- Email: [email protected]
44.2 Avoidant Restrictive Food Intake Disorder: Medical Assessment, Management, and Safe Renourishment
CLINICAL PERSPECTIVES 44.1 — 44.4
Conclusions: With the recent inclusion of the ARFID diagnosis in DSM-5, child and adolescent psychiatrists are likely to receive increased referrals for assessment and treatment and will benefit from a comprehensive understanding of the services offered.
CON, TREAT, EA http://dx.doi.org/10.1016/j.jaac.2017.07.251
44.3 WORKING TOGETHER: NUTRITION AND OCCUPATIONAL THERAPY ROLES IN CARING FOR PATIENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER Anne Sinha, OTR/L, Lucile Packard Children’s Hospital Stanford, [email protected]
Objectives: Psychological assessment of avoidant/restrictive food intake disorder (ARFID) is a vital part of a comprehensive evaluation. The evaluation of the etiology of the avoidant/restrictive behaviors, as well as the psychological consequences of this avoidance, directs the treatment approach. Participants will learn about the following: 1) types of fears and avoidant behaviors; 2) ways that these fears develop and factors that maintain their existence; and 3) therapeutic approaches that help the patient and family challenge the fears and decrease the avoidant/restrictive behaviors. These approaches will include assessment/teaching-alternative coping strategies, assessment of motivation to challenge fears, and creation of an exposure hierarchy. The treatment approach includes elements of CBT, exposure response prevention, and a modified family-based therapy approach to support families in helping the patient take on challenge foods/situations. Methods: Assessment protocols will be presented along with treatment plans and protocols. Clinical case vignettes will illustrate the use of these tools. Results: 1) Participants will have a greater understanding of how these fears and avoidant behaviors develop; 2) participants will be able to use the ARFID assessment tools in their practice to evaluate their patients; and 3) participants will be able to use the ARFID treatment plans/protocols to create individualized treatment plans for their patients. Conclusions: Although the presentation of ARFID can be quite varied, clinicians will be able to comprehensively assess their patients and create individualized treatment plans.
Objectives: Clinical nutrition and occupational therapy assessment of avoidant/ restrictive food intake disorder (ARFID) are vital parts of a comprehensive evaluation among team members in the treatment of ARFID patients. Participants will learn about the nutritional assessment, which includes an evaluation of current anthropometrics, growth history, assessment of biochemistry and clinical data, physical activity, nutrition history, and calculation of estimated nutrition needs. Occupational therapy evaluation includes the following: the feeding components of the avoidant/restrictive behaviors and physiological patterns during feeding, as well as the current way that it is impacting patient function and goals of the family and patient. Considerations of the following physical components may be present in ARFID patients by patient type: lifetime of picky eating, children with sensory issues, and patients who have experienced a fear-related episode. Participants will learn about the treatment approach, which includes a comprehensive and individualized nutritional plan of care, occupational therapy’s therapeutic use of self, feeding sessions, learning coping techniques to address fears and physiological patterns, behavior modification plan, and parent-feeding education. Participants will also learn about clinical nutrition, including the different types of meal planning with a probable need for calorie tracking, replacement protocols, various enteral nutrition plans, and parent nutrition education. Methods: Our team clinical dietitian and occupational therapist will share their method of assessment and treatment. Results: Participants will have a greater understanding of ways to help patients progress medically through systematic refeeding and the oral motor/ eating patterns that may impact these patients. Participants will have a clear sense of the step-by-step process of reintroducing food during repeated feeding sessions in a structured, reinforced pattern that progresses nutrition. Participants will understand physiological patterns that may arise in patients and methods of addressing them through physiological coping strategies. Conclusions: Through a team approach and treatment plan, ARFID patients can progress; parents are empowered in facilitating changes that support long-term health.
