User:StudentC820/Avoidant/restrictive food intake disorder

Info for the article on Avoidant/Restrictive Food Intake Disorder (ARFID)


 * So far the page has a short section on signs/symptoms, diagnosis, comorbidities and treatment, but all of them could use some upgrading.  
 * The following are some important takeaways from a few studies found using APA PsycInfo, which I’m going to reword into more meaningful paragraphs and add into the sections already on the page.

 Use some mixture of these quotations to add to/improve the short introduction part at the beginning of the article or the section on diagnosis: 


 * “ARFID is a serious mental health condition that is not motivated by shape or weight concerns. Individuals with ARFID restrict their food intake - by volume and/or variety - due to sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating food" (from CBT article)
 * “Common clinical signs are failure to thrive, gastrointestinal reflux, constipation, nausea, early satiety, abdominal pain, and global developmental delay” The symptoms can often be misconstrued as a GI issue because of the medical complications so it is easily overlooked.(from article about symptoms in general pediatric sample)
 * ARFID patients do not have a fixation on their body appearance or losing weight. “Instead they often have a narrow range of accepted foods based on tase, texture, color, appearance, or odour, a fear of swallowing, choking or vomiting, and/or a lack of interest in food or disgust” (from article comparing ARFID to AN)
 * "ARFID is characterized by lack of adequate food intake leading to weight loss or failure to make expected weight gains, nutritional deficiencies, dependency on nutritional supplements or enteral feeding, and/or psychosocial interference" (from article on health care provider familiarity)

 Thinking of adding this info in the section on signs and symptoms: 


 * Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample
 * ARFID was added to the fifth edition of the DSM in 2013 in order to replace/update feeding disorder diagnoses of infancy or early childhood. Although it can also be found in adolescents and adults
 * “Common clinical signs are failure to thrive, gastrointestinal reflux, constipation, nausea, early satiety, abdominal pain, and global developmental delay” The symptoms can often be misconstrued as a GI issue because of the medical complications so it is easily overlooked.
 * May have similar outward characteristics to anorexia nervosa (AN), but the motives behind the disorders differ. ARFID patients do not have a fixation on their body appearance or losing weight. “Instead they often have a narrow range of accepted foods based on tase, texture, color, appearance, or odour, a fear of swallowing, choking or vomiting, and/or a lack of interest in food or disgust”
 * Generally more prevalent in younger populations and boys than other eating disorders and is often associated with other physical or psychological issues.


 * Avoidant/restrictive food intake disorder: psychopathological similarities and differences in comparison to anorexia nervosa and the general population
 * Though the physical symptoms may be similar, anorexia nervosa (link to that wiki?) differs from ARFID because in ARFID the lack of food intake is not related to body image or weight concerns. Additionally, in a study analyzing the similarities between patients with AN and patients with AN, those with ARFID were significantly younger (10.8 vs 14.1 yrs old) with an earlier onset of illness (6.2 vs 13.7 yrs old) and a longer evolution time (61.2 vs 8.4 months). Also, a greater proportion of the ARFID patients were male rather than female (60.6% vs 6.1%).
 * Patients are characterized by the presence of restrictive and/or selective food intake behaviors, significant weight loss or pondoestatural delay, relevant nutritional deficiency, dependence on oral or enteral nutritional supplements and major psychosocial difficulties
 * Classified into three psychopathological dimensions: those with lack of interest in food and eating, those with food restriction deriving from sensorial reaction to foods, and those avoiding specific foods due to fears
 * Also showed greater medical and psychiatric comorbidity (42.4 vs 12.1% and 81.8 vs 33.3%)

 These next two articles to use in the section about treatment: 


