Micali N, Trompeter N, Jewell T. A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID). Int J Eat Disord 2024; 57:27-61. [PMID: 37876356 DOI: 10.1002/eat.24073] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE This scoping review identifies and describes psychological interventions for avoidant restrictive food intake disorder (ARFID) and summarizes how outcomes are measured across such interventions. METHOD Five databases (Cochrane, Embase, Medline, PsycInfo, Web of Science) were searched up to December 22, 2022. Studies were included if they reported on psychological interventions for ARFID. Studies were excluded if participants did not have an ARFID diagnosis and if psychological interventions were not delivered or detailed. RESULTS Fifty studies met inclusion criteria; almost half were single-case study designs (23 studies) and most studies reported on psychological interventions for children and adolescents with ARFID (42 studies). Behavioral interventions (16 studies), cognitive-behavioral therapy (10 studies), and family therapy (5 studies), or combinations of these therapeutic approaches (19 studies) were delivered to support patients with ARFID. Many studies lacked validated measures, with outcomes most commonly assessed via physical health metrics such as weight. DISCUSSION This review provides a comprehensive summary of psychological interventions for ARFID since its introduction to the DSM-5. Across a range of psychological interventions and modalities for ARFID, there were common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement. Currently, studies reporting on psychological interventions for ARFID are characterized by small samples and high levels of heterogeneity, including in how outcomes are measured. Based on reviewed studies, we outline suggestions for clinical practice and future research. PUBLIC SIGNIFICANCE Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food. We reviewed the literature on psychological interventions for ARFID and the outcomes used to measure change. Several psychological interventions have been developed and applied to patients with ARFID. Outcome measurement varies widely and requires further development and greater consensus.
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Affiliation(s)
- Emma Willmott
- Psychological and Mental Health Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Dickinson
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Celine Hall
- Psychological and Mental Health Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Kevser Sadikovic
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Emily Wadhera
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Mental Health Services of the Capital Region of Denmark, Eating Disorders Research Unit, Ballerup Psychiatric Centre, Copenhagen, Denmark
| | - Nora Trompeter
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Tom Jewell
- Psychological and Mental Health Services, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Pickard K, Burrell TL, Brasher S, Buckley D, Gillespie S, Sharp W, Scahill L. Examining adaptations necessary to support the implementation of a parent-mediated intervention for children with autism spectrum disorder and moderate feeding problems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2434-2445. [PMID: 37062908 DOI: 10.1177/13623613231166181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
LAY ABSTRACT Moderate feeding problems and disruptive mealtime behaviors are common in children with autism spectrum disorder. Although parent-mediated interventions are able to support feeding problems in autistic children, most research has occurred within specialty clinics when delivered by highly trained clinicians. Thus, the fit of these interventions within community settings is not clear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to improve its fit and use within community settings. Participants were 14 multidisciplinary providers who attended one of the three intensive workgroups that included focus groups about the fit of MEAL Plan in their practice setting. Qualitative analysis was used to determine the main themes that came up within the focus groups. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, how providers might adapt their delivery of MEAL Plan, billing and insurance considerations, administrator support for MEAL Plan, and the content and format of ongoing training and consultation. By proactively considering and responding to these factors, it may be possible to enhance MEAL Plan so that it is better able to be delivered and sustained within community practices that support autistic children.
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Affiliation(s)
| | - T Lindsey Burrell
- Atlanta Children's Center, Emory University, USA
- Children's Healthcare of Atlanta, USA
| | | | | | | | - William Sharp
- Emory University, USA
- Children's Healthcare of Atlanta, USA
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13
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Noel RJ. Avoidant restrictive food intake disorder and pediatric feeding disorder: the pediatric gastroenterology perspective. Curr Opin Pediatr 2023; 35:566-573. [PMID: 37461875 DOI: 10.1097/mop.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE OF REVIEW Avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) are the newest evolutions of frameworks for dysfunctional feeding and share overlapping features but maintain notable differences. This review will compare the two frameworks, highlighting some of the latest advances in diagnosis and management. RECENT FINDINGS Dysfunctional feeding, particularly withing the PFD definition, benefits from multidisciplinary care with equal attention to medical, nutritional, skill-based, and behavioral domains. Management requires medical attention, often with functional gastrointestinal disease and anxiety. Pharmacologic appetite stimulation may play a role. A single empirically proved behavioral approach has not been described and multiple options exist regarding type, location, and intensity of feeding therapy. SUMMARY ARFID and PFD not only share areas of overlap, but also differ, likely based on the origins of each framework. Ultimately, both frameworks describe dysfunctional feeding and require input from medical providers. The more effective approaches tend to be multidisciplinary, addressing medical, nutritional, skill-based, and/or behavioral aspects of the disorder (the PFD model). Future evolution of both ARFID and PFD frameworks is likely to generate refinement in their defining criteria, hopefully generating a structured link between the two.
