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Treating Avoidant Restrictive Food Intake Disorder in Children and Adolescents


Thursday, March 23, 2017: 2:00 PM-3:30 PM
La Sirena II (Green Valley Ranch)

Background: Diagnostic criteria of avoidant restrictive food intake disorder and epidemiology will be reviewed. Session will discuss common presentations in children, illustrated by clinical case examples and discussion of treatment challenges. Program development and assessment data will be discussed, supporting specific program considerations to improve clinical outcomes in the pediatric population.

Objectives: Understand Avoidant Restrictive Food Intake Disorder (ARFID) diagnostic criteria and epidemiology Describe common pediatric presentations and apply to clinical case studies Discuss ARFID treatment challenges and effective clinical strategies to improve clinical outcomes

  1. Background - review of Avoidant or Restrictive Food Intake Disorder (ARFID) diagnostic criteria and epidemiology, as well as reviewing common presentations/subtypes seen in the pediatric population

  2. Treatment Challenges - discuss common treatment challenges faced when working with children and adolescents diagnosed with ARFID and their families

  3. Role of Program Assessment – discuss assesment of clinical treatment outcomes and importance of developing evidence based treatment for children with ARFID, using example from the Center for Pediatric Eating Disorders for ARFID specific treatment track (outcome data will be presented)

  4. Case Discussions – discuss 2-3 clinical case examples of children and adolescents diagnosed with ARFID illustrating unique treatment considerations and effective treatment strategies

  5. Questions/Additional Discussion

Objectives: ARFID was found in 5-14% of children treated in inpatient ED programs.1 One recent longitudinal study in a pediatric hospital found that children diagnosed with ARFID were presenting younger, with longer hospital stays and increased use of enteral feeding methods, compared with peers diagnosed with AN.2Our project aimed to develop a treatment protocol for avoidant/restrictive food intake disorder (ARFID) in the pediatric psychiatric hospital setting to improve efficacy of multidisciplinary, family-centered interventions. Methods: Program evaluation data were obtained from an existing clinical database of 47 pediatric patients between 7 and 17 years old (Mean age, 13.1 years, 56% Female, 25% Hispanic, 44% Caucasian, 31% Other) presenting to the hospital setting for treatment. Exploratory analysis was completed to examine prevalence rates of ARFID, descriptive data regarding comorbidities, and correlations between factors affecting length of stay and treatment outcomes. Results: Analysis was used to inform treatment protocol for an ARFID specific treatment track, targeting reduction in length of stay and improved parental education and behavioral management training. The ARFID track is currently in pilot stages, including an ARFID specific history and diagnostic intake process, multidisciplinary interventions, and various therapy modalities, including exposure/response prevention and parent training/positive behavioral management components. Program outcome data specific to this ARFID track will be presented in addition to clinical case examples and discussion of treatment challenges. Conclusions: Creating an ARFID specific treatment track for these patients has improved the intake process, has decreased length of stay and enhanced treatment outcomes. Next steps include longitudinal data analysis of ARFID track programs and expanding on this proposed treatment track for ARFID to include cultural and age group considerations. Bibliography: 1.Norris et al. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat. 2016; 12; 213–218. 2.Strandjord SE, Sieke EH, Richmond M, Rome ES. Avoidant/restrictive food intake disorder: Illness and hospital course in patients hospitalized for nutritional insufficiency. J of Adol Health. 2015; 57; 673-678.

Primary Presenter:
Briana Sacco, MD

Briana Sacco, MD completed her medical degree at University of Texas Medical Branch in Galveston, Texas. She pursued residency training at University of Pittsburgh Medical Center in Triple Board, a combined training in pediatrics, general adult psychiatry as well as child & adolescent psychiatry. She joined the University of Texas Southwestern Medical Center as Assistant Professor of Psychiatry in 2014. She works with children and teens at hospital levels of care at Children’s Health Center for Pediatric Eating Disorders, where she also serves as Medical Director.



Co-Presenter:
Sonia Schwalen, PhD

Sonia Schwalen, PhD, NCSP is a psychologist at the Center for Pediatric Eating Disorders at Children’s Health Plano and Assistant Professor in Psychiatry at University of Texas Southwestern Medical Center. Dr. Schwalen supervises trainees and is integral in program development. Her areas of research include the spectrum of pediatric eating disorders and issues in supervision. Her PhD in School Psychology and experience through completion of APA accredited predoctoral internship and postdoctoral fellowship has positioned her well to assist in linking systems of care for patients and families. Dr. Schwalen was featured as a media expert on CBS.com, mirror-mirror.org and Gurze Books Newsletter.



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