Involvement of children and young people in the conduct of health research: A rapid umbrella review.

BACKGROUND: Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research. AIMS: This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement. METHODS: We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis. RESULTS: The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts-based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership. CONCLUSION: Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated. PATIENT/PUBLIC CONTRIBUTION: This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility.

OBJECTIVES: Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample. METHODS: One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence. RESULTS: The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress. CONCLUSIONS: The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.

Validating and developing a shortened version of the detail and flexibility (DFlex) questionnaire for eating disorders, anxiety and depression.

OBJECTIVE: To validate the original and a shortened version of the Detail and Flexibility (DFlex) Questionnaire. METHOD: Confirmatory factor analyses, internal consistency, and discriminant validity estimates were conducted within individuals with a diagnosis of an eating disorder (ED) (n = 124), an anxiety disorder and/or depression (n = 219), and a community sample (n = 852) (Part 1). Convergent validity of the DFlex through comparisons with the Autism Spectrum Quotient, Wisconsin Card Sorting Task, and Group Embedded Figures Task was undertaken within a combined ED and community sample (N = 68). Test-retest reliability of the DFlex was also examined across 2 years in a community sample (N = 85) (Part 2). RESULTS: The original factor structure of the DFlex was not supported. Hence, a shortened version, the DFlex-Revised, was developed. Good discriminant validity was obtained for the DFlex and DFlex-Revised, however, support for convergent validity was mixed. Finally, the 2-year test-retest reliability for the two DFlex versions was found to be low, suggesting potential malleability in construct over this timeframe. CONCLUSIONS: Further research is needed to validate the DFlex in clinical and non-clinical populations using different neurocognitive tests. Test-retest, using varied time intervals, should also be assessed.

When eating disorder attitudes and cognitions persist after weight restoration: An exploratory examination of non-cognitive responders to family-based treatment for adolescent anorexia nervosa.

OBJECTIVE: Family-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment. METHODS: Data were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7% female, Agemean [SD] = 14.66 [1.73]). RESULTS: By 12 months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period. CONCLUSIONS: A subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months after FBT even when weight restoration is achieved.

Bridging of childhood obsessive-compulsive personality disorder traits and adult eating disorder symptoms: A network analysis approach.

OBJECTIVES: Obsessive-compulsive personality disorder (OCDP) traits are commonly associated with eating disorders (EDs), with evidence demonstrating that these traits predispose and exacerbate the ED illness course. However, limited research has examined the symptomatic interplay between ED and OCDP traits. We used network analysis to (1) identify the most central symptoms in a network comprised of OCPD traits retrospectively assessed in childhood and ED symptoms and (2) to identify symptoms which bridged OCPD traits and ED symptoms. METHODS: Participants were 320 females with an ED (anorexia nervosa n = 227, bulimia nervosa n = 93), who completed the semi-structured EATATE interview and the Eating Disorder Inventory-2. Expected influence (EI) was computed to determine each symptom's influence in the network. Bridge symptoms were identified by computing bridge EI. RESULTS: A regularised partial correlation network showed that ascetism, social insecurity, ineffectiveness, and impulsivity had the highest EI in the OCPD and ED network. With respect to bridging symptoms, interpersonal distrust emerged as a possible bridging node between the OCPD and ED trait/symptom clusters. DISCUSSION: These findings highlight the centrality of non-specific ED symptoms in the ED symptom network and suggest that interpersonal distrust may play a functional role through which childhood OCPD traits and ED symptoms are connected.

Gender-based clinical differences in evidence-based treatment for adolescent anorexia nervosa: analysis of aggregated randomized controlled trials.

PURPOSE: Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited. METHODS: Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (% median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE). RESULTS: There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant. CONCLUSION: Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men. LEVEL OF EVIDENCE: Level 1, secondary data analysis of randomized controlled trials.

Family-based treatment for adolescent anorexia nervosa: Outcomes of a stepped-care model.

OBJECTIVE: Stepped-care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family-based treatment (FBT), we developed an FBT-based stepped-care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end-of-treatment. METHOD: Adolescents (N = 82), aged 12-18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16-18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms. RESULTS: Remission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed. DISCUSSION: This stepped-care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped-care models for adolescents with AN.

Do orthorexia and intolerance of uncertainty mediate the relationship between autism spectrum traits and disordered eating symptoms?