AD, CON, EA
EA, PAT, SP
http://dx.doi.org/10.1016/j.jaac.2017.07.252
http://dx.doi.org/10.1016/j.jaac.2017.07.254
44.2 AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER: MEDICAL ASSESSMENT, MANAGEMENT, AND SAFE RENOURISHMENT
44.4 WORKING TOGETHER: DIETITIAN AND OCCUPATIONAL THERAPY ROLES IN CARING FOR PATIENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER
44.1 PSYCHOLOGICAL ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER Mary Sanders, PhD, Stanford University, maryjsand@ yahoo.com
Jennifer Carlson, MD, Stanford University, carlson2@ stanford.edu Objectives: Children and adolescents with avoidant/restrictive food intake disorder (ARFID) may present with medical issues that range in both scope and acuity. Participants will learn about the following: 1) the health issues that should be considered during initial evaluation; 2) the growth and health concerns specific to children versus adolescents with ARFID; and 3) the medical monitoring and treatment recommendations during renourishment. Methods: With the use of clinical case vignettes, medical issues and treatment recommendations will be reviewed. Medical management in both the inpatient and outpatient settings will be addressed, referenced to current literature, as well as expert practice models. Results: By the end of the session, participants will be able to do the following: 1) identify the key medical information to be obtained during an initial evaluation; 2) identify the medical complications of ARFID in both children and adolescents; and 3) have a greater understanding of the medical management during renourishment/treatment. Conclusions: The medical presentation of ARFID in children and adolescents can be quite varied. Identifying and understanding the potential medical complications of ARFID will allow for the safest management of this population.
ADOL, EA, MIC http://dx.doi.org/10.1016/j.jaac.2017.07.253
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Allyson Sy, RD, Lucile Packard Childrens Hospital Stanford, [email protected] Objectives: Clinical nutrition and occupational therapy assessment of avoidant/ restrictive food intake disorder (ARFID) are vital parts of a comprehensive evaluation and team members in the treatment of patients with ARFID. Participants will learn about the nutritional assessment, which includes an evaluation of current anthropometrics, growth history, assessment of biochemistry and clinical data, physical activity, nutrition history, and calculation of estimated nutrition needs. Occupational therapy evaluation includes the feeding components of the avoidant/restrictive behaviors, physiological patterns during feeding, and the current way that it is impacting patient function and the goals of the family and the patient. Considerations of the physical components that may be present in patients with ARFID by patient type are as follows: lifetime of picky eating, children with sensory issues, and patients with a postfear-related episode. The treatment approach includes a comprehensive and individualized nutritional plan of care, occupational therapy’s therapeutic use of self, feeding sessions, information on coping techniques to address fears and physiological patterns, behavior modification plan, and parent-feeding education. Clinical nutrition information covers different types of meal planning, with a probable need for calorie tracking, replacement protocols, various enteral nutrition plans, and parent nutrition education.
www.jaacap.org
S65
Conclusions: With the recent inclusion of the ARFID diagnosis in DSM-5, child and adolescent psychiatrists are likely to receive increased referrals for assessment and treatment and will benefit from a comprehensive understanding of the services offered.
CON, TREAT, EA http://dx.doi.org/10.1016/j.jaac.2017.07.251
44.3 WORKING TOGETHER: NUTRITION AND OCCUPATIONAL THERAPY ROLES IN CARING FOR PATIENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER Anne Sinha, OTR/L, Lucile Packard Children’s Hospital Stanford, [email protected]
Objectives: Psychological assessment of avoidant/restrictive food intake disorder (ARFID) is a vital part of a comprehensive evaluation. The evaluation of the etiology of the avoidant/restrictive behaviors, as well as the psychological consequences of this avoidance, directs the treatment approach. Participants will learn about the following: 1) types of fears and avoidant behaviors; 2) ways that these fears develop and factors that maintain their existence; and 3) therapeutic approaches that help the patient and family challenge the fears and decrease the avoidant/restrictive behaviors. These approaches will include assessment/teaching-alternative coping strategies, assessment of motivation to challenge fears, and creation of an exposure hierarchy. The treatment approach includes elements of CBT, exposure response prevention, and a modified family-based therapy approach to support families in helping the patient take on challenge foods/situations. Methods: Assessment protocols will be presented along with treatment plans and protocols. Clinical case vignettes will illustrate the use of these tools. Results: 1) Participants will have a greater understanding of how these fears and avoidant behaviors develop; 2) participants will be able to use the ARFID assessment tools in their practice to evaluate their patients; and 3) participants will be able to use the ARFID treatment plans/protocols to create individualized treatment plans for their patients. Conclusions: Although the presentation of ARFID can be quite varied, clinicians will be able to comprehensively assess their patients and create individualized treatment plans.
