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This study examined the feasibility and preliminary effectiveness of a cognitive‐behavioral, family‐centered partial hospitalization program (PHP) for adolescents with anorexia nervosa (AN) and atypical AN (AAN), and described the outpatient services received following discharge. Participants (N = 31) completed anthropometric and self‐report assessments at admission, discharge, and six and twelve months after discharge from the PHP. Descriptive statistics explored markers of feasibility. Paired samples t‐tests evaluated changes in weight and eating disorder (ED) symptomatology from admission to discharge, admission to six‐month follow‐up, and admission to twelve‐month follow‐up. Descriptive statistics and effect sizes compared symptoms at each timepoint between participants with AN and AAN. Results indicated that we were successful at recruiting greater than 50% of adolescents approached for this study. We collected follow‐up data from more than 70% of participants at discharge, but did not meet this retention benchmark at six‐month and twelve‐month follow‐ups. The entire sample demonstrated significant improvements in weight and ED symptomatology from admission to discharge, and generally maintained these improvements at six‐ and twelve‐month follow‐up. While descriptive statistics suggested that participants with AN and AAN received similar outpatient services following discharge from the PHP, those with AN experienced greater improvement in self‐reported ED symptomatology than those with AAN at six‐ and twelve‐month follow‐up. These findings provide preliminary support for the efficacy of PHPs in treating adolescents with AN and AAN. Further research with larger sample sizes should investigate whether adolescents with AAN experience poorer outcomes than those with AN following discharge from a PHP. Key points: Satisfactory benchmarks for recruitment at PHP admission and retention at PHP discharge were met, but these benchmarks were not met at the two follow‐up timepoints. Future studies should utilize improved retention strategies.Preliminary results indicate that adolescents with AN and AAN experienced significant improvements from admission to discharge, further supporting the effectiveness of PHPs for people with AN and AAN.The sample also experienced significant weight increases and ED symptom reductions on all self‐report measures changes from admission to six‐month and twelve‐month follow‐up, suggesting that the treatment gains made in the PHP were generally maintained over time.Descriptively, trends suggest that adolescents with AN and AAN may continue to experience similar increases in %MBMI in the year after discharge from a PHP, but different trajectories of self‐reported ED symptoms, as adolescents with AAN tended to report higher scores on measures of ED symptomatology at follow‐up relative to discharge.This study provides support for the feasibility of a larger study evaluating the effectiveness of a cognitive‐behavioral, family‐centered PHP for adolescents with AN and AAN. Future versions of the study with larger sample sizes should aim to statistically compare differences between outcomes in the AN and AAN groups. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the factorial, divergent, and criterion‐related validity of the Youth‐Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y‐NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED). Method: Participants included 310 patients (82.9% female, 77.4% White, Age M = 14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three‐factor of the Y‐NIAS. One‐way analysis of variance compared Y‐NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion‐related validity of the obtained Y‐NIAS cut‐scores. Results: CFA supported the original three‐factor structure of the Y‐NIAS. Clinically‐elevated scores were observed in all diagnostic groups except for binge‐eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE‐Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%). Discussion: The Y‐NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y‐NIAS for identifying clinically‐significant ARFID presentations from other ED diagnoses. Key points: The Y‐NIAS demonstrated acceptable factorial validity, internal consistency, and discriminant validity with a measure of weight/shape‐driven disordered eating.Mean scores on the Y‐NIAS subscales did not significantly differ between those diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID) and those diagnosed with other eating disorders.Cut scores for the picky eating (PE) and Fear subscales with high sensitivity and acceptable specificity were identified, but positive predictive value (PPV) was low.Despite limited ability to discriminate ARFID from other eating disorders, the Y‐NIAS was able to identify clinically‐elevated scores in all diagnostic groups with restrictive eating disorders, indicating that it may have the potential to serve as a transdiagnostic ED screener. [ABSTRACT FROM AUTHOR]