PURPOSE: Autism spectrum disorder traits have been implicated in the psychopathology of eating disorders and may also be relevant for the development of orthorexia symptoms. Further, intolerance of uncertainty (IUS) may indirectly contribute to the development of disordered eating, as the displacement of anxiety onto food may help achieve a sense of control and maximise certainty. We examined a new cognitive model of eating pathology which assessed the role of IU and orthorexia symptoms as potential mediators of the relationship between autistic traits and disordered eating in a community sample. METHODS: Three-hundred-and-ninety-six female participants (M = 20.07, SD = 4.52 years old) completed an online self-report questionnaire which assessed the variables of interest. RESULTS: Despite finding significant bivariate correlations, our model results showed that autistic traits did not directly predict disordered eating or orthorexia symptoms. Significant indirect relationships were found between autistic traits and eating disorder symptoms through both IU and orthorexia symptoms. CONCLUSION: The findings provide partial support for our proposed model suggesting that autistic traits may increase the vulnerability for disordered eating, not directly, but through their associations with mechanisms such as IU and the development of problematic eating behaviours typical of orthorexia. Future research should focus on whether targeting IU may assist in preventing the development of disordered eating. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The cognitive-interpersonal model of disordered eating: A test of the mediating role of alexithymia.

OBJECTIVE: The cognitive-interpersonal model proposes that high levels of attention to detail and cognitive rigidity confer risk for the development of eating disorders (EDs) and that socioemotional deficits, such as alexithymia, contribute to their maintenance. However, no studies have examined the direct and indirect relationships of these constructs. We investigated the mediating role of specific alexithymia traits (difficulties describing feelings, difficulties identifying feelings, and externally oriented thinking) on the relationship between attention to detail, cognitive rigidity, and ED symptoms while controlling for anxiety and depression symptoms. METHOD: Four hundred and one nonclinical female participants (M = 20.57, SD = 4.99 years old) completed self-report measures assessing the variables of interest. RESULTS: Path analyses revealed that difficulties identifying feelings was the only significant mediator between attention to detail and cognitive rigidity to ED symptoms. However, these mediation effects became nonsignificant after controlling for anxiety and depression. CONCLUSIONS: Difficulties identifying feelings may in part underlie the relationship between attention to detail and cognitive rigidity and ED symptoms, providing support for the cognitive-interpersonal model. However, these relationships are heavily influenced by anxiety and depression symptoms. Enhancing individual's ability to identify emotional states may help to decrease ED symptoms for individuals who report high levels of attention to detail and cognitive rigidity.

Family-based treatment for adolescent anorexia nervosa: What happens to rates of comorbid diagnoses?

OBJECTIVE: Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family-based treatment (FBT). METHODS: Adolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association. RESULTS: Rates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p < .05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = -1.63, p = .04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT. CONCLUSIONS: Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co-occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment.

Variability in remission in family therapy for anorexia nervosa.

OBJECTIVE: The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. METHOD: We conducted a secondary analysis of data from a single-site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end-of-treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. RESULTS: We found wide variability in remission rates (21.7-87.7%; Cochran's Q χ2 (10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. DISCUSSION: Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.

Eating disorder symptoms across the weight spectrum in Australian adolescents.

OBJECTIVE: Despite known associations between eating disorders and obesity, little is known about the current prevalence of symptoms of eating disorders across the weight spectrum. This study therefore aimed to estimate the population prevalence of eating disorder symptoms in relation to weight status in adolescents. METHOD: The sample comprised 3,270 participants (14-15 years; 52% boys) drawn from Wave 6 of the Longitudinal Study of Australian Children. Symptoms of anorexia nervosa (AN) and bulimia nervosa (BN) were assessed using self-report on the Branched Eating Disorder Test. This measure identifies clinically significant symptoms in the past 3 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Using study-derived cross-sectional population weights, the prevalence of each symptom was estimated for the total population and by sex and weight status. RESULTS: The estimated population prevalence was high (14.3-25.7%) for body image symptoms such as fear of weight gain and overvaluation of body weight but lower (0.5-3.7%) for behavioral symptoms such as binge eating and compensatory behaviors. Symptoms were more prevalent among adolescents with overweight or obesity. Although most symptoms tended to have higher prevalence among girls than boys, boys with obesity had higher prevalence of binge eating and excessive exercise than girls with obesity. The overall estimated population prevalence for AN and BN was 0.20% and 0.10%, respectively. DISCUSSION: The study highlights a need for clinicians to be cognizant of disordered eating behaviors regardless of weight status and has implications for both eating disorder and obesity prevention and intervention.

