Abstract

Most randomized controlled treatment trials for eating disorders (ED) show no differences, or differences that diminish over time, between treatment arms. The most likely explanation for this is that there is too much variability within the patient groups. For young people the evidence for the effectiveness of treatment is stronger than for adults, in that (probably) most young people (who have parental/carer support) with an ED (or at least with anorexia nervosa) should be offered family therapy (in conjoint, separated or multifamily format) as first line treatment on an outpatient (or if too sick, day patient) basis. In addition, research suggests that inpatient treatment is not best considered as the next step when outpatient treatment fails, and that specialist multidisciplinary Child and Adolescent ED services detect more cases, provide better continuity of care and reduce admissions. Clinicians need frameworks for practice based on research, clinical experience and the perspectives of patients and carers that facilitate problem solving at an individual patient level. Ideally a stepped care model will determine the level of care offered at each stage of presentation and provide clear thresholds for changing therapeutic direction or transfer to other services. Such a model may also facilitate a better understanding not simply of ‘does treatment X work?’ but ‘for who does it work?’ i.e. mediators and moderators of treatment response, thereby improving prediction of individual prognosis. This presentation will review what is known about treatment response in children and adolescents, with a focus on the early stages of presentation, and suggest factors to consider in developing a stepped model for child and adolescent eating disorders.
Keywords: feeding; eating disorders; stepped care model.

Presentation
Download the full presentation here (pdf file, 31 slides).