Family vs Individual Treatment for Children With Avoidant/Restrictive Food Intake Disorder: A Randomized Clinical Trial

OBJECTIVE: To examine the efficacy of family-based treatment for avoidant/restrictive food intake disorder (FBT-ARFID) compared with individual psychoeducational motivational therapy (PMT) for underweight children with ARFID between 6 and 12 years of age. The main outcome evaluated was the difference between groups on change in percent estimated body weight (%EBW) from baseline to end of treatment (EOT). METHOD: A total of 98 children with ARFID were randomized to 14 sessions of telehealth FBT-ARFID or PMT conducted over 4 months. Assessments of weight/height, eating-related cognitions, and behaviors associated with ARFID were collected online at baseline, 1 month, 2 months, and EOT by assessors masked to treatment condition. RESULTS: FBT-ARFID was superior to PMT at EOT in promoting increased %EBW. There were no differences between groups regarding improvements in overall severity of ARFID symptoms or other related ARFID symptoms; however, baseline severity of ARFID symptoms moderated the effect, with children who were most symptomatic improving significantly more in FBT-ARFID than in PMT (exploratory analyses). CONCLUSION: FBT-ARFID is superior to PMT for promoting weight gain in low-weight children with ARFID, especially children with greater severity of ARFID symptoms. CLINICAL TRIAL REGISTRATION INFORMATION: Confirming the Efficacy/Mechanism of Family Therapy for Children With Low Weight ARFID. https://clinicaltrials.gov/study/NCT04450771.