Canadian practice guidelines for the treatment of children and adolescents with eating disorders

OBJECTIVES

Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline.

METHODS

Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.

RESULTS

Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed.

CONCLUSIONS

Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Brief, Intensive, and Concentrated Treatment of Specific Phobia in a Child With Minimally Verbal Autism Spectrum Disorder

This case study illustrates a brief, intensive, cognitive behavioral therapy (CBT) for a young male client with a specific phobia of dogs and comorbid autism spectrum disorder (ASD). CBT has been shown to be an effective treatment for anxiety in children with ASD; however, this work has not often been extended to children with language impairment. This case study presents significant modifications to one-session treatment (OST) for specific phobia to make it applicable to a child with minimally verbal ASD. The intervention included four 3-hr treatment sessions conducted over the course of four consecutive days. Assessment sessions were conducted before treatment, and 1 week and 3 months following treatment. The client’s phobia symptoms decreased following the intervention at both the posttreatment and follow-up sessions. The Reliable Change Index (RCI) was calculated to evaluate changes from pretreatment to posttreatment and follow-up and demonstrated a clinically significant decrease in phobia symptomology following intervention. The results suggest the potential efficacy for a brief, intensive, and concentrated CBT treatment for a child with minimally verbal ASD and a severe phobia.

When Outpatient Care Is Not Enough: Successful Use of an Inpatient Behavioral Intervention for a Child With ARFID

Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating in the absence of body image disturbance or drive for thinness, resulting in the persistent failure to meet appropriate nutritional and/or energy needs and/or psychosocial impairment. ARFID is a heterogeneous diagnosis with diverse etiologies. Thus, identification of best practice guidelines and evidence-based treatments for ARFID is challenging and, to our knowledge, randomized treatment studies have not been published. Existing literature promotes a multidisciplinary care approach that integrates behavioral, cognitive behavioral, and family-based interventions. In this report, we present the case of an 8-year-old female with ARFID who began restricting her food and fluid intake following a viral illness. The patient also choked on a lozenge at school and peers laughed in response, resulting in heightened fears of eating, subsequent dehydration, and admission to a gastroenterology unit at a pediatric hospital. While hospitalized, she was diagnosed with ARFID, a nasogastric tube (NGT) was placed, and was referred to outpatient eating disorder specialists. Despite participating in 16-outpatient therapy sessions, progress was limited and the patient was medically admitted to safely remove the NGT in the context of behavioral interventions targeting food refusal. This case report describes the successful use of an intensive inpatient behavioral intervention used for the patient, which resulted in the rapid resumption of food and fluid intake, by mouth. This case study supports the use of such intervention for ARFID when sufficient progress is not achieved in outpatient care.