Children gained weight steadily in family-based treatment, while individual therapy didn’t tip the scale
STUDY: Lock J et al, J Am Acad Child Adolesc Psychiatry 2026
STUDY TYPE: Randomized controlled trial
FUNDING: National Institute of Mental Health
Background
Avoidant/restrictive food intake disorder (ARFID), added to the DSM-5 in 2013, involves limited interest in eating, sensory sensitivity, or fear of choking, without the body image concerns that define anorexia. There are no adequately powered trials have tested treatments in this new diagnosis, so this is a first, comparing family vs individual tele-therapy in children.
Besides the family involvement, the two therapies differ in approach. Family-based treatment puts parents in charge of feeding; individual therapy coaches the child and asks parents to hold back.
The Study
- 98 underweight children, ages 6 to 12, randomized to 14 telehealth sessions of family-based or individual therapy over 4 months
- Primary outcome: change in percent expected body weight
Results
Percent expected body weight rose from 85.7% to 90.5% with family therapy, while it barely changed through individual therapy, 86.7% to 86.5% (effect size 0.77 favoring family therapy).
Both therapies brought similar reductions in ARFID severity on the eating disorder scale (PARDI). The most symptomatic children gained most from family therapy. For individual therapy, authoritarian parents’ predicted a worse response.
Side Effects
Both treatments were well tolerated, with no ARFID-related hospitalizations or serious adverse events in either arm.
Limitations
The trial screened out 42% of otherwise eligible children for not being underweight, so findings apply only to underweight ARFID. Weight was parent-reported.
Practice Implications
- Start with family-based therapy for children with ARFID.
- Other childhood disorders that respond better to family vs individual-based thearpy include anorexia, bipolar, depression, and substance use disorders.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
