scholarly journals Widening the reach of family-based interventions for Anorexia Nervosa: autism-adaptations for children and adolescents

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rachel Loomes ◽  
Rachel Bryant-Waugh
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Young People ◽  
Children And Adolescents ◽  
Autism Spectrum ◽  
English Summary ◽  
Current Form ◽  
Short Period ◽  
Family Based ◽  
Family Based Interventions

Abstract Family-based interventions are widely recommended as a first line treatment for children and young people with Anorexia Nervosa. There is clear evidence that model-adherent delivery of specific eating disorder focused family interventions has the potential to help adolescents with Anorexia Nervosa, who have typically engaged in extreme dietary restriction and lost a significant amount of weight over a relatively short period of time. Nevertheless, there remains a significant number of young people with restrictive eating disorders for whom family-based interventions for Anorexia Nervosa prove less effective, suggesting adaptations may be indicated for some. In this paper we provide a rationale and structure for considering a number of possible adaptations to the delivery of family-based therapy for anorexia nervosa specifically intended to enhance its relevance and potential effectiveness for children and adolescents on the autism spectrum; a subgroup known to represent a significant minority in eating disorder populations who have been identified as having relatively poor outcomes. Plain English summary Past research has shown that certain family-based treatments are effective for many children and adolescents who develop Anorexia Nervosa. At the same time this type of treatment approach in its current form does not work for everyone. Recent research has highlighted the overlap between anorexia and autism and the need for the development of adaptations to existing treatments to better meet the requirements of people on the autism spectrum who develop anorexia. With this in mind we propose a number of autism-related adaptations that could be made to family-based treatments for anorexia. We hope that these might be formally tested in the future to see if these adaptations improve outcomes for this group of individuals.

scholarly journals Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lukasz Cybulski ◽  
Darren M. Ashcroft ◽  
Matthew J. Carr ◽  
Shruti Garg ◽  
Carolyn A. Chew-Graham ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Young People ◽  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Autism Spectrum ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Health Crisis ◽  
Self Harm ◽  
The Uk

Abstract Background There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Methods Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. Results The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. Conclusion The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

scholarly journals Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
A. Hambleton ◽  
D. Le Grange ◽  
J. Miskovic-Wheatley ◽  
S. Touyz ◽  
M. Cunich ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Young People ◽  
Treatment Effectiveness ◽  
Digital Health ◽  
Evidence Based ◽  
Treatment Needs ◽  
Evidence Based Treatment ◽  
Face To Face ◽  
Family Based Treatment ◽  
Family Based

Abstract Background Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues. Method Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness. Discussion The study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.

scholarly journals Anorexia nervosa: an increasing problem in children and adolescents

2009 ◽  
Vol 11 (1) ◽  
pp. 100-103 ◽  
Keyword(s):  
Anorexia Nervosa ◽  
Risk Factor ◽  
Eating Disorder ◽  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Early Recognition ◽  
Major Risk Factor ◽  
Family Treatment ◽  
Young Adolescents ◽  
Children And Young Adolescents

Information from eating disorder clinics across five continents suggests that anorexia nervosa is becoming an increasing problem in children and young adolescents. There is some indication that anxiety disorders in childhood may be a major risk factor for the development of anorexia nervosa. Early recognition and family treatment for this disorder are essential to prevent chronic impairment.

Development and preliminary validation of a depressive symptomatology detection scale among children and adolescents on the autism spectrum

Autism ◽  
2020 ◽  
pp. 136236132095820
Author(s):  
Lucie Bellalou ◽  
Naomi Downes ◽  
Emilie Cappe
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Symptoms ◽  
Young People ◽  
Depressive Disorder ◽  
Children And Adolescents ◽  
Autism Spectrum ◽  
Behavioral Changes ◽  
Major Depressive ◽  
Future Studies ◽  
Two Factors

