Feeling and Body Investigators (FBI)-ARFID Division: Sensory and Somatic Exposure for Children with Avoidant Restrictive Food Intake Disorder

感觉和身体调查员 (FBI)-ARFID 部门：患有回避型限制性食物摄入障碍的儿童的感觉和躯体暴露

• 批准号: 10472736
• 负责人: GUILLERMO R SAPIRO
• 金额: $ 72.04万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-20 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10472736
• 关键词: 9 year old; Address; Affect; Aftercare; Age; Age of Onset; Ambulatory Care; Attention; Body mass index; Caregivers; Cartoons; Cells; Cellular Phone; Child; Clinical; Code; Computers; Consumption; Control Groups; Curiosities; DSM-V; Decision Trees; Depressed mood; Development; Diagnosis; Diagnostic; Diet; Diet Fads; Disease; Distress; Dose; Early Diagnosis; Early Intervention; Eating; Eating Disorders; Emotional; Emotions; Engineering; Esthesia; Etiology; Evaluation; Face; Family; Feeling; Food; Fright; Goals; Growth; Growth and Development function; Guidelines; Heterogeneity; Home; Impairment; Individual; Intervention; Interview; Investigation; Lead; Learning; Link; Maps; Measurement; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Morbidity - disease rate; Motivation; Outcome; Parents; Pathway interactions; Pattern; Primary Health Care; Randomized; Randomized Controlled Trials; Reaction; Research; Research Personnel; Retreatment; Risk; Role; Self Perception; Sensory; Smell Perception; Symptoms; Syndrome; Testing; Texture; Time; Vomiting; Work; approach avoidance behavior; approach behavior; arm; autism spectrum disorder; avoidant restrictive food intake disorder; base; clinical diagnostics; comorbidity; design; dietary; dosage; early childhood; effective intervention; emotional reaction; experience; family support; feeding; follow-up; food avoidance; food consumption; gastrointestinal; improved; improved functioning; interest; machine learning algorithm; negative affect; novel; nutrition; personalized intervention; psychologic; psychosocial; reduce symptoms; response; social; theories; tool; treatment response

Avoidant Restrictive Food Intake Disorder (ARFID) is a newly articulated eating disorder in the DSM-5 in which individuals are not able to consume an adequate quantity or variety of food to sustain healthy growth and de- velopment. ARFID typically onsets in early childhood, yet identification of the disorder is poor. The end result is that children often have sustained inadequate nutrition with resulting severe physical consequences and threats to optimal social and emotional development. Early intervention is essential. However, there are no em- pirically validated treatments for young children with ARFID. Children with ARFID are known to be sensitive individuals: with a low threshold for noticing internal body sensations (e.g., gastrointestinal distress) and exter- nal sensory sensations (e.g., smells) and experiencing these sensations as uncomfortable/aversive. This sen- sitivity, and the associated negative emotional reactions (e.g., of disgust, fear, sadness), may encourage avoidance of activities that cause these sensory experiences, such as eating. An intervention that could change reactions to sensory and somatic sensations to one of playful curiosity may increase approach behav- ior and food consumption. We designed an acceptance-based interoceptive exposure treatment for children to achieve this goal. We teach children and caregivers to be “FBI Agents,” individuals who view somatic and sen- sory sensations as clues to a mystery via the use of engaging illustrative cartoon characters (e.g., Gassy Gus), body investigations that provoke intense sensations and worksheets that map sensations to meanings and ac- tions. The goal is to make somatic and sensory experiences playful – and to promote adaptive self-awareness and food approach. The overall objective of this study is to determine whether treatment results in reduced negative emotions to somatic and sensory sensations, including those associated with food and eating, and whether this, in turn, increases food approach. This will be accomplished by a randomized controlled trial (N = 140, 70 per cell) comparing The Feeling and Body Investigators (FBI) - ARFID Division treatment, a 20-session outpatient treatment, to a control group in children (5 to 9 years of age) with ARFID. The control treatment (FAD: Family-Assisted Diet) will provide family-supported exposure. Our proposed mediator of treatment re- sponse is negative affect: a child’s facial affect in response to food presentation as measured via smartphone videos. Outcomes include changes in anthropometric measurements, nutrition variety and adequacy, and psy- chosocial functioning. Medical and psychological measurements will be assessed pre- and post-treatment, at every session, and 3-month follow-up. Deliverables include an empirically validated treatment(s); medical guidelines for the early detection of insufficient nutrition; practical tools for assessing food acceptance in the home via smartphones; and guidance about the number of food presentations necessary to facilitate acceptance. Ultimately, we will evaluate this treatment and disseminate materials via primary care to provide tools to intervene early on food avoidance.

避免限制性食物摄入障碍（ARFID）是DSM-5中新提出的饮食障碍，其中 个人不能消耗足够数量或种类的食物来维持健康的生长和发育， - 谢谢ARFID通常在幼儿期发病，但对这种疾病的识别很差。最终的结果是 儿童往往营养不足，造成严重的身体后果， 对最佳社交和情感发展的威胁。早期干预至关重要。然而，没有EM- 为患有ARFID的幼儿提供经临床验证的治疗。患有ARFID的儿童是众所周知的敏感 个体：具有用于注意内部身体感觉的低阈值（例如，胃肠道不适）和埃克斯特- 最终感觉（例如，气味）并将这些感觉体验为不舒服/厌恶。这个森- 敏感性，以及相关的负面情绪反应（例如，厌恶，恐惧，悲伤），可能会鼓励 避免引起这些感官体验的活动，如进食。一种干预， 改变对感官和身体感觉的反应，以一种好玩的好奇心，可能会增加接近的敏感性， IOR和食物消费。我们为儿童设计了一种基于接受的内感受性暴露治疗， 以实现这一目标。我们教孩子和照顾者成为“联邦调查局特工”，个人谁查看躯体和感官- 通过使用吸引人的说明性卡通人物（例如，Gassy Gus）， 身体调查，激发强烈的感觉和映射感觉的意义和交流， 选择。目标是使身体和感官体验变得有趣-并促进适应性自我意识 食物的方法。本研究的总体目标是确定治疗是否会降低 对身体和感官的负面情绪，包括与食物和饮食有关的负面情绪，以及 这是否反过来增加了食物的接近。这将通过一项随机对照试验（N = 140，70每细胞）比较的感觉和身体调查员（FBI）- ARFID司治疗，20届 门诊治疗，以ARFID儿童（5至9岁）为对照组。对照处理 (FAD：家庭辅助饮食）将提供家庭支持的接触。我们建议的治疗调解人重新- sponse是负面影响：通过智能手机测量儿童对食物呈现的面部影响 视频.结果包括人体测量的变化，营养的多样性和充足性，以及心理健康。 社会功能将在治疗前和治疗后评估医学和心理测量结果， 每一个疗程，以及3个月的随访。可行性包括经经验验证的治疗;医疗 早期发现营养不足的指导方针; 家庭通过智能手机;和指导的食物介绍，以促进必要的数量 验收最终，我们将评估这种治疗方法，并通过初级保健传播材料， 早期干预食物避免的工具。