Avoidant/Restrictive Food Intake Disorder. A longitudinal study of malnutrition and psychopathological risk factors from 2 to 11 years of age

Aim: To evaluate different types and degrees of malnutrition over time in a sample of children diagnosed with Infantile Anorexia (IA), based on the DC:0-3R criteria, and recently defined by DSM-5 as the first subtype of Avoidant/Restrictive Food Intake Disorder (ARFID), and to investigate the relationship between children’s severity of malnutrition and emotional/behavioral development, and mothers’ long-term psychopathological symptoms. Methods: A total of 113 children (58 boys, 55 girls), originally diagnosed with IA, and their mothers, were evaluated at four assessment points at the children’s mean age of 2, 5, 7, and 11 years. Several measures were used to assess the children’s growth and level of malnutrition, mothers’ psychopathological symptoms and eating attitudes, as well as their children’s emotional/behavioral functioning. Results: A steady improvement in the severity of malnutrition over time emerged, but 73% of children still had ongoing mild to moderate to severe malnutrition at 11 years of age. Moreover, the children showed increasing internalizing and externalizing emotional/behavioral problems, and their mothers’ psychopathological symptoms and eating problems worsened as well over time. At 11 years of age, the girls’ emotional/behavioral problems and their mothers’ psychopathology and disturbed eating attitudes were more severe than that of the boys and their mothers. Finally, during the last assessment, significant associations between the mothers’ psychopathology and disturbed eating attitudes, the severity of the children’s malnutrition, and their emotional/behavioral problems emerged. Discussion: Our longitudinal study points out that the developmental course of children, originally diagnosed with IA and who received limited psychosocial treatment, is characterized by an enduring risk of malnutrition and increasing psychopathological symptoms in both, the children and their mothers, up to the sensitive period of pre-pubert

Feeding and eating disorders of infancy and early childhood

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Avoidant/restrictive food intake disorder from early childhood to preadolescence: clinical assessment and treatment

Objectives: Avoidant/Restrictive Food Intake Disorder (ARFID) in DSM-5 has replaced Feeding Disorder of Infancy or Early Childhood in DSM-IV. It has expanded the earlier more limited diagnostic criteria by introducing 3 main categories and by applying the criteria to individuals of all ages. The new criteria describe an eating or feeding disturbance that is characterized by e.g. apparent lack or interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating. This workshop will clarify how to diagnose and treat the three different subtypes of ARFID at different ages. Methods: Drs. Chatoor and Lucarelli will present research, clinical cases, and videos demonstrating the longitudinal course of toddlers with “apparent lack of interest in food” into preadolescence, those with and without specific treatment. They will clarify the diagnosis of each of the three subtypes of ARFID at different ages and highlight the importance of specific treatments for each of the subtypes, including parent training, play therapy, psychotherapy, and medication. Results: The research shows continuation of symptoms of ARFID, when untreated, and highlights the importance of early diagnosis and treatment. Conclusions: The new diagnosis ARFID has expanded the spectrum of feeding/eating disorders that can be diagnosed and treated at different ages

Feeding Development and Disorders

An important developmental process in the first years of life is the acquisition of autonomous internal regulation of feeding. A model of 3 stages of feeding development is presented to provide an understanding of how children develop internal versus external regulation of eating. This model is used to understand how different feeding disorders develop at these 3 stages of feeding development, and how some feeding disorders can occur at any age of the child. A classification of 6 feeding disorders, which was developed by Chatoor and published in DC: 0-3R, is outlined and its relationship to Avoidant/Restrictive Food Intake Disorder in DSM-5 is discussed. Diagnostic criteria, clinical picture, review of the literature, comorbidity between various feeding disorders, and treatment guidelines are described by Chatoor and Lucarelli for each of the six subtypes in DC: 0-3R. Current research is examined addressing the challenges of treating feeding disorders in infants and young children

PART IV. INFANCY AND EARLY CHILDHOOD 10. Mental Health and Developmental Disorders in Infancy and Early Childhood-IEC 0-3 IEC01 Sleep Disorders IEC02 Feeding and Eating Disorders IEC03 Elimination Disorders

Now completely revised (over 90% new), this is the authoritative diagnostic manual grounded in psychodynamic clinical models and theories. Explicitly oriented toward case formulation and treatment planning, PDM-2 offers practitioners an empirically based, clinically useful alternative or supplement to DSM and ICD categorical diagnoses. Leading international authorities systematically address personality functioning and psychological problems of infancy, childhood, adolescence, adulthood, and old age, including clear conceptualizations and illustrative case examples