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      Clinical Outcomes in a Large Sample of Youth and Adult Patients Receiving Virtual Evidence‐Based Treatment for ARFID: A Naturalistic Study

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          ABSTRACT

          Objective

          Treatment outcomes research for avoidant/restrictive food intake disorder (ARFID) has been limited to small, mixed‐age feasibility trials in face‐to‐face care settings. This study aims to examine clinical characteristics and treatment outcomes in a large sample of youth and adult patients receiving virtual multidisciplinary team treatment for ARFID.

          Method

          The sample included N = 783 patients (532 youth and 251 adults) diagnosed with ARFID. Patients received cognitive behavioral therapy for ARFID (CBT‐AR) or family‐based treatment for ARFID (FBT‐ARFID) enhanced by specialized support from a multidisciplinary team. Patients (or caregivers) completed a number of measures assessing ARFID and mood‐related symptoms upon admission and throughout treatment.

          Results

          Youth patients on weight restoration (56%) started treatment around 85% [84%, 86%] of their target weight, and increased to 94% [93%, 96%] by week 35. Adults on weight restoration (47%) started at 85% [84%, 87%] and reached 92% [90%, 94%]. Scores improved for both groups on all PARDI‐AR‐Q subscales: (sensory sensitivity: b = −0.25 [−0.33, −0.16]; lack of interest: b = −0.08 [−0.16, −0.00]; fear of aversive consequences: b = −0.12 [−0.19, −0.04]). Both youth and adults demonstrated reliable improvements in willingness to try new foods ( b = −0.64 [−0.89, −0.37]), anxiety symptoms ( b = −0.71 [−0.95, −0.48]), and depression symptoms ( b = −0.86 [−1.07, −0.64]).

          Discussion

          Youth and adult patients demonstrated reliable symptom improvements over the course of treatment across all measures, offering preliminary support for the effectiveness of FBT‐ARFID and CBT‐AR delivered virtually by a multidisciplinary care team.

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          Most cited references38

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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                Author and article information

                Contributors
                dr.megan.hellner@gmail.com
                Journal
                Int J Eat Disord
                Int J Eat Disord
                10.1002/(ISSN)1098-108X
                EAT
                The International Journal of Eating Disorders
                John Wiley & Sons, Inc. (Hoboken, USA )
                0276-3478
                1098-108X
                07 January 2025
                April 2025
                : 58
                : 4 ( doiID: 10.1002/eat.v58.4 )
                : 680-689
                Affiliations
                [ 1 ] Research Equip Health Inc Carlsbad USA
                Author notes
                [*] [* ] Correspondence:

                Megan Hellner ( dr.megan.hellner@ 123456gmail.com )

                Author information
                https://orcid.org/0000-0002-3407-023X
                https://orcid.org/0009-0008-6853-9543
                https://orcid.org/0000-0003-4914-0226
                https://orcid.org/0000-0002-3997-2398
                https://orcid.org/0000-0003-4294-2680
                https://orcid.org/0000-0001-7588-4216
                Article
                EAT24355
                10.1002/eat.24355
                11969026
                39775778
                97f5e31d-dd45-42fe-969e-d092c6fdaacc
                © 2025 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 11 November 2024
                : 08 October 2024
                : 30 November 2024
                Page count
                Figures: 0, Tables: 4, Pages: 10, Words: 7400
                Funding
                Funded by: Equip Health, Inc.
                Categories
                Original Article
                Original Article
                Custom metadata
                2.0
                April 2025
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.4 mode:remove_FC converted:04.04.2025

                Clinical Psychology & Psychiatry
                avoidant restrictive food intake disorder,cbt‐ar,children and adolescents,fbt‐arfid,feeding disorders,picky eating,treatment outcomes,virtual treatment

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