(PS6-B31) Parenting Behaviors as Predictors of Engagement in Food Exposure for Avoidant/restrictive Food Intake Disorder

Introduction. Parent involvement is an important factor in the treatment of child psychopathology. The “parent-therapist” model involves teaching parents treatment skills to implement in the home with their child, and therefore requires a high level of parental involvement. Parent-therapist models are foundational to the treatment of pediatric feeding and eating disorders, including avoidant/restrictive food intake disorder (ARFID), where parents need to implement daily mealtime hygiene and food exposures. However, ineffective parenting strategies, such as coercive parenting, as well as negative parent-child relationships have posed barriers to engagement in treatment of other childhood psychological disorders, such as attention-deficit hyperactivity disorder. The current study examined parenting behaviors as predictors of completion of daily food exposures in a brief, parent-training treatment approach for ARFID. We hypothesized that consistent and positive parenting would be positively correlated and coercive parenting and negative parent-child relationship would be negatively correlated with number of exposures per week, four weeks into treatment. Methods. Children ages 5-12 and their parent(s) (n=13) completed two sessions of a parent-training program for ARFID. Families were tasked with completing five food exposures per week on average. Parents completed the Parenting and Family Adjustment Scales (PAFAS) at baseline and self-reported average number of exposures completed four weeks into treatment. Results. T-tests were run to compare parenting styles between parents who did and did not engage in at least five exposures per week by four-week follow-up.  Due to the small sample size, effect sizes are being reported in addition to p-values. Based on effect sizes, high levels of coercive parenting (p=0.31, d=0.67), low encouragement (p=0.45, d=0.59), and poor parent-child relationship (p=0.16, d=0.70) were predictive of not engaging in daily food exposures, and consistent parenting was not predictive of engaging in exposures (p=0.33, d=0.04). Although results were not statistically significant, effect sizes were medium to large for coercive parenting, encouragement, and parent-child relationship. Discussion. Parents are often vital to the implementation of psychological treatments, particularly in feeding and eating disorders, such as ARFID. Our results support our hypotheses that parenting behaviors are predictive of engagement in a treatment requiring regular food exposures, with moderate to large effect sizes. Given the need for consistent practice in the treatment of feeding and eating concerns, typically implemented by parents, treatment approaches will likely benefit from addressing parenting concerns prior to or in the beginning of treatment for ARFID. A primary limitation of the current study is the small sample size, and results should be replicated in other studies of evidence-based treatment.