Family Therapy for ARFID
Recruiting in Palo Alto (17 mi)
Age: < 18
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Stanford University
No Placebo Group
Approved in 1 jurisdiction
Trial Summary
What is the purpose of this trial?This trial is testing if family therapy can help children aged 6-12 with eating problems. The therapy involves the whole family and aims to boost parents' confidence in feeding their children.
Will I have to stop taking my current medications?
If you are taking medication for other conditions, you must be on a stable dose for at least 8 weeks before joining the study. If you need to stop a medication to participate, you must do so before starting the treatment.
What data supports the effectiveness of the treatment Family Therapy for ARFID?
Research on family therapy for conditions like asthma shows that it can improve family interactions and reduce hospital readmissions, suggesting it may help manage symptoms and improve outcomes. This indicates that family therapy could be beneficial for ARFID by enhancing family support and treatment adherence.
12345Is Family Therapy for ARFID safe for humans?
Family-based treatment (FBT) has been used safely in various settings for different conditions, including pediatric obesity and eating disorders like anorexia nervosa and bulimia nervosa. While specific safety data for ARFID is limited, FBT is generally considered safe as it involves family support and behavioral strategies rather than medication.
678910How is Family-Based Treatment (FBT) for ARFID different from other treatments?
Family-Based Treatment (FBT) for ARFID is unique because it involves the whole family in the treatment process, focusing on empowering parents to help their child overcome eating challenges. Unlike other treatments, FBT is adapted from its use in treating other eating disorders like anorexia nervosa and is tailored to address the specific needs of ARFID, such as sensory sensitivities or fear of eating.
6791112Eligibility Criteria
This trial is for children aged 6-12 with Avoidant/Restrictive Food Intake Disorder (ARFID) who are medically stable, have not had more than 3 sessions of Family-based Treatment (FBT), and are on a stable medication dose if needed. They must speak English fluently and live with their families.Inclusion Criteria
I have had fewer than 4 sessions of brain therapy.
Exclusion Criteria
My body weight is either less than 75% or more than 88% of what is expected for my height.
I have undergone 4 or more FBT sessions.
Participant Groups
The study compares family therapy to usual care for ARFID in children. It aims to confirm if family therapy helps better by improving how parents feel about feeding their kids and identifying which patients benefit most from this approach.
2Treatment groups
Experimental Treatment
Active Control
Group I: Family-based Treatment for ARFID(FBT-ARFID)Experimental Treatment1 Intervention
FBT-ARFID is a manualized treatment based on the model of FBT that employs the same interventions as standard FBT for AN and BN: externalization, agnosticism, parental empowerment, a behavioral focus on changing eating behavior. Early sessions focus on inciting parents to make changes and include a family meal that allows therapists to observe \& consult directly to mealtime behaviors. FBT-ARFID for children 12 and under is manualized and consists of 2 phases. The first phase is focused on parents taking charge \& changing the eating behaviors of their child that are maintaining ARFID. The second phase focuses on the child taking up in an age-appropriate way managing their eating consistent with the changes the parents have employed in phase 1. Fourteen 1-hour sessions will be conducted approximately weekly over 4 months. Throughout medical monitoring and weekly dietary consultation are available to the family.
Group II: Manualized Non-Specific Usual Care for ARFID(NSC)Active Control1 Intervention
A manualized non-specific psycho-educational and motivational enhancement approach that is based on a supportive non-directive psychotherapy model that has been used in other RCTs with eating disorders as a comparison. NSC consists of sessions with the child alone and 5 parent-only meetings. Sessions are 1-hour. NSC matches FBT-ARFID for time and therapist attention. The focus of the NSC intervention is psychoeducation about health \& social impacts of restrictive eating and supporting parent \& child exploration of motivation to change eating patterns \& choices they make about changes to eating. The therapist does not initiate behavioral or cognitive interventions. Feelings about eating and making changes are explored in both the child and parent sessions. Medical and dietary advice are provided weekly.
Family-based Treatment for ARFID is already approved in United States for the following indications:
🇺🇸 Approved in United States as Family-Based Treatment for:
- Avoidant/Restrictive Food Intake Disorder (ARFID)
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Stanford UniversityStanford, CA
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Who is running the clinical trial?
Stanford UniversityLead Sponsor
National Institutes of Health (NIH)Collaborator
National Institute of Mental Health (NIMH)Collaborator
References
Treating systemic issues in families affected by cystic fibrosis: A solution-focused approach. [2021]Cystic fibrosis (CF) presents with various symptoms that impair day-to-day functioning and require lifelong treatment. Due to the chronic and severe nature of this disease, families are often impacted by the stress associated with treatment, complications of the disease, and the understanding that their loved one will one day die from CF. This article seeks to address a perceived gap in the literature for providing a model-specific approach to address psychosocial stress in families affected by CF. We provide a rationale for using solution-focused brief therapy (SFBT) to work with this population based on its empirically supported effectiveness, versatility, and capacity to be brief in nature. We describe how SFBT interventions can be used by practitioners working with this population, present a fictitious case illustration depicting the clinical use of specific SFBT interventions, and offer suggestions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Delayed diagnosis of avoidant/restrictive food intake disorder and autism spectrum disorder in a 14-year-old boy. [2023]Psychiatric comorbidities are common among individuals with ARFID and may contribute to a failure to establish an accurate diagnosis, delayed diagnosis, and poor long-term prognosis, especially among children and adolescents.
Feasibility and acceptability of a CF-specific cognitive-behavioral preventive intervention for adults integrated into team-based care. [2022]A cystic fibrosis (CF)-specific cognitive-behavioral therapy intervention (CF-CBT) was developed in partnership with the CF community to advance preventive mental health care. Multidisciplinary providers across three centers were trained to deliver CF-CBT for this pilot assessing feasibility/acceptability and preliminary effectiveness of an integrated model of care.
