Table 2 Treatment interventions
From: Avoidant/restrictive food intake disorder (ARFID) in New Zealand and Australia: a scoping review
Author and year (Country) | Study Population focus | Study Focus | Setting | Methodology | Key data collected | n | Gender (Age) | Ethnicity | Summary results |
|---|---|---|---|---|---|---|---|---|---|
Steen (SA, Australia) [27] Int J Eat Disord | Clinical Case ARFID | Presentation and treatment for adult male with co-occurring food avoidance, and alcohol use disorder | Eating disorders service (outpatient) | CBT 10 sessions | Background history; MINI; BMI; EDE-Q; DASS-21 | 1 | M (42y) | Not stated | Increased diversity in diet, reduced binge drinking at end treatment, but relapse at three-month follow up, with increased drinking binges, decreased overall food intake, and severe depression and anxiety. Chronic alcohol use disorder inhibited effectiveness of short therapy, and definite diagnosis of ARFID |
Taylor (Australia) [43] Eur J Behav Anal | Clinical case, ARFID*, ASD | Replication of a side deposit treatment package in a home setting | Paediatric feeding | Behaviour analytic treatment | Realtime participant and feeder behaviours, interobserver agreement, procedural integrity and caregiver satisfaction | 1 | M (9y) | European | Treatment initially unsuccessful, but with addition of side-deposit consumption increased 100%. Treatment gains maintained over a year post implementation |
Taylor (Australia) [40] J Adolesc | Clinical case, ARFID | Application of established behaviour intervention procedure in a home setting | Paediatric feeding | Behaviour-analytic treatment | Measures of consumption of food, interobserver agreement, procedural integrity, social acceptability, and caregiver satisfaction | 1 | F (13y) | Not stated | Consumption increased from 7 foods at baseline to 61 foods at 2Â weeks post treatment. Parents reported high social acceptability of intervention (4.88/5), and high caregiver satisfaction (4.82/5). At 9-month follow-up food consumption remained stable |
Taylor (Australia) [48] J Dev Phys Disabil | Clinical case, ARFID, ASD | Application of established behaviour intervention procedure (exit criterion) in a home setting | Paediatric feeding | Behaviour-analytic treatment | Measures of consumption of food across food preference groups, procedural integrity, interobserver agreement, social acceptability, and caregiver satisfaction | 1 | M (11y) | Not stated | 100% decrease in inappropriate mealtime behaviour, and 99% reduction in negative vocalisations at end of treatment evaluation. Variety of 79 foods achieved in < 2 weeks. Parents reported complete resolution of feeding problem at 2-year follow-up, high social acceptability of intervention, and high caregiver satisfaction |
Taylor (Australia) [33] J Pediatr Psychol | Clinical case, ARFID*, ASD | Side-deposit treatment in home-based program | Paediatric feeding | Behaviour analytic (side deposit) | Measures of consumption of food, procedural integrity, and social acceptability) | 2 | M (5y) M (4y) | Asian European European | Consumption for both participants increased by 100% when the side deposit was added to the treatment package. Increased consumption was maintained up to 3Â years |
Taylor (Australia) [42] Learn Motiv | Clinical case, ARFID, ASD | Effectiveness of behaviour-analytic treatment in a home setting for a child with no history of chewing behaviour | Paediatric feeding | Behaviour-analytic treatment | Measures of consumption of food across food preference groups, procedural integrity, interobserver agreement, social acceptability, and caregiver satisfaction | 1 | M (5y) | European | Successfully introduced chewing and swallowing behaviour during treatment period. 100% increase in consumption and chewing and 100% decrease in inappropriate mealtime behaviour at end-treatment. At 1-year follow-up, parents rated progress at 4–5/5, high social acceptability of intervention (5/5), and high caregiver satisfaction (5/5) |
Taylor 2020 (Australia) [44] Learn Motiv | Clinical cases, ARFID (in siblings of ARFID cases) | Intensive in-home feeding program concurrent to an older siblings’ feeding treatment | Paediatric feeding | Behaviour analytic (baseline escape, differential attention, contingent access, noncontingent access) | Realtime measures of participant and feeder behaviours (frequency of bites, time to swallow, inappropriate mealtime behaviours) and total food consumption. Interobserver agreement, and caregiver satisfaction | 2 | M (2.5y) M(2y) | Asian Australian South American Australian | Short (< 10 days), intensive in-home treatment resulted in increased food consumption 100%, and decreased negative mealtime behaviours for two developmentally normal toddlers. At 3-year follow-up treatment gains were maintained |
Burton (Melbourne, Australia) [58] J Can Acad Child Adolesc Psychiatry | Clinical cases, ARFID, ASD | Application of Family Based Treatment (FBT) + Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) | Paediatric psychology | FBT + UP-C/A | Treatment goals (no objective outcome measures used) | 2 | F (6y) F (11y) | Not stated | Application of FBT + UP-c/A for ARFID with comorbid ASD appeared to contribute towards increased oral intake and food variety, and reduced reliance on NGT feeding |