Predictors of early response in conjoint and separated models of family-based treatment for adolescent anorexia nervosa.

OBJECTIVE: Early response, as indicated by early weight gain, in family-based treatment (FBT) for adolescent anorexia nervosa (AN) predicts remission at end of treatment. However, little is known about what factors contribute to early response. Further, no previous studies have examined early response to separated forms of FBT. METHOD: Data from a randomised clinical trial of conjoint FBT and separated FBT (parent-focused treatment, PFT) were analysed to examine the timing and amount of early weight gain that predicted remission and identify factors associated with early response. RESULTS: Weight gain of at least 2.80 kg in FBT (N = 55) and 2.28 kg in PFT (N = 51), by Session 5, were the best predictors of remission at end of treatment. Early response in FBT was predicted by greater paternal therapeutic alliance and lower paternal criticism. Early response in PFT was predicted by less severe eating-disorder symptoms and negative affect at baseline, lower maternal criticism, and greater adolescent therapeutic alliance. CONCLUSIONS: The results confirm that early weight gain is an important prognostic indicator in both conjoint FBT and PFT and suggest that addressing negative emotion, parental criticism, and therapeutic alliance early in treatment could improve remission rates.

Tackling mixed messages: Practitioner reflections on working with adolescents with atypical anorexia and their families.

The treatment of atypical anorexia nervosa (AN) poses new research and practice challenges for the field of eating disorders. The objective of this study was to describe frontline practitioners' perceptions of differences between adolescents living with atypical versus typical AN, as well as the intervention challenges they experience when working with these adolescents and their families. We followed the principles of fundamental qualitative description and recruited a purposeful sample of practitioners treating adolescent eating disorders to complete a one-on-one semi-structured interview. Conventional content analysis and the constant comparison technique were used for data analysis. A total of 23 practitioners from four countries participated in this study. Practitioners described that adolescents with atypical AN present with higher pre-morbid weights and rates of weight-based teasing compared to their AN peers. Clinical challenges perceived by practitioners to be specific to working with adolescents with atypical AN included: addressing conflicting messages about eating disorders and weight loss, empathizing with a justified fear of weight gain, and increased risk for parental and therapist collusion with the eating disorder. Findings have implications for delivering interventions to adolescents seeking care for atypical AN.

Feasibility of a parent education and skills workshop for improving response to family-based treatment of adolescent anorexia nervosa.

OBJECTIVE: Early response to family-based treatment (FBT) is a robust predictor of positive outcomes for adolescents with anorexia nervosa (AN). We introduced a parent education and skills workshop in the first 4 weeks of treatment with the aim of improving changes in parent self-efficacy in FBT and, in turn, patient weight gain. METHOD: Forty-five families who had at least one parent attend the workshop were compared to a matched control of families who did FBT before the workshop was introduced. RESULTS: Among adolescents who were underweight at baseline, weight gain by Week 4 of treatment was higher for adolescents whose parents attended the workshop (M = 90.84% median BMI) than those who did not (M = 88.54% mBMI, p < .05). There was no significant difference in weight at Week 12 or at end of treatment, nor was there a difference in self-efficacy as measured by the Parent Versus Anorexia Scale. Participants reported a high level of satisfaction with the workshop and significant improvements in knowledge and confidence. DISCUSSION: Overall, the workshop was a feasible adjunct for improving early response to FBT.

The Participation of Mothers, Fathers, and Siblings in Family-Based Treatment for Adolescent Anorexia Nervosa.

In family-based treatment (FBT) for adolescent anorexia nervosa, all family members are encouraged to attend sessions with the understanding that absences negatively impact treatment. There are, however, many obstacles to family members' attendance, and there is no research to indicate whether family member attendance improves treatment outcomes. We examined attendance patterns of 198 families who participated in FBT at a specialist pediatric eating disorders program and assessed the extent to which participation by mothers (n = 194), fathers (n = 175), and siblings (n = 165; 50% female) predicted outcome. All mothers attended at least one session, and 74% attended all sessions. By comparison, 95% of fathers and 73% of siblings attended at least one session, and 33% of fathers and 1% of siblings attended all sessions. The mean proportion of sessions attended was 94% for mothers, 72% for fathers, and 20% for siblings. Over 6 months of treatment, the proportion of mothers who attended each session was largely stable; fathers' attendance declined slowly, and siblings' attendance declined more rapidly. Greater attendance by fathers predicted higher weight and lower eating disorder symptoms in adolescents at end of treatment. Remission at end of treatment was associated with higher attendance by fathers (M = 81% vs. M = 69%). Achieving sustained engagement of the whole family system in FBT is a considerable challenge. However, this study demonstrates that implementing processes that encourage and enable family members to attend treatment sessions could have significant benefits for patient outcomes.