High rates of depressive disorders are reported among young people on the autism spectrum. This condition is generally assessed using measures validated for typically developing young people. Tools adapted to children on the autism spectrum are not tailored to detect Major Depressive Disorder, nor have they been used among samples with an intellectual disability. To fill this gap, this article builds a novel Scale for evaluating depressive symptoms among youth on the autism spectrum ( Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme) and evaluates its performance using a sample of 153 young people on the autism spectrum in France. The Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme was completed by parents of children and adolescents (aged 3–17 years) via an interview with a psychologist. The Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme has very good internal consistency, as well as good content validity. The scale is composed of two factors: (1) behavioral changes and (2) emotional and cognitive changes. Future studies should replicate this validation study with a larger sample size and investigate interrater reliability. Overall, results suggest preliminary support for using the Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme among youth on the autism spectrum. Lay abstract Many individuals on the autism spectrum experience depressive symptoms. These symptoms contribute to poor quality of life and may have a more negative impact than core autistic features. However, identifying depressive symptoms among individuals on the spectrum is a real challenge. In this study, we investigate the psychometric qualities of a French scale for evaluating depressive symptoms among youth on the autism spectrum. Participants were 153 autistic children and adolescents aged between 3 and 17 years. The majority of the sample was male (73.86%). One of their parents completed the scale for evaluating depressive symptoms among youth on the autism spectrum during an interview with a psychologist. Overall, the findings indicate the scale may be reliably used with children and adolescents on the autism spectrum. Experts deemed the items as being representative of depressive symptoms. The scale is composed of two factors: behavioral changes on one hand and cognitive and emotional changes on the other. The results are encouraging and show the scale is a promising instrument for assessing Major Depressive Disorder symptomatology among youth on the spectrum. Future studies should focus on testing this scale among adults and developing an auto-evaluative section.

Psychopharmacology in the Treatment of Eating Disorders

2018 ◽  
pp. 384-403
Author(s):  
Lindsay J. Moskowitz ◽  
Benson Ku ◽  
Shervin Shadianloo ◽  
Victor M. Fornari
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Behavioral Therapy ◽  
Mood Stabilizers ◽  
United States Food ◽  
Family Based

Given the high morbidity and mortality rates associated with eating disorders (EDs), many studies have examined the use of medications to treat these disorders. However, with the exception of fluoxetine (for those 12 years and older with bulimia nervosa) and lisdexamfetamine (for adults with moderate-to-severe binge eating disorder), no other medications have been approved by the United States Food and Drug Administration to treat any eating disorder. This article will review many of the positive and negative studies for use of medication in the treatment of eating disorders, including anorexia nervosa, bulimia nervosa, atypical anorexia nervosa, avoidant/restrictive food intake disorder, and binge eating disorder. Various classes of medication will be reviewed, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Although the information in this article is important in the education of both patients and their parents, medications should be used cautiously in those with EDs. It should be emphasized that to date, therapy—family-based therapy and enhanced cognitive behavioral therapy—is the mainstay of treatment, with nutrition therapy and correction of malnutrition as the crucial first step in treatment.

Autistic Traits in Patients with Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder: A Pilot Study

2017 ◽  
Vol 41 (S1) ◽  
pp. S100-S100 ◽  
Author(s):  
C. Gesi ◽  
C. Carmassi ◽  
M. Luciano ◽  
L. Bossini ◽  
V. Ricca ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Autistic Traits ◽  
Autism Spectrum ◽  
Autism Spectrum Quotient ◽  
Attention Switching ◽  
Feeding And Eating Disorders

IntroductionPrevious data showed higher autistic traits in individuals with anorexia nervosa (AN) compared to healthy controls (CTL). It is not known, however, whether this characteristic is shared by other feeding and eating disorders (FEDs) or it is uniquely associated to AN.ObjectivesTo compare autistic traits among individuals with AN, bulimia nervosa (BN), binge eating disorder (BED) and CTL and to investigate which specific dimensions differentiate one group from another.MethodsA total of 241 FED patients (53 AN, 41 BN, 42 BED) and 105 CTL were administered the autism-spectrum quotient (AQ), the adult autism subthreshold spectrum (AdAS Spectrum), the Ritvo autism and Asperger diagnostic scale 14-item (RAADS-14 Screen).ResultsFED subjects reported higher AQ, AdAS spectrum and RAADS-14 total and subscales scores compared to CTL (all P < .001). No differences were found amongst AN, BN and BED subjects in questionnaires’ total scores. BN group scored higher than AN in the hyper-/hyporeactivity to sensory input domain of the AdAS spectrum (P < .001); AN group scored higher than BED in the attention switching domain of the AQ (P < .001), and BED group scored lower than both AN and BN in the mentalizing deficit domain of the RAADS-14 (all P < .001).ConclusionsWe reported for the first time that not only AN but also BN and BED patients show greater autistic traits compared to CTL. Longitudinal studies are needed to confirm this preliminary report and to elucidate whether autistic traits either precede, co-occur or follow FEDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Family members’ reflections upon a family-based inpatient treatment program for adolescent anorexia nervosa: a thematic analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jan-Vegard Nilsen ◽  
Øyvind Rø ◽  
Inger Halvorsen ◽  
Hanne Weie Oddli ◽  
Trine Wiig Hage
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Treatment Program ◽  
Inpatient Treatment ◽  
Treatment Approach ◽  
Family Members ◽  
Adolescent Anorexia Nervosa ◽  
Family Based Treatment ◽  
Family Based ◽  
Treatment Settings