Objectives: Clinical nutrition and occupational therapy assessment of avoidant/ restrictive food intake disorder (ARFID) are vital parts of a comprehensive evaluation among team members in the treatment of ARFID patients. Participants will learn about the nutritional assessment, which includes an evaluation of current anthropometrics, growth history, assessment of biochemistry and clinical data, physical activity, nutrition history, and calculation of estimated nutrition needs. Occupational therapy evaluation includes the following: the feeding components of the avoidant/restrictive behaviors and physiological patterns during feeding, as well as the current way that it is impacting patient function and goals of the family and patient. Considerations of the following physical components may be present in ARFID patients by patient type: lifetime of picky eating, children with sensory issues, and patients who have experienced a fear-related episode. Participants will learn about the treatment approach, which includes a comprehensive and individualized nutritional plan of care, occupational therapy’s therapeutic use of self, feeding sessions, learning coping techniques to address fears and physiological patterns, behavior modification plan, and parent-feeding education. Participants will also learn about clinical nutrition, including the different types of meal planning with a probable need for calorie tracking, replacement protocols, various enteral nutrition plans, and parent nutrition education. Methods: Our team clinical dietitian and occupational therapist will share their method of assessment and treatment. Results: Participants will have a greater understanding of ways to help patients progress medically through systematic refeeding and the oral motor/ eating patterns that may impact these patients. Participants will have a clear sense of the step-by-step process of reintroducing food during repeated feeding sessions in a structured, reinforced pattern that progresses nutrition. Participants will understand physiological patterns that may arise in patients and methods of addressing them through physiological coping strategies. Conclusions: Through a team approach and treatment plan, ARFID patients can progress; parents are empowered in facilitating changes that support long-term health.
AD, CON, EA
EA, PAT, SP
http://dx.doi.org/10.1016/j.jaac.2017.07.252
http://dx.doi.org/10.1016/j.jaac.2017.07.254
44.2 AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER: MEDICAL ASSESSMENT, MANAGEMENT, AND SAFE RENOURISHMENT
44.4 WORKING TOGETHER: DIETITIAN AND OCCUPATIONAL THERAPY ROLES IN CARING FOR PATIENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER
44.1 PSYCHOLOGICAL ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER Mary Sanders, PhD, Stanford University, maryjsand@ yahoo.com
Jennifer Carlson, MD, Stanford University, carlson2@ stanford.edu Objectives: Children and adolescents with avoidant/restrictive food intake disorder (ARFID) may present with medical issues that range in both scope and acuity. Participants will learn about the following: 1) the health issues that should be considered during initial evaluation; 2) the growth and health concerns specific to children versus adolescents with ARFID; and 3) the medical monitoring and treatment recommendations during renourishment. Methods: With the use of clinical case vignettes, medical issues and treatment recommendations will be reviewed. Medical management in both the inpatient and outpatient settings will be addressed, referenced to current literature, as well as expert practice models. Results: By the end of the session, participants will be able to do the following: 1) identify the key medical information to be obtained during an initial evaluation; 2) identify the medical complications of ARFID in both children and adolescents; and 3) have a greater understanding of the medical management during renourishment/treatment. Conclusions: The medical presentation of ARFID in children and adolescents can be quite varied. Identifying and understanding the potential medical complications of ARFID will allow for the safest management of this population.
ADOL, EA, MIC http://dx.doi.org/10.1016/j.jaac.2017.07.253
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Allyson Sy, RD, Lucile Packard Childrens Hospital Stanford, [email protected] Objectives: Clinical nutrition and occupational therapy assessment of avoidant/ restrictive food intake disorder (ARFID) are vital parts of a comprehensive evaluation and team members in the treatment of patients with ARFID. Participants will learn about the nutritional assessment, which includes an evaluation of current anthropometrics, growth history, assessment of biochemistry and clinical data, physical activity, nutrition history, and calculation of estimated nutrition needs. Occupational therapy evaluation includes the feeding components of the avoidant/restrictive behaviors, physiological patterns during feeding, and the current way that it is impacting patient function and the goals of the family and the patient. Considerations of the physical components that may be present in patients with ARFID by patient type are as follows: lifetime of picky eating, children with sensory issues, and patients with a postfear-related episode. The treatment approach includes a comprehensive and individualized nutritional plan of care, occupational therapy’s therapeutic use of self, feeding sessions, information on coping techniques to address fears and physiological patterns, behavior modification plan, and parent-feeding education. Clinical nutrition information covers different types of meal planning, with a probable need for calorie tracking, replacement protocols, various enteral nutrition plans, and parent nutrition education.
www.jaacap.org
S65