Background: Since the inception of Avoidant Restrictive Food Intake Disorder (ARFID) becoming recognized within the DSM 5, differential diagnosis and complexity in symptom presentation has continued to be a challenge in devising effective treatment. More specifically, co-occurring diagnoses such as ASD, ADHD and anxiety continue to pose challenges in the realm of symptom hierarchy and treatment modalities. After thoroughly discussing the current state of the literature, the panel will assist in understanding the relations between these diagnoses, their potential to impact eating disorder treatment and potential solutions to implementing evidence-based interventions.
Objectives: 1. Identify similarities and differences between avoidance restrictive food intake disorder, autism spectrum disorder,attention-deficit hyperactivity disorder, and anxiety while explaining treatment adaptation to fit the needs of the patient. 2. Outline evidence-based approaches to assessment and intervention with eating disorder children experiencing co-morbid diagnoses. 3. Develop an awareness of how co-morbid diagnoses can impact eating disorder behaviors.
- Review prevalence, diagnostic criteria, and symptoms associated across the four diagnoses
- Review differential diagnoses and comborbity in young children, as well as how presentation of patient shifts when more than one of these diagnoses are present
- Review frequently encountered questions/concerns posed by colleagues of various specializations when referring and assessing patient needs (i.e., ABA, Occupational Therapists, use of stimulant medications in the treatment of ADHD and its impact on appetite)
- Review how cognitive and emotional developmental stages can impact eating disorder behaviors and presentation in children
B. A Clinical Case Presentation highlighting multifaceted symptoms within this co-occurring diagnostic categorie and assessment protocol
- Establish the relationship and build rapport with child/adolescent/family
- Identify symptoms present that are associated with co-occurring disorders, and thus requires additional attention and evaluation
- Strategically ruling out diagnoses (i.e., lack of body image disturbance ruling out anorexia)
- Responding to parental/caregiver concerns regarding diagnostic features, maladaptive behaviors, and treatment recommendations
C. The presenter will role play a patient and request the audience complete an assessment checklist to identify patient's symptoms and diagnostic considerations
- Opportunity for audience to utilize in-vivo scenarios to explore assessment and rule out diagnoses when symptom clusters overlay various diagnostic categories
- Encourage audience to collaborate in pairs and generate discussion and questions regarding the evaluation process
As we explore the nuances of a newer diagnosis, we seek to call attention to the importance of effective initial assessment. Assessment and evaluation lay a critical foundation for psychoeducation and connecting patients to quality care best suited to their needs. Patients present with symptoms including but not limited to food rules/rigidity, taste and/or textural aversions, low hunger cues, somatic distress, fear, cognitive rigidity and anxiety surrounding food. These symptoms present unique considerations because they can be interrelated and cross diagnostic lines, often leaving families and treatment providers feeling as though they are treading murky and unfamiliar waters. This becomes pivotally important as skilled professionals of various specializations coalesce to provide comprehensive and individualized treatment (i.e., applied behavioral therapists, medical providers, psyhiatric, etc.).
Our hope is to highlight the ways in which providers can skillfully navigate this complex crossroad during initial phases of assessment and connect patients to care. A clinical case presentation and role-play will provide a deeper understanding of how to navigate interrelated symptoms and co-occurring disorders. Through the exploration of how these various diagnoses co-occur and present in practice, we can continue to increase awareness and foster long-term treatment outcomes.
Andrea Fessler is an admission clinician at the UCSD Eating Disorder Center. She graduated with her BA in Psychology from Arizona State University and went on to obtain her MA in Clinical Mental Health Counseling from the University of San Diego. During her graduate studies she was awarded the Dean’s Merit Scholarship wherein her research interests centered upon the integration of positive psychology, strengths based approaches, and trauma informed care into mental health treatment. She previously interned at Center for Community Solutions of San Diego wherein she provided individual, couple, group and family therapy to survivors of sexual trauma and intimate partner violence. Her present clinical interests and specialized training include evidence-based trauma treatment, risk and trauma assessment, as well as the scientific and neurobiological underpinnings of eating disorders as it relates to treatment and advocacy.
Samira is an Admission Clinician at UCSD Eating Disorder Center. She graduated with her B.S. in Psychology from James Madison University and earned her M.Ed./Ed.S. in Mental Health Counseling from the University of Virginia. Samira has experience providing individual and group therapy to adolescents and families in a residential setting and was employed as a Behavioral Support Specialist for a non-profit organization in San Diego. Samira is passionate about providing clinical services and support to children, adolescents, families, and adults. She conducts thorough intake assessments to diagnose and determine medical and clinical necessity while providing psychoeducation on eating disorders, depressive and anxiety disorders as well as evidence-based treatment modalities.
