Avoidant Restrictive Food Intake Disorder (ARFID)-Looking beyond the eating disorder lens?

Avoidant Restrictive Food Intake Disorder (ARFID) was first included as a diagnostic category in 2013, and over the past 10 years has been adopted by the international eating disorder community. While greater awareness of these difficulties has increased identification, demand and enabled advocacy for clinical services, the heterogeneous nature of ARFID poses unique challenges for eating disorder clinicians and researchers. This commentary aims to reflect on some of these challenges, focussing specifically on the risk of viewing ARFID through an eating disorder lens. This includes potential biases in the literature as most recent research has been conducted in specialist child and adolescent eating disorder clinic settings, bringing in to question the generalisability of findings to the broad spectrum of individuals affected by ARFID. We also consider whether viewing ARFID predominantly through an eating disorder lens risks us as a field being blinkered to the range of effective skills our multi-disciplinary feeding colleagues may bring. There are opportunities that may come with the eating disorder field navigating treatment pathways for ARFID, including more joined up working with multi-disciplinary colleagues, the ability to transfer skills used in ARFID treatment to individuals with eating disorder presentations, and most notably an opportunity to provide more effective treatment and service pathways for individuals with ARFID and their families. However, these opportunities will only be realised if eating disorder clinicians and researchers step out of their current silos.

A call for autism-led research exploring definitions of recovery in Autistic individuals with an eating disorder.

RESEARCH GAP: It is now established that definitions of recovery in eating disorders (EDs) should be informed by the lived/living experience of individuals and consider a broad range of physical, behavioral, and psychological factors. Autism is a common co-occurring condition in EDs reflecting unique needs and experiences; however, very little research to date has explored definitions of recovery from EDs in Autistic populations. The current article will briefly review what we know about autism and EDs, before addressing how we can apply and extend what we know about broader ED recovery research to the unique needs of Autistic individuals with ED. SUGGESTED APPROACH: We propose that future studies are urgently required exploring definitions and conceptualizations of recovery in Autistic individuals with EDs, rooted in autism-led, participatory research approaches and incorporating physical, behavioral, and psychological factors. DISCUSSION: Benefits and possible obstacles of implementing the proposed approach are discussed, before the authors outline specific suggestions for participatory designs and targets for future studies. Multidimensional and mixed method approaches to ED recovery will work toward integrating clinically measurable outcomes with lived/living experience perspectives. PUBLIC SIGNIFICANCE: EDs are common in Autistic individuals, however, very little is known about definitions of ED recovery in this population. Cross-disciplinary, research-driven definitions involving lived/living experience at all stages of the research process will generate meaningful and translational research.

Sensory processing and eating behaviours in autism: A systematic review.

OBJECTIVES: The aim of this study was to assess the relationship between sensory processing and a broad range of eating behaviours across the lifespan. METHODS: Five electronic databases of published and unpublished quantitative studies were systematically searched, evaluated for risk of bias and synthesised according to identified eating outcomes. RESULTS: Across 25 studies, there was consistent evidence of a relationship between sensory processing and a range of eating behaviours. There was early evidence for the particular role of taste/smell sensitivities, as well as hypersensitivities, although future research is needed looking at different sensory patterns and modalities. There was also tentative evidence to suggest this relationship extends across development. DISCUSSION: Study findings are discussed in relation to implications for sensory-based eating and feeding interventions and the development of eating disorders. Methodological and conceptual limitations are discussed and suggestions for future research are made to address these limitations. A broader investigation of multi-sensory issues and clearly defined eating behaviours, including disordered eating in clinically diagnosed samples, will allow for a more comprehensive and robust understanding of the relationship between sensory processing and eating behaviours in autism.

What factors influence dyadic synchrony? A systematic review of the literature on predictors of mother-infant dyadic processes of shared behavior and affect.

Dyadic behavioral synchrony is a complex interactional process that takes place between the mother and her infant. In the first year of life, when the infant is prelinguistic, processes such as synchrony enable the dyad to communicate through shared behavior and affect. To date, no systematic review has been carried out to understand the risk and protective factors that influence behavioral synchrony in the mother-infant dyad. The aim of this review was to identify and evaluate the factors that influence behavioral synchrony in the mother-infant dyad, when the infant is between 3 and 9 months old. Key electronic databases were searched between 1970 and April 2021, and 28 eligible studies were identified for review. As the results were largely heterogeneous, four subgroups of factors were identified: (i) infant demographics, (ii) physiological factors, (iii) maternal mental health, and (iv) miscellaneous factors. Identified risk factors and covariates suggest that social determinants of health, underpinned by biological factors, play a large role in influencing behavioral synchrony within the dyad. Implications for the need to identify additional risk and protective factors, as well as design support for at-risk families are discussed.