There is very little information available regarding the health needs of transgender and gender diverse adolescents and young adults with gender dysphoria who reside in rural areas of the United States. This study aims to determine if residing in a rural area is associated with the use of telemedicine services, such as synchronous voice-video appointments, for initial contact for medical interventions for gender-related reasons in adolescents and young adults with gender incongruence. This study is a retrospective chart review of patients (N = 176) ages 10–24 years who had an initial medical appointment for gender-related concerns between July 1, 2020 and June 30, 2022. Participants were determined to be rural or not based on address eligibility for rural-related health care services by the Centers for Medicare and Medicaid Services Rural Health Clinics Program or the Federal Office of Rural Health Policy grant programs. The use of telemedicine versus in-person appointments were compared, as were initial medical prescriptions (hormones, psychotropic medications, contraceptives, etc.) and recommendations for medical follow-ups made at this initial appointment. Most participants did not reside in a rural location (N = 130). There was no statistically significant difference in the use of telemedicine versus in-person care in rural patients (22% vs. 78%) as compared to nonrural patients (21% vs. 79%), nor any statistically significant differences in the medical decisions made at the initial appointment with respect to rurality or modality of care. Residing in a rural area is not associated with either choice of in-person care versus telemedicine services for initial medical appointments or medical decision-making. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P). Method: The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6–18, N = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). Results: After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q (r =.69), and moderate convergent validity with child scores on the GAD-7 (r =.37) and PHQ-9 (r =.46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns. Discussion: The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between‐session and within‐session habituation. Method: We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology. Results: Multilevel models found that pre‐exposure SUDS decreased over time, providing some evidence that between‐session habituation occurred. In contrast, the difference between pre‐exposure and post‐exposure SUDS did not decrease over time, indicating that within‐session habituation did not occur. Weight gain predicted greater between‐session habituation to feared foods, but did not predict within‐session habituation. Between‐session habituation, but not within‐session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure. Discussion: Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within‐session habituation, and to better understand between‐session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs. Public Significance: This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between‐session habituation, but not within‐session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within‐session habituation when conducting food exposure for EDs, and understand the importance of between‐session habituation as a potential mechanism of food exposure. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess long‐term outcomes of patients with avoidant/restrictive food intake disorder (ARFID) treated in a partial hospitalization program (PHP) for eating disorders (ED). Method: A cross‐sectional study comparing patients with ARFID to those with anorexia nervosa (AN) who had been discharged from a PHP for at least 12 months was performed. Percent median body mass index (%MBMI), scores on the Children's Eating Attitudes Test (ChEAT), and treatment utilization were assessed, with intake and discharge data collected via retrospective chart review. Results: Of the 137 eligible patients, 62 (45.3%) consented to follow‐up data collection. Patients with ARFID and AN exhibited similar increases in %MBMI from intake to discharge and reported low scores on the ChEAT by discharge. Patients with ARFID and AN maintained good weight outcomes and low ChEAT scores at follow‐up. Most participants were still receiving outpatient treatment from a variety of providers, although fewer with ARFID than AN continued to receive services from our multidisciplinary ED clinic. Discussion: Patients with ARFID and AN exhibit similar improvements in %MBMI when treated in the same PHP and appear to maintain treatment gains at long‐term follow‐up. Additionally, most patients continue to utilize outpatient services after being discharged from a PHP. [ABSTRACT FROM AUTHOR]

OBJECTIVES: With this study, we aim to describe transgender and nonbinary adolescents and young adults' stated gender treatment goals at the time of initial presentation to medical care. METHODS: This is a retrospective chart review of transgender and nonbinary patients aged 10 to 24 seeking specific gender-affirming health care. Charts were reviewed for specifically stated goals of future hormonal or surgical care for gender and analyzed by the experienced or asserted gender (man, woman, nonbinary, eclectic) of participants. RESULTS: In total, 176 patient encounters were reviewed. Of these, 71% were assigned female at birth. Most participants experienced a masculine gender (46.6%), identified as white (65.3%), and had private health insurance (73.3%). Most patients had a goal of initiating hormone therapy (97.4%) and eventual surgery (87.1%). Of those who had a surgical goal, most (87.5%) desired surgery of the chest or breast, and a minority (29.3%) desired eventual genital surgery. The second-largest gender group was patients who either declined to state an asserted gender or felt unable to describe their gender experience (eclectic, 23.3%), and this group's treatment goals did not mirror any other group's goals. CONCLUSIONS: At the time of initial presentation to medical care for gender-specific needs, many adolescents are capable of asserting specific treatment goals. Most do not desire genital surgery. A large minority of patients decline to state an asserted gender or feel unable to assert a specific gender, and this population appears distinct from more traditional genders in terms of treatment goals. [ABSTRACT FROM AUTHOR]

The Fear of Food Measure (FOFM) was developed to assess eating-related anxiety and evaluate outcomes of food exposure treatment. The FOFM scores in adult community and clinical samples have demonstrated good factor structure, reliability, and validity, but the FOFM has yet to be evaluated in adolescents, despite eating disorders (EDs) being extremely prevalent during adolescence. The current research evaluated the psychometric properties of the FOFM in three independent child and adolescent samples ages 11–18: patients at two separate intensive treatment programs for EDs (N = 688, N = 151) and students in an all-girl high school (N = 310). The revised adolescent version of FOFM (FOFM-A) consists of 10 items and three subscales: Anxiety About Eating, Food Anxiety Rules, and Social Eating Anxiety. We also found support for the use of a global FOFM-A score in an adolescent population. The FOFM-A scores evidenced good internal consistency as well as convergent, discriminant, and incremental validity across all samples. FOFM-A subscales strongly correlated with other measures of ED symptoms and moderately to strongly correlated with measures of anxiety and depression. Adolescents diagnosed with EDs scored significantly higher on all subscales of FOFM-A compared to a community high school sample without ED diagnoses. We identified that a total FOFM-A cutoff score of 1.93 best differentiates between those with and without ED diagnoses. The FOFM-A may be useful in the assessment and treatment of eating-related anxiety and avoidance in adolescents. Public Significance Statement: The study provides evidence for reliability and validity of the scores of the Fear of Food Measure adapted to adolescents (FOFM-A). The FOFM-A can be used to access eating-related anxiety in adolescents with and without an ED diagnosis and help assess outcomes of exposure-informed treatment programs. [ABSTRACT FROM AUTHOR]