Family Functioning and Treatment Adherence in Children and Adolescents with Cystic Fibrosis. [2021]Background: Cystic fibrosis (CF) is one of the most challenging pediatric illnesses for families to manage. There is, however, limited research that considers the associations between family functioning and treatment adherence in children and adolescents with CF. Methods: Nineteen children with CF (mean age=12.42 years, mean forced expiratory volume in one second (FEV1)=90.9% predicted) and their families participated in the study. Caregiver and child participants completed interview-based assessments and were then videotaped during a family mealtime. Results: Mean scores on several domains of family functioning fell in the "unhealthy" range. Better family functioning was found among older children. Better family functioning was also associated with better adherence to antibiotic treatment and worse adherence to enzymes. Conclusions: Findings suggest that family functioning may be an important correlate of treatment adherence in children and adolescents with CF. Future research should replicate these findings in larger samples of children and adolescents with CF.
[Bronchial asthma and systematic family therapy: treatment concept, initial contact and therapy follow-up]. [2009]Psychosocial factors play an important role in pathogenesis and maintenance of bronchial asthma. However, besides conventional treatment family therapy seems to be less applied. A treatment plan for the integration of systemic family therapy into pediatric management of asthma has been developed and validated. Its special feature is an invariant family treatment offer after the initial session, with the decision of acceptance or rejection upon the family. The main focuses of family therapy are coping and family interaction, thus indirectly influencing the course of illness. Up to now 66 family sessions have been conducted with 11 families; five families agreed to the first session only. In a mean observation time of two years after the end of family therapy we found a drastic reduction in hospital readmissions of the asthmatic patients, even in the patients of families who took part in the initial session only. This may indicate a better control of asthma symptoms in patients and families. Family therapy is suggested as a valuable and additional tool in treatment of asthmatic children, irrespectively of their allergic status.
Applying family-based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa. [2019]This article uses three brief case reports to illustrate how family-based treatment (FBT) can be used to treat pre-adolescents with avoidant/restrictive food intake disorder (ARFID).
Case Presentations Combining Family-Based Treatment with the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents for Comorbid Avoidant Restrictive Food Intake Disorder and Autism Spectrum Disorder. [2021]Avoidant Restrictive Food Intake Disorder (ARFID) is a Feeding and Eating Disorder newly added to the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition, which presents with high prevalence rates in community and clinical settings. Given its recent diagnostic recognition, validated and standardized treatments for this population are lacking. In addition, given the complexity, heterogeneity of symptoms, and high rates of psychiatric comorbidities in the ARFID population, new models of care are required. The current therapy model combines two evidence-based treatments - Family Based Treatment (FBT) and the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) - for young patients with ARFID plus Autism Spectrum Disorder (ASD), which allows clinicians to personalize care based on each patient's unique presenting needs. This paper presents two distinct cases which showcase the use of the FBT+UP for ARFID approach for treating comorbid ARFID and ASD in a clinical setting. Case 1 demonstrates the application and reliance on FBT, while Case 2 draws upon UP to facilitate behavioural change in the patient. Case backgrounds, presenting problems, and treatment approaches combining the two evidence-based treatments are presented and discussed. The cases demonstrate the unique challenges of treating young patients with comorbid ARFID and ASD, along with the proposed benefits of the combined approach with this population.
Weight gain and parental self-efficacy in a family-based partial hospitalization program. [2022]Family-based treatment (FBT) is an outpatient therapy, though FBT principles have been incorporated in higher levels of care (e.g., partial hospitalization programs, PHPs). It is unknown how participation in a family-based PHP impacts weight restoration and parental self-efficacy.
Family-Based Treatment for a Preadolescent With Avoidant/Restrictive Food Intake Disorder With Sensory Sensitivity: A Case Report. [2022]Individuals with Avoidant/Restrictive Food Intake Disorder (ARFID) experience eating problems that cause persistent failure to meet appropriate nutritional and/or energy needs. These eating problems are not driven by body image concerns but rather by persistent low appetite, sensory sensitivity, or fear of aversive consequences of eating (e.g., choking or vomiting). Although increasing numbers of youth are being referred for treatment of ARFID, no evidence-based treatments yet exist for the disorder. Given family-based treatment (FBT) has demonstrated effectiveness with other pediatric eating disorders (anorexia nervosa, bulimia nervosa), a manualized version of FBT adapted for use with ARFID patients has been developed and is currently under study.
Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. [2022]Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.
Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder. [2019]Treatments for avoidant/restrictive food intake disorder (ARFID) lack strong empirical support. There is a critical need to conduct adequately powered studies to identify effective treatments for ARFID. As a first step, the primary aim of this study was to assess the feasibility of conducting a randomized clinical trial (RCT) comparing Family-based Treatment for ARFID (FBT-ARFID) to usual care (UC). The primary outcomes were recruitment, attrition, suitability, and expectancy rates. The secondary aim was to assess changes in percent estimated body weight, eating related psychopathology, and parental self-efficacy from baseline to end of treatment/UC period in both groups. Recruitment rates were 1.87 per month; 28 children with ARFID and their families were randomized and attrition rate was 21%. Therapeutic suitability and expectancy rating suggested that FBT-ARFID was acceptable to families. Effect size (ES) differences on measures of weight and clinical severity were moderate to large, favoring FBT-ARFID over UC. Parental self-efficacy improvement also demonstrated a large ES favoring FBT-ARFID, which was correlated with improvements in ARFID symptoms. There is a research gap between our knowledge base on how to treat children with ARFID and clinical need. The data presented suggest that an RCT comparing FBT-ARFID and UC is feasible to conduct.
Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments. [2023]To date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program.