 * Using telehealth to provide outpatient followup to children with avoidant/restrictive food intake disorder
 * In two pilot studies, researchers examined the possibility of using telehealth services as a treatment and follow up option for children with feeding disorders. There are many possible benefits to a virtual appointment, particularly during the COVID-19 pandemic and for children with feeding disorders. Many caregivers reported that local services were not tailored for eating disorders and were not effective in improving their child’s feeding habits and that they had to go great distances to make sure their child received worthwhile care. With the implementation of telehealth, caregivers and patients can interact with clinicians from their home, saving time and cost for the families. Additionally, when the sessions are conducted from the patient’s home, the patient is acting in the typical environment in which they would normally eat and clinicians can observe any interactions and factors of the home that could impact feeding. When in the home, caregivers also have access to all the necessary materials for feeding, like food and utensils.
 * Could be issues with the technology, but usually not an issue and the mediums were fairly user friendly. Could also be issue of child getting distracted by the computer screen, but try to place it out of view or so the child can’t see their own image on the screen
 * All of them had gone through in person day treatment, so unclear if telehealth viable and an initial treatment option
 * The first study involved a within participant design which involved three young participants, all of  whom “had received services in and graduated from an intensive, day-treatment feeding program; and received outpatient follow-up services.” The follow up services began immediately after discharge and for each of the three participants included both in clinic and telehealth sessions. Clinicians observed patient (acceptance, mouth clean, inappropriate mealtime behavior) and caregiver activity and tailored interventions to each patient. (correct escape, correct praise, correct attention)
 * Results from the study reveal that outcomes were similar whether in a clinical setting versus at home and whether it was in person versus using telehealth
 * “Patient and caregiver behavior was relative equivalent”
 * “Rates of acceptance and mouth clean were similarly high in-clinic and for telehealth appointments across the three participants. Rates of inappropriate behavior were slightly lower for in-clinic relative to telehealth and one participant had equal rates of inappropriate mealtime behavior across locations”
 * The second study had two separate groups of participants, 6 receiving follow up solely via telehealth and 6 receiving follow up in the clinic
 * “Our clinical practice is to set goals and evaluate patient progress at 3-month intervals during the outpatient follow-up program...Typical goals for the 3-month intercal focused on maintaining the gains participants had made during the day-treatment admission.
 * “Results suggest that participants who received outpatient follow-up in-clinic or via telehealth met an equivalent percentage of their goals over time...telehealth services are just as effective as in-clinic services for meeting meaningful goals and maintaining appropriate participant and caregiver behavior during outpatient follow-up.”

 Not Sure what do do with this info...might not end up adding it cause I have a lot of other good stuff 
 * Cognitive behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents
 * There is some evidence that cognitive behavioral therapy (link to other wiki about CBT?) may be beneficial to aid people in improving their feeding habits. A preliminary study of 20 patients diagnosed with ARFID between the ages of 10 and 17 years old shows promising results. The study was for “proof of concept” purposes and was not a randomized trial but more of a pilot to see if cognitive behavioral therapy might be a feasible treatment option for children and adolescents. Participants were involved in a treatment that consisted of 20-30 50 minute sessions over four stages. Stage 1 included education about ARFID and helping the patient increase food volume or variety. Stage 2 involved further educating patients on nutrition deficiencies and continuing to support gaining weight and/or trying more novel foods. Stage 3 differs based on the maintaining mechanisms of the ARFID (whether that be sensory sensitivity, fear of aversive consequences of lack of interest in eating). In Stage 4, physicians evaluate the patient's progress and make a plan in case the patient relapses into old feeding habits. The patients were prohibited from receiving other treatments concurrently but were monitored medically by a pediatrician or adolescent medicine physician.
 * Of the 25 patients who were offered the opportunity for the treatment, 20 of them elected to do so and 17 of those followed the treatment through to completion. The patients and their families rated the treatment as credible upon starting and were satisfied by its end. Therapists, patients and parents noted significant improvements; fear of aversive consequences, sensory sensitivity, and food neophobia (fear of trying new foods) decreased. Notably, by the completion of treatment 70% of patients no longer met the criteria for ARFID.
 * Health professionals’ familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder


 * Disorders of gut-brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder
 * Disorders of gut-brain interaction (DGBI) - “GI conditions without underlying structural abnormality...two of the most common DGBI include functional dyspepsia and irritable bowel syndrome”
 * “Previous data suggest that symptoms of DGBI persist beyond ED treatment for up to 77% of patients”
 * “Relatively higher frequency of ARFID compared to other shape/weight motivated EDs among individuals with DGBI, so we hypothesized that DGBI would be significantly more frequent among patients with ARFID compared to patients with shape/weight EDs.”
 * “Among outpatients presenting for ED treatment evaluation...bothersome GI symptoms were common (72%) and DGBI were also relatively frequent (39%)...there was not a higher rate of DGBI among patients with ARFID compared to shape/weight EDs...those with DGBI more frequently had ARFID fear of aversive consequences prototype and presence of multiple comorbid prototypes than those without DGBI”