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Affiliation(s)
- Richard J Noel
- Department of Pediatrics, Duke University, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Durham, North Carolina, USA
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Islam N, Hathaway KL, Anderson BS, Sharp WG, Loechner KJ. Brief Report: Decreased Bone Health in Children with Autism Spectrum Disorder and Avoidant Restrictive Food Intake Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05976-x. [PMID: 37179523 DOI: 10.1007/s10803-023-05976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Children with autism spectrum disorder (ASD) and food selectivity are at increased risk for nutritional deficiencies which could affect bone health. METHODS We report on four male patients with ASD and avoidant restrictive food intake disorder (ARFID) with significant bone conditions including rickets, vertebral compression fractures, osteopenia, and slipped capital femoral epiphyses. RESULTS Each patient was at risk for at least one nutritional deficiency. Two out of four patients had deficiencies in Vitamins A, B12, E, and zinc. Calcium and Vitamin D deficiency were noted in all four. Two out of four patients with Vitamin D deficiency developed rickets. CONCLUSION Provisional evidence suggests that children with ASD and ARFID are at elevated risk for serious adverse bone health outcomes.
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Affiliation(s)
- Noreen Islam
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Kristin L Hathaway
- Children's Multidisciplinary Feeding Program, Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, 30329, USA
| | - Brooke S Anderson
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
- Children's Multidisciplinary Feeding Program, Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, 30329, USA
| | - Karen J Loechner
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
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Proctor KB, Rodrick E, Belcher S, Sharp WG, Kindler JM. Bone health in avoidant/restrictive food intake disorder: a narrative review. J Eat Disord 2023; 11:44. [PMID: 36949522 PMCID: PMC10031860 DOI: 10.1186/s40337-023-00766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is an eating/feeding disturbance characterized by severe food avoidance or restriction that results in faltering growth, nutritional deficiencies, dependence on formula supplementation, and/or significant psychosocial impairment. Compared to other eating disorders, ARFID is observed to have an earlier childhood onset and chronic course without intervention. Childhood represents a sensitive period for longitudinal growth and bone accrual, setting the stage for long-term health outcomes associated with longevity and quality of life, including risk for fracture and osteoporosis. RESULTS This narrative review discusses published scientific literature on bone health in individuals with ARFID by describing the current understanding of ARFID's effect on bone health, how common dietary constraints characteristic of ARFID may present unique risks to bone health, and the current clinical recommendations for bone health assessment. Reviewing what is known of clinical data from anorexia nervosa (AN) and similar cohorts, the chronicity and etiology of dietary restriction observed in ARFID are hypothesized to compromise bone health significantly. Although limited, examination of bone health in ARFID patients suggests children with ARFID tend to have shorter stature compared to healthy reference datasets and have lower bone density compared to healthy individuals, similar to those with AN. There remains a substantial knowledge gap in how ARFID may interrupt bone accrual during childhood and adolescence, and subsequent impact on attainment of peak bone mass and peak bone strength. The longitudinal effects of ARFID may be subtle and overlooked clinically in the absence of severe weight loss or growth stunting. Early identification and remediation of threats to bone mass accrual have significant personal and population-level implications. CONCLUSION For patients with ARFID, delayed identification and intervention to address feeding disturbances may have a long-lasting impact on various body systems and processes, including those relating to longitudinal growth and bone mass accrual. Further research employing rigorous prospective observational and/or randomized study designs are required to clearly define effects of ARFID, as well as clinical interventions aimed at addressing ARFID-related feeding disturbances, on bone accrual.
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Affiliation(s)
- Kaitlin B. Proctor
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Athens, GA USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
| | - Staci Belcher
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
| | - William G. Sharp
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Athens, GA USA
| | - Joseph M. Kindler
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
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Abstract
PURPOSE OF REVIEW To review the literature pertaining to the assessment and treatment of avoidant/restrictive food intake disorder (ARFID) ten years following its introduction to DSM-5. RECENT FINDINGS Several structured clinical interviews for assessing ARFID have been developed, each with its own strengths and limitations. There is no clear leading self-report measure for tracking treatment progress and outcome in ARFID. Medical assessment is comprised of examining anthropometrics, vitamin deficiencies, and other comorbidities. To date, several studies have reported on cognitive behavioral therapy, family-based treatment, and other approaches to the treatment of ARFID. These treatments appear promising; however, they rely on data from clinical case series and very small randomized controlled trials. Several promising assessments and treatments for ARFID are in the early stages of research. Yet, controversies remain. These include (a) overlap with criteria for pediatric feeding disorder; (b) the optimal method for assessing nutrient deficiencies; (c) disciplines involved in treatment. Future research innovation is necessary to improve the psychometric properties of ARFID assessments and evaluate treatment efficacy with larger samples and randomized designs.
