This presentation will familiarize child and adolescent psychiatrists with avoidant/restrictive food intake disorder (ARFID) and provide a better understanding of specific and emerging evidence-based practices for the treatment of this condition.

Among children and adolescents, anxiety disorders are common psychiatric disorders that confer risk of comorbid psychiatric disorders and social and academic impairment. This review focuses on the assessment and treatment of anxiety disorders among children and adolescents, with attention to separation anxiety disorder, social phobia disorder (social anxiety disorder), panic disorder, and generalized anxiety disorder. Comprehensive assessment of child and adolescent anxiety disorders benefits from a multimethod approach to evaluation and diagnosis, including semistructured interviews; child and informant questionnaires; collateral information from parents, teachers, pediatricians, and school psychologists; and behavioral observations. Because anxiety symptoms can include avoidance behaviors, somatic complaints, social difficulties, and sleep disturbances, consideration of a differential diagnosis is important. Among the available psychosocial interventions, cognitive-behavioral therapy (CBT) and exposure-based therapies have emerged as the most well-established treatment approaches for addressing anxiety disorders among children and adolescents. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) have been established to be safe and efficacious for the treatment of pediatric anxiety and are considered the medications of choice for this population. Research indicates that CBT plus SSRI medication is the most effective treatment of anxiety for youths ages seven to 17, compared with either CBT or medication alone. Medication monotherapy and CBT monotherapy have also been demonstrated to be effective treatments.

Studies have generally failed to find a significant relationship between common measures of dietary restraint and food consumption. This raises the question of whether these scales represent valid measures of dietary restriction. The aim of the present study was to investigate whether the restraint subscale of the Three Factor Eating Questionnaire (TFEQ-R) predicts caloric intake in a laboratory meal.

OBJECTIVE:This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery.METHOD:Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment.RESULTS:Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery.CONCLUSIONS:As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B.

The ability to exert self-control in the face of appetitive, alluring cues is a critical component of healthy development. The development of behavioral measures that use disease-relevant stimuli can greatly improve our understanding of cue-specific impairments in self-control. To produce such a tool relevant to the study of eating and weight disorders, we modified the traditional go/no-go task to include food and non-food targets. To confirm that performance on this new task was consistent with other go/no-go tasks, it was given to 147 healthy, normal weight volunteers between the ages of 5 and 30. High-resolution photos of food or toys were used as the target and nontarget stimuli. Consistent with expectations, overall improvements in accuracy were seen from childhood to adulthood. Participants responded more quickly and made more commission errors to food cues compared to nonfood cues (F(1,140)=21.76, P<0.001), although no behavioral differences were seen between low- and high-calorie food cues for this non-obese, healthy developmental sample. This novel food-specific go/no-go task may be used to track the development of self-control in the context of food cues and to evaluate deviations or deficits in the development of this ability in individuals at risk for eating problem behaviors and disorders.

Eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), are serious psychiatric illnesses. The morbidity and mortality rates for these disorders are among the highest seen for any psychiatric illness. The serious and complex nature of these illnesses and their associated features have led to the development of psychosocial and medical treatments that utilize a range of treatment settings. Intensive treatments have evolved in efforts to interrupt maladaptive eating and associated behaviors and to manage the medical complications that are commonly present. In this chapter, we introduce and describe intensive treatment for eating disorders and review the evidence for this approach across a range of treatment settings. In addition, we address some of the treatment challenges specific to intensive treatment for eating disorders, with attention to the treatment of the patients who are not voluntary participants in treatment.

Background: Prior studies have reported that students with overweight and obesity have impairments in performance IQ and executive function and worse school functioning in comparison with peers of normal weight. The present study assessed school and cognitive functioning in a sample of adolescents with severe obesity being evaluated for laparoscopic adjustable gastric banding.Methods: Eligible candidates for bariatric surgery were referred for psychiatric evaluation, which included a semistructured clinical interview measuring school functioning and the vocabulary and matrix reasoning subtests of the Wechsler Abbreviated Scale of Intelligence (WASI).Results: Self-reported school problems were common, with 55.5% of adolescents failing a grade or subject, 38.7% attending summer school, and 17.8% failing a citywide examination. A significant relationship was observed between body mass index, estimated WASI IQ (r = -.250; P = .005), and the vocabulary subtest (r = -.241; P = .006), but not matrix reasoning (r = -.126; P = NS).Conclusion: Even among a sample of adolescents with severe obesity, increased body mass index was associated with lower WASI IQ and vocabulary subtest scores. Increasing awareness of potential cognitive and school problems in bariatric candidates among teachers, school counselors, and other mental health providers is an important first step to improving academic support and educational systems deficiencies for students with overweight and obesity. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

CME Educational Objectives 1. Describe the core clinical features of anorexia nervosa (AN). 2. Understand the concerns surrounding the DSM-IV criteria for AN. 3. Delineate the changes in the diagnostic criteria for AN recommended for DSM-5 . The clinical descriptions of anorexia nervosa by Richard Morton in 1689 remains remarkably similar to the condition we recognize as anorexia nervosa today. 1 In fact, the medical history of Mary, Queen of Scots, born in 1542, is thought to be compatible with a diagnosis of anorexia nervosa. 2