A Behavioral Parent-Training Intervention for a Child With Avoidant/Restrictive Food Intake Disorder

Abstract

Avoidant/restrictive food intake disorder (ARFID) is a feeding disorder classification in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM–5; American Psychiatric Association, 2013) that describes a pervasive and disruptive pattern of food refusal and/or severe food selectivity. Currently, there is need for the development of evidence-based behavioral treatments for food selectivity that can be implemented in outpatient clinics, involve parents in treatment, and generalize to the child’s real-world environment. We have described in this study a behavioral feeding intervention that integrates components from intensive feeding programs with parent-training strategies in the treatment of a 6-year-old girl with ARFID. Treatment was primarily parent-mediated and included psychoeducation, in vivo parent coaching, parent modeling, differential reinforcement, gradual exposure to novel foods, and contingency management. The course of the intervention was divided into an initial differential reinforcement phase and subsequent directive strategies phase. Results indicate increased dietary repertoire, clinically significant decreases in problematic parent and child feeding behaviors, and acceptance of bites of 30 novel foods from pre to postintervention. Positive treatment outcomes were maintained at 6-week posttreatment follow-up.