Flexibility is key when treating adolescents with avoidant/restrictive food intake disorder, experts say.
Researchers at the Murdoch Children’s Research Institute have found their newly developed treatment protocol for adolescents with avoidant/restrictive food intake disorder to be feasible in adolescents.
Avoidant/restrictive food intake disorder is a rare condition that commonly co-occurs with psychiatric, developmental and medical conditions. Although single disorder treatments such as family-based therapy (FBT) have been successful for treating ARFID, more diverse treatment options may be required.
A new Australian case series published in the International Journal of Eating Disorders evaluated the feasibility of FBT, with optional integration of the Unified Protocol for Adolescents (UP-A), in treating adolescents with ARFID.
“Due to the high co-occurrence of emotional disorders alongside ARFID in young people, we developed a new, two-phase approach that observes family eating habits, challenges inflexible and negative thinking, builds resilience and supports healthy, sustainable weight gain,” said Dr Claire Burton, a clinical psychologist and lead author of the new research.
“We empowered parents and carers to address disordered eating by supporting their child to eat enough and also independently. The FBT + UP treatment can also help young people cope with feelings of distress and to reduce the use of avoidance as a way of coping with their eating challenges.”
Researchers recruited 13 adolescents aged 13-18 years (11 females, average age 15.1 years) with a confirmed diagnosis of ARFID. Ten participants had a co-occurring psychological or neurological diagnosis, while six individuals had at least one co-occurring chronic medical diagnosis.
The adolescents were offered up to 36 sessions over a 36-week period, starting with an ARFID-specific version of FBT. Participants were given the option to also complete UP-A after they had been through four sessions of FBT and gained at least 1.8kg since starting the study protocol. Intensive parental coaching was provided to adolescents who did not achieve the desired weight gain over the first four weeks. FBT was reintroduced if adolescents lost weight or ceased continuing to gain weight.
All participants completed the first four FBT sessions. Two adolescents did not gain the required 1.8kg over the first four sessions, and two adolescents declined to participate in UP-A.
Parents were satisfied with the suitability of the treatment (mean rating of 9 on a 0-10 scale, where 0 is not at all suitable and 10 is extremely suitable) and had high expectations that the treatment would be successful (mean rating 8.5) after the first four weeks of treatment. Clinicians were slightly more reserved when describing the UP-A aspect of the treatment, describing the mean therapeutic relationship during this phase as “average” and treatment compliance as “intermediate”.
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The expected body weight percentage of adolescents increased from 82.3% at baseline to 90.3% at the end of treatment before dipping slightly to 88.9% at the 12-week follow-up. Scores on the Eating Disturbances in Youth Questionnaire were similar (30.0 at baseline, 22.9 at the end of treatment and 25.6 at the 12-week follow-up).
“While the UP-A did show promise in reducing symptoms of depression, we did not find a treatment response for anxiety,” the researchers wrote.
“This is surprising given that anxiety was the most common co-occurring condition identified in this sample and previous studies have shown the UP-A to be effective in treating both adolescent anxiety and depression.
“[However,] the study took place during the covid pandemic, a time of heightened anxiety for adolescents, and this may have contributed to the lack of treatment response.”
Dr Burton felt their findings offered hope for young people with eating disorders.
“The findings show the potential of this new, combined eating disorder treatment to boost the confidence of adolescents with ARFID, but larger studies are needed to establish whether this approach could be offered [more] widely.”
ARFID affects less than 2% of young people and is associated with eating a limited range or amount of food due to avoidance of specific tastes, textures, smells or temperatures. People with ARFID also display a lack of interest in food and may believe that eating will lead to pain or discomfort.
Dr Jim Hungerford, CEO of the Butterfly Foundation, said AFRID was one of Australia’s least understood eating disorders but that it was becoming increasingly prevalent.
“We regularly hear about the debilitating impact that ARFID has not only on the individual, but also on those who care for and support them. As Australia’s national charity for those impacted by eating disorders, Butterfly welcomes advancements in treatment and research that will allow more people and their families to access the person-centred, evidence-based care that will allow them to fully recover,” he said in a statement.