Abstract Background Family-based outpatient treatment is usually recommended as the treatment of choice when a child develops anorexia nervosa. However, some young persons will inevitably require higher levels of care. Qualitative research on family perspectives may help inform strategies to adapt family-based practices into intensified treatment settings. Our overarching aim was to investigate family members’ perspectives following a family-based inpatient treatment program for adolescent anorexia nervosa and to discuss clinical implications for treatment providers. Methods A subsample of eight families taking part in a naturalistic outcome study at a specialized eating disorder unit participated in the study (8 patients, 14 parents, and 10 siblings). The thematic analyses were inductive, predominantly descriptive, and guided by a multi-perspective framework. Results Five main themes were identified: 1: Expectations and evaluation of needs. Entering treatment from different vantage points, 2: Interactions with peers during the admission as highly beneficial or problematic, 3: Perspectives on staff expertise and the eating disorder unit’s structure, 4: Influencing within family relationships in different ways, and 5: Being admitted is at best only half the job: reflections on leaving the eating disorder unit. Conclusions Our study offers insight into how former inpatients and their family members experienced an inpatient treatment program designed to align treatment with the central elements of an outpatient family-based treatment approach for adolescent anorexia nervosa. Overall, the findings support emerging research underlining the necessity of strengthening the family-based treatment approach within intensified treatment settings. Moreover, the results emphasized the need for more knowledge on how to optimize inpatient treatment as well as the importance of providing smooth transitions between care settings.

scholarly journals Externalizing your eating disorder: a qualitative interview study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Marthe M. Voswinkel ◽  
Cleo Rijkers ◽  
Johannes J. M. van Delden ◽  
Annemarie A. van Elburg
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Qualitative Interview ◽  
Behavioural Therapy ◽  
Interview Study ◽  
Epistemic Injustice ◽  
Cognitive Behavioural ◽  
Qualitative Interview Study ◽  
Family Based ◽  
Specialist Supportive Clinical Management

Abstract Background Anorexia nervosa (AN) is a psychiatric disorder with an ego-syntonic nature, causing many patients to perceive their AN as part of their personal identity. Therefore, an important part of treatment is the externalization of the eating disorder, in order to help patients to perceive AN as an external influence. Studies on patient experiences of externalization in treatment for AN are sadly missing. The aims of this study were to investigate, first, patients’ perspectives on the relation between identity and anorexia nervosa (AN) and second, their experiences of an externalizing approach during treatment. Method A qualitative interview study was conducted including fourteen patients with AN in either Family Based Treatment, the Maudsley Model for Anorexia Nervosa Treatment for Adults, Specialist Supportive Clinical Management-Severe Enduring or Cognitive Behavioural Therapy-Enhanced. Results There are important differences in participants’ perceptions on how AN is related to identity. AN was perceived as part of identity, as alien or as a different side of the self. Patients’ experiences towards an externalizing approach were ambivalent. Externalization was considered helpful, whilst also evoking a negative response. Participants reported feeling as if all their behaviour was referred to as part of AN, which elicited feelings of not being taken seriously or being wrongfully accused of being dishonest. Conclusions First, there is considerable variation in the perceived relation between AN and identity. Second, an externalizing approach within treatment may lead to so called epistemic injustice. Awareness of these two facts is of importance for clinicians and the therapeutic relationship because that will help them to refrain from actions that can be perceived as epistemic injustice.

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