Parental Expressed Emotion During Two Forms of Family-Based Treatment for Adolescent Anorexia Nervosa.

High parental expressed emotion (EE), reflected by criticism or emotional over-involvement, has been related to poorer outcome in family-based treatment (FBT) for adolescent anorexia nervosa. This study assessed EE in 89 mothers and 64 fathers at baseline and end of treatment in a randomised trial comparing conjoint FBT to parent-focused FBT (PFT). Compared with conjoint FBT, PFT was associated with a decrease in maternal criticism, regardless of adolescent remission. Furthermore, an increase in maternal criticism was more likely to be observed in conjoint FBT (80%) than PFT (20%, p = 0.001). Adolescents of mothers who demonstrated an increase in EE, or remained high in EE, were less likely to remit compared with adolescents for whom EE decreased or remained low (33% and 0% vs. 43% and 50%, p = 0.03). There were no significant effects for paternal EE. The results highlight the importance of considering EE when implementing FBT for adolescents with anorexia nervosa. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Body image diversity in the media: A content analysis of women's fashion magazines.

ISSUE ADDRESSED: The narrow representation of body image in the media has been linked to body dissatisfaction, particularly among readers of women's fashion magazines. Some countries have made efforts to improve body image diversity in the media and the fashion industry. This has included attempts to regulate minimum body size of models (eg, Israel, France), and the development of codes of practices such as the Australian Industry Code of Conduct on Body Image. However, there is little evidence of whether these efforts have impacted media content. METHOD: This study aimed to gauge the state of body image diversity in the print media 5 years after the introduction of the Australian Code of Conduct via a content analysis of 13 Australian women's fashion magazines published in 2015. RESULTS: Results revealed low levels of diversity in body size, ethnicity and age among models depicted in fashion magazine images. Models were predominantly young, white and underweight. CONCLUSION: The results suggest that efforts to improve body image diversity have had little impact on print media. Further research is needed to understand the barriers to increased diversity in the representation of body image in the media so that the industry and regulatory bodies can further address this important issue. This is increasingly pressing given the proliferation of content now enabled through online media platforms.

"They don't really get heard": A qualitative study of sibling involvement across two forms of family-based treatment for adolescent anorexia nervosa.

Little is known about the involvement of siblings in family-based treatment (FBT) for anorexia nervosa (AN). To explore the experience of families, adolescents who had completed FBT, their siblings, and parents were interviewed. Siblings reported that involvement in FBT enhanced their understanding of anorexia and that they supported their family in various ways. While siblings often wished they had attended more sessions, there was no consensus among parents and patients regarding sibling attendance and many were concerned about potential negative impacts on siblings. Clinicians should discuss sibling roles and expectations early in FBT and work actively with families to address concerns.

A case series of family-based treatment for adolescents with atypical anorexia nervosa.

The aim of this case series was to examine engagement in and outcomes of family-based treatment (FBT) for adolescents with DSM-5 atypical AN, that is, adolescents who were not underweight at presentation. Consecutive referrals for FBT of adolescents with atypical AN to a specialist child and adolescent eating disorder program were examined. Engagement in treatment (i.e., dose of treatment, completion rate), and changes in psychological symptomatology (i.e., eating disorder symptoms, depressive symptoms, self-esteem, obsessive compulsiveness), weight, and menstrual function were examined. The need for additional interventions (i.e., hospitalization and medication), and estimated remission rates were also examined. The sample comprised 42 adolescents aged 12-18 years (88% female). Engagement in FBT was high, with 83% completing at least half the treatment dose. There were significant decreases in eating disorder and depressive symptoms during FBT (p < .05) but no improvement in self-esteem. There was no significant change in percent of median BMI for age and gender for the sample as a whole (105 vs. 106%, p = .128). However, adolescents who were not admitted to hospital prior to FBT gained some weight (M = 3.4 kg) while those who were admitted did not gain weight during FBT (M = 0.2 kg, p < .01). The overall remission rate ranged from 38 to 52% depending on the criteria applied. FBT appears to be an effective treatment for adolescents with atypical AN. However, more research is needed into systematic adaptations of FBT and other treatments that could improve overall remission rates.