2 - (SYM 5) Addressing Heterogeneity in Presentation of Clinically-significant Selective Eating Using a Pcit-informed Approach: Recent Lessons Learned Within Flexeat

Introduction: Disturbances in eating behavior are observed across a range of clinical populations and are associated with marked clinical impairment and negative psychosocial outcomes. Accordingly, clinically-significant selective eating in youth often presents alongside other clinical issues, such as disruptive behavior, anxious avoidance, mood dysregulation, repetitive behaviors, and hyperactivity, which may make treatment engagement and selection of intervention targets challenging. In response to this clinical challenge, we have developed a novel approach to treating co-occurring disruptive behaviors and selective eating through integration of techniques from Parent-Child Interaction Therapy (PCIT) and behavioral eating interventions, termed “FlexEAT.”     

Methods: We present data from an iterative case series (N = 7; 71.4% male; ages = 6-8) exploring the feasibility of and clinical response to FlexEAT delivered within a university training clinic. Participants completed semi-structured interviews at intake and completed self-report measurements throughout treatment. Trainee therapists implementing the treatment engaged in PCIT coding each session and provided qualitative feedback on experiences delivering the protocol.

Results: All cases endorsed clinically-significant selective eating, but only one participant endorsed growth/malnutrition concerns. Participants presented with a range of co-occurring diagnoses, including attention deficit/hyperactivity disorder, anxiety disorders, and mood disorders. While most cases (71.4%) demonstrated clinical improvements via incorporation of new foods and/or meeting PCIT skill mastery, deviations from the FlexEAT protocol were observed in all cases; most often occurring due to challenges engaging parents in eating-focused treatment and/or a need to address other pressing behavioral issues prior to eating behaviors.

Discussion: Our initial case series data yields several insights regarding a need for greater flexibility in protocol implementation to meet the diverse needs of youth with disruptive behaviors and challenges in food consumption. We highlight our responses to these clinical issues as well as several future directions for adaptations to our approach to ensure effective engagement of families and improved outcomes.