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. 2020 Oct;53(10):1636-1646.
doi: 10.1002/eat.23355. Epub 2020 Aug 9.

Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents

Jennifer J Thomas  1   2 , Kendra R Becker  1   2 , Megan C Kuhnle  1   3 , Jenny H Jo  1   3 , Stephanie G Harshman  1   2   3 , Olivia B Wons  1   3   4 , Ani C Keshishian  1   5 , Kristine Hauser  3 , Lauren Breithaupt  1   2 , Rachel E Liebman  1   2   6 , Madhusmita Misra  2   3 , Sabine Wilhelm  2   7 , Elizabeth A Lawson  2   3 , Kamryn T Eddy  1   2
Affiliations

Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents

Jennifer J Thomas et al. Int J Eat Disord. 2020 Oct.

Abstract

Objective: Little is known about the optimal treatment of avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate feasibility, acceptability, and proof-of-concept for cognitive-behavioral therapy for ARFID (CBT-AR) in children and adolescents.

Method: Males and females (ages 10-17 years) were offered 20-30 sessions of CBT-AR delivered in a family-based or individual format.

Results: Of 25 eligible individuals, 20 initiated treatment, including 17 completers and 3 dropouts. Using intent-to-treat analyses, clinicians rated 17 patients (85%) as "much improved" or "very much improved." ARFID severity scores (on the Pica, ARFID, and Rumination Disorder Interview) significantly decreased per both patient and parent report. Patients incorporated a mean of 16.7 (SD = 12.1) new foods from pre- to post-treatment. The underweight subgroup showed a significant weight gain of 11.5 (SD = 6.0) pounds, moving from the 10th to the 20th percentile for body mass index. At post-treatment, 70% of patients no longer met criteria for ARFID.

Discussion: This is the first study of an outpatient manualized psychosocial treatment for ARFID in older adolescents. Findings provide evidence of feasibility, acceptability, and proof-of-concept for CBT-AR. Randomized controlled trials are needed.

Keywords: ARFID; CBT; avoidant/restrictive food intake disorder; children and adolescents; clinical trial; cognitive-behavioral therapy; exposure therapy; feeding and eating disorders; modular treatment; sensory sensitivity.

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Conflict of interest statement

Conflicts of interest: Drs. Thomas and Eddy receive royalties from Cambridge University Press for the sale of their book Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. Drs. Thomas, Eddy, and Becker will receive royalties for the sale of their upcoming self-help book on cognitive-behavioral therapy for ARFID.

Figures

Figure 1.
Figure 1.
Patient flow diagram for proof-of-concept trial of cognitive-behavioral therapy for avoidant/restrictive food intake disorder (CBT-AR) in children and adolescents
See this image and copyright information in PMC

References

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    1. Becker KR, Keshishian AC, Liebman RE, Coniglio KA, Wang SB, Franko DL, Eddy KT, & Thomas JJ (2019). Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. International Journal of Eating Disorders, 52, 230–238. - PMC - PubMed
    1. Becker KR, Mancuso C, Azanza E, Izquierdo A, Wons O, Dreier M, Slattery M, Plessow F, Micali N, Eddy KT, Thomas JJ, Misra M, & Lawson EA Distinct ghrelin and PYY response in adolescent girls with low-weight avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. Under review.

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