Taylor (Australia) [45] Behav Change | Clinical case, ARFID, ASD | Effectiveness of move-on treatment component | Paediatric feeding | Behaviour-analytic treatment | Measures of consumption of food across food preference groups, procedural integrity, interobserver agreement, social acceptability, and caregiver satisfaction | 1 | F (5y) | Asian Australian | Move-on component added to treatment package resulted in increased consumption and decreased time to consume foods |
Taylor 2022 (Australia) [46] Behav Modif | Clinical case, ARFID, ASD | Medication administration in children with feeding disorders | Paediatric feeding | Behaviour-analytic treatment | Behaviour frequency, latency duration, procedural integrity, interobserver agreement, social validity and treatment acceptability | 1 1 | M (5y) M (8Y) | East Asian Australian South Asian Australian | Both participants demonstrated 100% increase in medication consumption with reduced inappropriate mealtime behaviour and quicker consumption. Treatment results were rapid (within 10Â min of session 1) |
Taylor (Australia) [37] Infants & Young Children | Clinical case, ARFID*, ASD | Redistribution treatment (movement of food in mouth via external tool, such as infant gum brush to discourage packing food in cheeks) in a home-based program | Paediatric feeding | Behaviour analytic (move-on, baseline escape, contingent access, non-contingent access, differential attention, redistribution) | Frequency of clean mouth, acceptance, inappropriate mealtime behaviour. Duration of latency to clean mouth, negative vocalisations, latency to acceptance. Interobserver agreement, social validity, treatment acceptability | 2 | F (4y) M (5y) | Asian Australian European | Patient A increased from 2 foods (within 1 food group) to 70 foods at end of 3Â day treatment evaluation. Patient B reached 77 foods. Consumption increased to 100% and results were maintained at 6-month follow up |
Taylor 2022 (Australia) [49] J Autism Dev Disord | Clinical case, ARFID, ASD | Treatment comparison | Paediatric feeding | Multi-element single-case experiment design | Latency to clean mouth, negative vocalisations, inappropriate mealtime behaviour, and expulsion events | 1 | M (4y) | European | Use of a liquid chaser to treat packing behaviour significantly decreased swallowing latency was more effective than multiple other treatments, including move-on, puree chaser, brush distribution, non-removal, re-presentation, contingent access, and differential attention methods |
Taylor (NSW, Australia) [38] Acta Paediatr | Clinical case, ARFID, ASD, Developmental delay, Intellectual disability | Maintenance of specialist treatment gains at home by trained parents | Paediatric feeding | Controlled consecutive case series Behaviour-analytic feeding treatment | Measures of consumption of food, procedural integrity, interobserver agreement, social acceptability, and caregiver satisfaction | 26 | 22 M (2-13y, mean = 6y) | 15 European Australian, others were of Asian, Arabic and European ethnicities | Individualised treatments were tailored to the child, and parents trained to a high standard to continue treatment protocol at home. At 2-3ys post treatment, 21 parents reported that their child’s feeding problem was better than before treatment. 5 parents reported that the feeding problem had resolved |
Taylor (Australia) [50] Child Fam. Behav Ther | Caregivers of children with paediatric feeding disorders | Social validity of treatment for paediatric feeding disorders | Paediatric feeding | Retrospective analysis Social validity correlations | Interobserver agreement, procedural integrity, caregiver satisfaction and acceptability measures | 32 | 24 M (2-13y, mean = 6y) | 18 European Australian, others = Asian, Arabic, European ethnicities | No significant correlations between treatment social validity and variables such as participant characteristics and goals, treatment procedures and treatment outcomes. Longer treatment programmes were associated with higher acceptability, although social validity ratings were very high across the sample |
Taylor (Australia) [51] Behav Interv | Caregivers of children with ARFID | Evaluate caregiver treatment acceptability across the range of specific procedures for paediatric feeding disorders, at pre- and post-treatment | Paediatric feeding | Caregiver survey | General Treatment Preferences survey (prior to starting program) Acceptance Procedures/ Clean mouth/Swallowing Procedures surveys (prior to component implementation). Treatment acceptability survey (items similar to the AARP and IRP-15), with open-ended survey questions (after program discharge) | 6 | 4 F (not stated) 2Â M (not stated) | Asian, Arabic, European, South American, and Pacific Island ethnicities /nationalities | Caregivers unanimously gave strong ratings of the importance of goals, and preferred that treatment be effective and quick, over minimizing side effects |