What's being said: exploring parental comments during a family meal session in family based treatment for avoidant/restrictive food intake disorder.

Objective: Avoidant/restrictive food intake disorder (ARFID) is characterized by an avoidance or restriction of food intake due to a lack of interest in eating or foods, sensory sensitivities, and/or fear of adverse consequences, resulting in physical, medical, or psychosocial impairment. While previous studies in other eating disorders have found correlations between parental hostility, critical comments, and treatment outcomes, the ways that parents display their emotions and thoughts have not been evaluated in families of children with ARFID. Method: This study coded parental emotions and responsiveness in therapist-guided family meals during session two of manualized Family-Based Treatment (FBT) for ARFID to examine what types of comments were made. Thirty-one recorded meals were randomly selected from a randomized clinical treatment trial for children 6-12 years old with low-weight ARFID receiving FBT. The videos were double-coded with consensus and scoring guidelines developed in alignment with expressed emotion constructs (warmth, positive comments, hostility, critical comments, and emotional overinvolvement) but modified to fit the age range of ARFID children and the setting of the family-meal. Results: The study found that parents tended to make more positive comments than critical comments, with low scores of hostile comments and emotional overinvolvement. Discussion: Overall, these findings may suggest that some families enter treatment with relational strengths that can be leveraged therapeutically to reduce mealtime conflicts and improve treatment outcomes. The findings also support the establishment of a coding framework for parental emotions during mealtimes of families of children with low-weight ARFID and highlight the need for further research.