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Affiliation(s)
- P Evelyna Kambanis
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Nitsch A, Watters A, Manwaring J, Bauschka M, Hebert M, Mehler PS. Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study. Int J Eat Disord 2023; 56:978-990. [PMID: 36695305 DOI: 10.1002/eat.23897] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population. METHOD We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission. RESULTS One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI). DISCUSSION This is the largest study to the authors' knowledge of medical presentations in adult patients with ARFID. Our results reflect that the adult patient with ARFID may, in some aspects, present differently than pediatric and adolescent patients with ARFID, or from ARFID patients requiring less intensive care. This study highlights the need for further investigation of adult patients with ARFID. PUBLIC SIGNIFICANCE ARFID is a restrictive eating disorder first defined in 2013. This study explores the medical presentations of adult patients (>18 years old) with ARFID presenting for specialized eating disorder treatment and identifies unique features of the adult presentation for treatment, compared to pediatric and adolescent peers.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jamie Manwaring
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Melanie Hebert
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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Evaluating Outcome Measure Data for an Intensive Interdisciplinary Home-Based Pediatric Feeding Disorders Program. Nutrients 2022; 14:nu14214602. [DOI: 10.3390/nu14214602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness of an interdisciplinary home-based feeding program, which is a unique service delivery model. Methods: Data were provided on oral intake, tube feeding elimination, and weight for patients who were dependent on tube feedings (n = 78). Weight data were collected for patients who showed failure to thrive (n = 49). Number of foods consumed and percentage of solids were collected for patients who were liquid-dependent (n = 23), and number of foods consumed were collected for patients who were food-selective (n = 61). Results: Data were analyzed using paired sample t-test with 95% confidence interval. For patients dependent on tube feedings, 81% achieved tube feeding elimination. Tube elimination was achieved after 8 months of treatment on average. All failure-to-thrive patients showed weight gain from baseline to discharge. For liquid-dependent patients, there was an increase in foods consumed from 2 foods at admission to 32 foods at discharge. For food selective patients, there was an increase from 4 foods at admission to 35 foods at discharge. For all dependent variables, results showed statistical significance and a large-sized effect. Conclusions: These data show that an intensive interdisciplinary home-based program can be successful in treating complex feeding problems in children.
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Williams K, Seiverling L. Behavior Analytic Feeding Interventions: Current State of the Literature. Behav Modif 2022:1454455221098118. [PMID: 35674422 DOI: 10.1177/01454455221098118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field.
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Phipps LE, Haney SD, Zeleny J, Andersen AS, Peterson KM, Orloski S. Using Behavior-Analytic Treatment to Teach Tongue Lateralization Skills to Children With Avoidant/Restrictive Food Intake Disorder. Clin Case Stud 2022. [DOI: 10.1177/15346501221092112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral-motor skills needed for efficient consumption of table-textured foods (e.g., tongue lateralization) often develop as children are exposed to food at increasingly higher textures (e.g., soft meltable, crunchy, and chewy; Volkert et al., 2014). For children with avoidant/restrictive food intake disorder (ARFID; American Psychiatric Association, 2013; World Health Organization, 2019), these oral-motor skills may not develop without intervention. We review case studies of three children diagnosed with ARFID who did not display the skills necessary for efficient consumption of regular table-textured food. We collaborated with a speech-language pathologist to identify oral-motor targets and used a behavior-analytic treatment to teach tongue lateralization skills necessary for safe and effective chewing. We used a treatment package consisting of nonremoval of the utensil with prompting and differential reinforcement to shape functional tongue movements. We discuss considerations for practitioners and the importance of individualized treatment and collaboration with other disciplines while teaching oral-motor skills necessary for chewing and consuming table-textured food.
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Affiliation(s)
- Laura E. Phipps
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
| | - Sarah D. Haney
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jason Zeleny
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ashley S. Andersen
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- Clinic 4 Kidz, Sausalito, CA, USA
| | - Kathryn M. Peterson
- Children’s Specialized Hospital, Somerset, NJ, USA
- Division of Child Neurology and Neurodevelopmental Disabilities, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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