AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER IS MORE THAN ONE DISORDER: DIAGNOSIS AND TREATMENT OF THREE SUBTYPES FROM INFANCY TO ADOLESCENCE.

Objectives: The goal of this Workshop is to describe the diagnosis and treatment of the following 3 subtypes of avoidant/restrictive food intake disorder (ARFID) at different ages from infancy to adolescence: 1) apparent lack of interest in eating or food; 2) avoidance based on sensory characteristics of food; and 3) concern about aversive consequences of eating. Methods: Irene Chatoor, MD, will provide the participants with handouts describing the major symptoms that characterize each of the 3 subtypes. She will begin with ARFID subtype “apparent lack of interest in food or eating,” described as infantile anorexia in the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood: Revised Edition (DC: 0-3R). Loredana Lucarelli, PsyD, will present videotapes of young children in dyadic interactions with their mothers and in triadic interactions with both mothers and fathers to illustrate the dysfunctional family interactions of these children. Dr. Chatoor will describe how to help families of young children, and Rebecca Begtrup, DO, will discuss the diagnosis and treatment of these children during school age and adolescence, including the use of cyproheptadine and olanzapine for appetite stimulation. The ARFID subtype “avoidance based on the sensory characteristics of food” describes children who avoid food in relation to the appearance, taste, texture, smell, or temperature of food (termed “sensory food aversions” in the DC:0-3R). Dr. Chatoor will demonstrate a new method to work with young children ranging in age from 3 to 6 years, which she has described as “focused family play therapy: feeding baby dolls with plastic food.” Dr. Begtrup will describe how school-aged children can be motivated when they understand that they are “supertasters” and that they can “tame their taste buds” by being brave and getting rewarded for each bite of a new food with “courage” points and prizes. She will also discuss how adolescents are often socially motivated to engage in desensitizing their taste buds. The ARFID subtype “concern about aversive consequences of eating” is characterized by its rather sudden onset of food refusal. After an incident of choking, gagging, or vomiting, the child becomes fearful of eating and refuses to drink from the bottle or eat any solid food, depending on the eating experience the child associates with the danger of eating. Treatment of younger children can be done through family play therapy. For the older children, desensitization by gradually increasing the texture of foods they are willing to eat may be effective. In addition, most of these children benefit from anxiolytic medication. Results: Treatment of these feeding/eating disorders can prevent ongoing distress in the child and the whole family. Conclusions: The new diagnosis of ARFID in the DSM-5 includes 3 major subtypes of feeding/eating disorders that have different characteristics and require different interventions at different ages. EA, FAM, DIAG https://doi.org/10.1016/j.jaac.2020.07.87