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Family-based treatment for avoidant/restrictive food intake disorder in children and adolescents: a systematic review

The objective of this systematic review was to evaluate the effectiveness of family-based treatments for children and adolescents presenting with ARFID.

A literature search was performed on EBSCO, PubMed and ScienceDirect from January 2013 to March 2021. Published research investigating the effect of family based/parental treatment for children and adolescents presenting with ARDID were eligible. All study designs were included given the limited clinical research available.

10 studies were included in this review (1 RCT, 5 case reports, 4 case series) involving 52 ARFID patients, 46% were female (n=24), 54% were male (n=28): all 10 investigated the clinical outcomes of a treatment method utilising patients families to improve ARFID symptomology. The sample included three individual subtypes of ARFID: lack of interest; fear of aversive consequences; sensory sensitivity and also a mixed subtype. Each of the included studies reported an improvement in outcomes from baseline to end of treatment. Eight of the ten measured weight as an outcome, three measured expansion of food variety and seven measured cognitive assessments. Two studies gathered follow-up data after end of treatment to examine effectiveness beyond treatment. Family-based interventions were applied across a variety of treatment settings with success. Discrepancies in treatment application were observed in the later phases. Differences in treatment effectiveness across subtypes were not found due to the generalisability of study findings.

Family-based treatment has begun to show promise for improving outcomes in children and adolescents with ARFID. Evidence is currently preliminary and requires controlled and improved non-controlled trials with comprehensively assessed baseline, end of treatment and follow-up data to draw statistically significant conclusion in future research.

Elliot Lee

Registered Dietitian

Northumbria Healthcare NHS Foundation Trust