Therapies show benefit for children with ARFID in randomized trial

A randomized clinical trial has found that two therapy approaches can reduce symptoms in children with avoidant restrictive food intake disorder, or ARFID, according to Stanford Medicine. The finding gives clinicians evidence for treating a pediatric eating disorder that can harm growth and disrupt daily life.

The study included 98 children ages 6 to 12 who met diagnostic criteria for ARFID and were underweight, Stanford Medicine said. The research, led by Stanford Medicine scientists, was published online in the Journal of the American Academy of Child & Adolescent Psychiatry.

ARFID is an eating disorder in which people eat too little for reasons other than trying to change body shape, Stanford Medicine said. Some children have low interest in food, some are highly selective, and others avoid eating after experiences such as choking or an allergic reaction.

Stanford Medicine said ARFID affects 2% to 6% of children and adolescents. The diagnosis was added to the Diagnostic and Statistical Manual of Mental Disorders in 2013.

How the trial worked

Researchers randomly assigned families to one of two treatments. Each approach involved 14 one-hour sessions over four months, all delivered online, allowing families across the United States to take part, Stanford Medicine said.

One approach was family-based therapy. In that treatment, parents were coached to take charge of changing eating-related behaviors, including very limited food variety, low intake and fear-driven avoidance tied to worries about choking or vomiting. Children, parents, siblings and therapists attended sessions together.

Brittany Matheson, a clinical associate professor of psychiatry and behavioral sciences at Stanford, said the therapist’s role is to guide families while recognizing that parents know their child and family routines best. Stanford Medicine said the treatment also stresses that the child is separate from the disorder.

The second approach, psychoeducational motivational therapy, focused more directly on the child. Children attended nine sessions with a therapist, while parents attended five, Stanford Medicine said. The child learned about ARFID and used play-based activities to identify reasons to try new foods or change eating patterns.

Parents in that arm learned about ARFID, ways to reduce conflict over food and how to support changes their child wanted to make, according to Stanford Medicine.

Weight gain differed, symptoms improved

The researchers measured weight and ARFID symptom severity. Stanford Medicine said children in the family-based therapy group gained a statistically significant amount of weight by the end of the study, while children in the individual-treatment group did not.

Children with more severe ARFID also had better outcomes with family-based treatment than with individual treatment, Stanford Medicine said. Both treatments, however, significantly improved ARFID symptoms, and the two approaches were similarly helpful on that measure.

Matheson said Stanford researchers now have two treatments that work for children ages 6 to 12 with ARFID. She said family-based therapy appeared to help children gain weight faster, while both family and individual therapy could help.

James Lock, the study’s lead author and a professor of psychiatry and behavioral sciences at Stanford, described the research as the first adequately powered randomized trial to systematically test treatments for ARFID worldwide. Lock is also part of the Comprehensive Eating Disorders Program at Stanford Medicine Children’s Health.

More than picky eating

Stanford Medicine said ARFID can be mistaken for ordinary picky eating in young children, which can delay diagnosis. In ARFID, severe restriction does not resolve on its own and can lead to medical problems.

Stanford Medicine cited risks including very low vitamin A levels that may threaten vision, vitamin C deficiency known as scurvy, dangerous weight loss after food-related trauma, poor growth, short stature and impaired fertility. The disorder can also interfere with school, vacations, camp, sleepovers and other social activities involving food.

ARFID is more common among children with attention-deficit/hyperactivity disorder, anxiety disorders and autism than in the general child population, Stanford Medicine said. Many patients can be treated as outpatients, though Stanford Medicine Children’s Health said some children and adolescents need hospitalization and medically supervised refeeding.

This story draws on original reporting from Medical Xpress.