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UNASSIGNED: Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterised by a pattern of eating that leads to failure to meet appropriate nutritional and/or energy needs.
UNASSIGNED: In the absence of evidence-based inpatient guidelines for adolescents with ARFID, we set out to develop and pilot an inpatient protocol for adolescents with ARFID. Identification of the key differences between managing inpatients with ARFID and anorexia nervosa (AN) led to modification of an existing AN protocol with the goals of better meeting patient needs, enhancing alignment with outpatient care, and improving outcomes. A case report of an adolescent with ARFID who had three hospital admissions is presented to highlight these changes. Interviews with this patient and her family were undertaken, together with key staff, to explore the challenges of the AN protocol for this patient and the perceived benefits and any limitations of the ARFID protocol for this patient and others.
UNASSIGNED: The new ARFID protocol supports greater choice of meals, without the need for rest periods after meals and bathroom supervision. The similarities with the AN protocol reflect the need to promote timely weight gain through meal support, including a staged approach to nutritional supplementation. The protocol appears to have been well accepted by the patient and her family, as well as by staff, and continues to be used in cases of ARFID.
UNASSIGNED: Further evaluation would help identify how well this protocol meets the needs of different adolescents with ARFID.
UNASSIGNED: Le trouble évitant/restrictif de la prise alimentaire (TERPA) est un trouble alimentaire caractérisé par un modèle d’alimentation qui entraîne une incapacité à répondre aux besoins nutritionnels et/ou énergétiques appropriés.
UNASSIGNED: En l’absence de lignes directrices fondées sur des données probantes en milieu hospitalier pour des adolescents souffrant de TERPA, nous avons entrepris de développer et de piloter un protocole en milieu hospitalier pour les adolescents souffrant de TERPA. L’identification des principales différences entre la prise en charge des patients hospitalisés souffrant de TERPA et d’anorexie mentale (AM) a mené à une modification d’un protocole d’AM existant dans le but de mieux répondre aux besoins des patients, d’accroître l’alignement avec les soins des patients ambulatoires, et d’améliorer les résultats. Un rapport de cas d’une adolescente souffrant de TERPA qui a eu trois hospitalisations est présenté pour souligner ces changements. Des entrevues avec cette patiente et sa famille ont été réalisées, de même qu’avec le personnel principal, afin d’explorer les difficultés du protocole d’AM pour cette patiente ainsi que les avantages perçus et toute limite du protocole TERPA pour cette patiente et d’autres.
UNASSIGNED: Le nouveau protocole TERPA supporte un plus grand nombre de repas, sans le besoin de périodes de repos après les repas et une supervision de la salle de bain. Les similitudes avec le protocole AM reflètent le besoin de promouvoir une prise de poids rapide grâce à un soutien aux repas, y compris une approche par étapes de supplémentation nutritionnelle. Le protocole semble avoir été bien accepté par la patiente et sa famille, ainsi que par le personnel, et continue d’être utilisé dans les cas de TERPA.
UNASSIGNED: Une évaluation plus poussée aiderait à identifier dans quelle mesure ce protocole répond aux besoins de différents adolescents souffrant de TERPA.

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BACKGROUND: Appetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment.
METHODS: Consecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case.
CONCLUSIONS: These findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed.

Though micronutrient deficiency is recognized to cause visual system dysfunction, avoidant/restrictive food intake disorder (ARFID) has been poorly described in relation to this.Review of 18 previously published similar cases highlights the importance of identifying other micronutrient deficiencies, even when vitamin A deficiency accounts for the presenting features. We present four patients with permanent visual loss as a result of highly restricted diets due to avoidant/restrictive food intake disorder (ARFID), and with autistic spectrum disorder (ASD).The four cases reported here make a total of 22 reported cases of visual impairment due to ARFID-like restricted diets in boys with ASD. The severity of ASD varied widely across the 22 cases, but all had extremely restricted diets, in some cases tolerating only one or two food items. The most avoided food groups in children with ASD and food selectivity have been reported from the USA as vegetables, fruit, dairy and protein, with the most preferred food items being bread, chicken, cereal and yoghurt. In the 22 cases reviewed or reported here, tolerated foods tended to be predominately carbohydrate based, with dry or crunchy textures and beige or pale colouring, i.e. French fries, potato waffles, potato chips (crisps), rice, white bread, bagels, biscuits or cookies.This case series and review highlights the need for heightened vigilance for visual problems in individuals with ASD-related ARFID and early and complete assessment of micronutrient deficiency.

