Family-based and individual therapy both improve outcomes in pediatric ARFID

In the first adequately powered randomized controlled trial of treatments for avoidant/restrictive food intake disorder (ARFID), both family-based therapy and an individual, play-based approach significantly improved ARFID symptom severity in children aged 6 to 12 years.¹ Family-based treatment also produced significant weight gain; the individual approach did not.¹

“This is the first study, worldwide, to take a systematic, randomized, adequately powered approach to testing treatments for this disorder,” said lead author James Lock, MD, PhD, professor of psychiatry and behavioral sciences at Stanford University School of Medicine.¹ “We now have an evidence base for how to help children with ARFID, at the age when they often present for treatment.”

Trial design and efficacy of family-based vs individual therapy for ARFID

The trial, conducted by Stanford Medicine investigators and published in the Journal of the American Academy of Child & Adolescent Psychiatry, enrolled 98 underweight children aged 6 to 12 years meeting DSM-5 criteria for ARFID.¹ Families were randomized to 1 of 2 telehealth interventions, each comprising 14 one-hour sessions over 4 months.¹ Family-based treatment for ARFID (FBT-ARFID) empowers parents to lead changes in mealtime behavior, with children, siblings, parents, and the therapist participating together in every session.² The comparator, psychoeducational motivational therapy (PMT), is individualized and play-based: children attend 9 sessions, and parents attend 5, with the child identifying his or her own motivators for change.¹

The primary outcome was change in percent estimated body weight, assessed by masked evaluators.² Children receiving FBT-ARFID gained a statistically significant amount of weight, whereas those in the PMT arm did not, and children with higher baseline severity responded better to family-based treatment.¹ Both interventions produced comparable, statistically significant reductions in ARFID symptom severity.¹

ARFID prevalence and diagnostic challenges in children

ARFID, added to the DSM-5 in 2013, differs from anorexia nervosa and bulimia nervosa in that affected children do not restrict intake for body-image reasons; low appetite, sensory aversion, or fear of choking or vomiting drives avoidance instead.¹ It affects an estimated 2% to 6% of children and is more prevalent among youth with ADHD, anxiety disorders, and autism spectrum disorder.¹ Diagnosis is often delayed because early symptoms are mistaken for normal picky eating, even though ARFID does not resolve spontaneously and can cause micronutrient deficiency and impaired growth.¹

Evolution of family-based treatment models for pediatric eating disorders

FBT-ARFID was adapted from family-based approaches previously validated in anorexia nervosa, with earlier Stanford feasibility work establishing that a manualized version was acceptable before this trial was designed.³ That pilot experience informed the study's telehealth model, which allowed nationwide recruitment rather than a single catchment area.²

Clinical interpretation of comparative efficacy findings

Coauthor Brittany Matheson, PhD, a clinical associate professor of psychiatry and behavioral sciences at Stanford, said the findings give clinicians 2 viable options rather than a single default pathway.¹ Because FBT-ARFID appeared more effective for weight restoration and for more severely affected children, clinicians may favor it for underweight patients needing faster rehabilitation, while PMT may suit children better served by an individually driven approach.¹ Both modalities stress that the child did not choose the disorder, a framing investigators say reduces family conflict at mealtimes.¹

Study limitations and next steps for ARFID treatment research

The trial was limited to underweight children aged 6 to 12 years, so findings may not generalize to adolescents, adults, or normal-weight patients with ARFID. Durability of gains beyond the end-of-treatment assessment was not reported. The authors note that some children with more severe presentations still require inpatient, medically supervised care, so outpatient psychotherapy is not sufficient for every severity level.¹

References

1. Lock J, Matheson B, Jo B, et al. Family vs individual treatment for children with avoidant/restrictive food intake disorder: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry. Published online April 20, 2026. doi:10.1016/j.jaac.2026.04.007

2. Stanford Medicine. Two treatments help ARFID, a common pediatric eating disorder, Stanford Medicine trial shows. EurekAlert! Published June 29, 2026. Accessed July 1, 2026. https://www.eurekalert.org/news-releases/1133918

3. Van Wye E, Matheson B, Citron K, et al. Protocol for a randomized clinical trial for Avoidant Restrictive Food Intake Disorder (ARFID) in low-weight youth. Contemp Clin Trials. 2023;124:107036. doi:10.1016/j.cct.2022.107036

4. Lock J, Sadeh-Sharvit S, L'Insalata A. Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord. 2019;52(6):746-751. doi:10.1002/eat.23077