La sincronía diádica del comportamiento es un proceso complejo de interacción que se lleva a cabo entre la madre y su infante, y en el primero año de vida, cuando el infante está en la época prelingüística. Los procesos como la sincronía le permiten a la díada comunicarse a través del comportamiento y el afecto compartido. Hasta la fecha, ninguna revisión sistemática se ha llevado a cabo para comprender los factores de riesgo y de protección que influyen la sincronía del comportamiento en la díada madre-infante. El propósito de esta revisión fue identificar y evaluar los factores que influyen la sincronía del comportamiento en la díada madre-infante, cuando el infante tiene entre 3 y 9 meses de nacido. Se investigaron bancos claves de datos electrónicos entre 1970 y abril de 2021, y se identificaron 28 estudios aptos para la revisión. Como los resultados fueron en gran parte heterogéneos, se identificaron cuatro subgrupos de factores: (i) datos demográficos del infante, (ii) factores fisiológicos, (iii) salud mental materna, y (iv) factores misceláneos. Los factores de riesgo y covariantes identificados señalan que los determinantes sociales de salud, sustentados por factores biológicos, juegan un papel grande en cuanto a influir la sincronía del comportamiento dentro de la díada. Se discuten las implicaciones para la necesidad de identificar factores de riesgo y de protección adicionales, así como también diseñar el apoyo para familias bajo riesgo.

La synchronie comportementale dyadique est un processus interactionnel complexe qui prend place entre la mère et son bébé. Dans la première année de la vie, quand le bébé ne parle pas, les processus tels que la synchronie permettent à la dyade de communiquer à travers un comportement et un affect partagés. Jusqu'à présent aucune revue systématique n'a été faite pour comprendre les facteurs de risque et les facteurs de protection qui influencent la synchronie comportementale chez la dyade mère-bébé. Le but de cette revue était d'identifier et d'évaluer les facteurs qui influencent la synchronie comportementale chez la dyade mère-bébé, quand le bébé avait entre 3-9 mois. Les bases de données électroniques clés ont fait l'objet des recherches entre 1970 et avril 2021, et 28 études admissibles ont été identifiée pour la revue. Puisque les résultats étaient largement hétérogènes, quatre sous-groupes de facteurs ont été identifiés: (1) données démographiques du bébé, (ii) facteurs physiologiques, (iii) santé mentale maternelle, et (iv) facteurs divers. Les facteurs de risque identifiés et les co-variables suggèrent que les déterminants sociaux de la santé, sous-tendus par des facteurs biologiques, jouent un rôle important en influençant la synchronie comportementale au sein de la dyade. Les implications quant au besoin d'identifier des facteurs de risque et de protection supplémentaire, ainsi que des soutiens aux familles à risque sont discutées.

Distress and Resilience Narratives within Pain Memories of Adolescents and Young Adults with Complex Regional Pain Syndrome: A Multi-Method Study.

A comprehensive understanding of pain memories requires consideration of risk and resilience factors across biopsychosocial domains. Previous research has typically focused on pain-related outcomes, largely ignoring the nature and context of pain memories. Using a multiple-method approach, this study explores the content and context of pain memories in adolescents and young adults with complex regional pain syndrome (CRPS). Recruited via social media and pain-related organizations, participants completed an autobiographical pain memory task. Two-step cluster analysis was conducted on the pain memory narratives of adolescents and young adults with CRPS (n=50) using a modified version of the Pain Narrative Coding Scheme. Narrative profiles generated from the cluster analysis subsequently guided a deductive thematic analysis. Cluster analysis identified two narrative profiles of Distress and Resilience, with the role of coping and positive affect emerging as important profile predictors across pain memories. Subsequent deductive thematic analysis, utilizing Distress and Resilience codes, demonstrated the complex interplay between affect, social, and coping domains. Findings highlight the importance of applying a biopsychosocial framework to pain memory research, accounting for both risk and resilience perspectives and encourage the use of multiple method approaches to improve understanding of autobiographic pain memories. Clinical implications of reframing and recontextualizing pain memories and narratives are discussed, and the importance of exploring the origins of pain and possible application to developing resilience-based, preventative interventions is highlighted. PERSPECTIVE: Using multiple methods, this paper presents a comprehensive account of pain memories in adolescents and young adults with CRPS. Study findings promote the importance of adopting a biopsychosocial approach to examining both risk and resilience factors in understanding autobiographical pain memories in the context of pediatric pain.