Cognitive behavioral therapy for Avoidant Restrictive Food Intake Disorder (ARFID; CBT-AR) is an emerging treatment for ARFID. However, this treatment modality has yet to be examined among older adults (e.g., older than 50 years) or with adults presenting with feeding tubes. To inform future versions of CBT-AR, we present the results of a singular case study (G) of an older male with the sensory sensitivity phenotype of ARFID who presented for treatment with a gastrostomy tube.
G was a 71-year-old male who completed eight sessions of CBT-AR in a doctoral training clinic. ARFID symptom severity and comorbid eating pathology changes were examined pre- and post-treatment.
Posttreatment, G reported significant decreases in ARFID symptom severity and no longer met diagnostic criteria for ARFID. Furthermore, throughout treatment, G reported significant increases in his oral food consumption (vs. calories being pushed through the feeding tube), solid food consumption, and the feeding tube was ultimately removed.
This study provides proof of concept that CBT-AR is potentially effective for older adults and/or those presenting for treatment with feeding tubes. Validation of patient efforts and severity of ARFID symptoms emerged as core to treatment success and should be emphasized when training clinicians in CBT-AR.
Cognitive behavior therapy for ARFID (CBT-AR) is the leading treatment for this disorder; however, it has yet to be tested among older adults or those with feeding tubes. This single-patient case study demonstrates that CBT-AR may be efficacious in reducing ARFID symptom severity among older adults with a feeding tube.

BACKGROUND: Individuals with Avoidant/Restrictive Food Intake Disorder (ARFID) experience restrictive or highly selective eating problems that interfere with growth and development. Despite the increasing number of referrals for ARFID, no evidence-based treatments exist. This compilation of case composites describes a novel manualized treatment, Psychoeducational and Motivational Treatment (PMT) for children with ARFID, focusing on exploring motivation to change eating behaviors. This approach is based on motivational non-directive psychotherapy models, psychoeducational interventions, and the usefulness of play to support psychotherapeutic learning in school-age children.
METHODS: Three cases of children with ARFID treated using PMT are presented: a 7-year-old, a 10-year-old, and a 12-year-old. These cases illustrate how a clinician delivers PMT interventions in the context of developmental abilities and common comorbidities associated with ARFID.
CONCLUSIONS: PMT is a promising therapy for ARFID in school-age children. Challenges and strategies are discussed, including ways to address obstacles such as young age, comorbidities, and use of the virtual environment.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

The mechanisms through which cognitive-behavioral therapies (CBTs) for avoidant/restrictive food intake disorder (ARFID) may work have yet to be elucidated. To inform future treatment revisions to increase parsimony and potency of CBT for ARFID (CBT-AR), we evaluated change in food neophobia during CBT-AR treatment of a sensory sensitivity ARFID presentation via a single case study.
An adolescent male completed 21, twice-weekly sessions of CBT-AR via live video delivery. From pre- to mid- to post-treatment and at 2-month follow-up, we calculated percent change in food neophobia and ARFID symptom severity measures. Via visual inspection, we explored trajectories of week-by-week food neophobia in relation to clinical improvements (e.g., when the patient incorporated foods into daily life).
By post-treatment, the patient achieved reductions across food neophobia (45%), and ARFID severity (53-57%) measures and no longer met criteria for ARFID, with sustained improvement at 2-month follow-up. Via visual inspection of week-by-week food neophobia trajectories, we identified that decreases occurred after mid-treatment and were associated with incorporation of a food directly tied to the patient\'s main treatment motivation.
This study provides hypothesis-generating findings on candidate CBT-AR mechanisms, showing that changes in food neophobia were related to food exposures most connected to the patient\'s treatment motivations.
Cognitive-behavioral therapies (CBTs) can be effective for treating avoidant/restrictive food intake disorder (ARFID). However, we do not yet have evidence to show how they work. This report of a single patient shows that willingness to try new foods (i.e., food neophobia), changed the most when the patient experienced a clinical improvement most relevant to his motivation for seeking treatment.

BACKGROUND: Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder diagnosis, and there is need to better understand this disorder\'s presentation. Diagnostic criteria for ARFID require that there are no body image distortions. People with ARFID symptoms may have body image concerns that require careful consideration and more information about the interplay of these is needed to help clinicians appropriately diagnose and manage ARFID.
METHODS: This clinical observation reports a case of ARFID in a nine-year-old with severe malnutrition who positively views her small size and values thinness. The patient reported that her own desire for thinness was influenced by social media beauty ideals and praise of thinness witnessed in social situations. Despite this, the motivation for avoidant and restrictive eating behaviors was low appetitive drive, fear of trying new foods, and fear of adverse consequences from eating.
CONCLUSIONS: Although concerning, the patient\'s body image was not of clinical significance as a motivating factor for the disordered eating behaviors. Body image dissatisfaction is common. The requirement to exclude body image distortions in the diagnostic criteria for ARFID may require consideration of the pervasiveness of societal body ideals to which young people are exposed.