"You Feel Like You Kind of Walk Between the Two Worlds": A Participatory Study Exploring How Technology Can Support Emotion Regulation for Autistic People.

An increasing amount of technological solutions aiming to support emotion regulation are being developed for Autistic people. However, there remains a lack of understanding of user needs, and design factors which has led to poor usability and varied success. Furthermore, studies assessing the feasibility of emotion regulation technology via physiological signals for autistic people are increasingly showing promise, yet to date there has been no exploration of views from the autistic community on the benefits/challenges such technology may present in practice. Focus groups with autistic people and their allies were conducted to gain insight into experiences and expectations of technological supports aimed at supporting emotion regulation. Reflexive thematic analysis generated three themes: (1) communication challenges (2) views on emotion regulation technology (3) 'how' technology is implemented. Results provide meaningful insight into the socio-emotional communication challenges faced by autistic people, and explore the expectations of technology aimed at supporting emotion regulation.

"It's not about wanting to be thin or look small, it's about the way it feels": an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents.

BACKGROUND: Despite increasing evidence to support an overlap between autism and anorexia nervosa (AN), underlying mechanisms remain poorly understood. Social and sensory factors have emerged as promising targets in both autism and AN, however there remains scope to compare these differences across autistic and non-autistic experiences of AN. Drawing on dyadic multi-perspectives, this study explored experiences of social and sensory differences in autistic and non-autistic adults and their parents and/or carers. METHODS: Using interpretative phenomenological analysis (IPA), dyadic interviews were conducted with 14 dyads, with seven autistic dyads and seven non-autistic dyads. Data analysis was subjected to a triangulation of interpretations: (1) the participants themselves; (2) a neurotypical researcher; (3) and an Autistic researcher with lived/living experience of AN. RESULTS: IPA identified three themes in each group, with similarities and differences between autistic and non-autistic dyads. Similar themes were identified regarding the importance of social connectedness and socio-emotional difficulties, as well a common lack of trust in the social and sensory self and body. Autism-specific themes centred on feelings of social 'defectiveness', disparities between sensing and expressing certain cues, and lifelong, multi-sensory processing differences. Non-autistic themes reflected social comparisons and inadequacy, and sensitivities to the learning of ideals and behaviour through early experiences. CONCLUSIONS: While similarities were observed across both groups, there appeared to be notable differences in the perceived role and influence of social and sensory differences. These findings may have important implications on the delivery and modification of eating disorder interventions. Specifically, they suggest that while treatment targets may look similar, subtle differences in underlying mechanisms and approaches may be required for Autistic individuals with AN across sensory, emotion and communication-based interventions.

A linguistic analysis of future narratives in adolescents with Complex Regional Pain Syndrome and their pain-free peers.

BACKGROUND: Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that often develops after injury, with a typical onset in adolescence. The impact of chronic pain is far-reaching, with many adolescents reporting atypical developmental trajectories compared with peers. Social Comparison Theory offers a framework for understanding how such comparisons influence well-being, whereby a heightened sense of disparity places adolescents at risk of poor cognitive, affective and social outcomes. Using a novel linguistic analysis programme, this study aims to investigate cognitive, affective and social language used by adolescents with CRPS in comparison to their peers during a task reflecting on their futures. METHODS: A story completion task was completed by adolescents with CPRS (n = 49) and adolescents without pain (n = 48). This task involved asking adolescents to describe their imagined future. Narratives were analysed using a novel linguistic analysis programme, focusing on the cognitive, affective and social dimensions. RESULTS: Findings revealed significant group differences in how adolescents with CRPS described their imagined futures. Adolescents with CRPS used significantly fewer positive affect and more negative affect, anger and sadness words, and greater insight and discrepancy words. No significant groups differences were found for social words. CONCLUSIONS: Substantial differences in cognitive and affective words were found between adolescents with and without CRPS. Findings provide novel insights into current understandings of cognitive, affective and social processes in adolescents living with chronic pain, particularly with regard to adolescent developmental trajectories, and may in turn highlight potential targets in psychosocial interventions for adolescents living with chronic pain. SIGNIFICANCE: Social comparisons are commonly undertaken by adolescents with CRPS in relation to peers, increasing risk for poor cognitive, affective and social outcomes. Findings promote the potential importance of targeting psychosocial factors in treatments for paediatric chronic pain.