Session One:

“What happens during the first months and years of life matters a lot…it sets either a sturdy or fragile stage for what follows.”  Shonkoff and Phillips. From Neurons to Neighborhoods: the science of early child development

The first session explores the formative years, when children learn to relate to food and their bodies. With a base of “typical” development around eating, knowing how, when and why an individual diverged from typical informs treatment. Negative experiences with food or mealtimes (including anything that made chewing, eating, swallowing, or digesting negative, difficult, or painful) increase the odds of avoidant eating. With a relational lens, understanding challenges such as aversive experiences, sensory differences, temperament, anxiety, and the piece that is often missing- feeding dynamics- informs treatment beyond merely addressing presenting symptoms.

We will also consider the spectrum of “picky” eating to ARFID, and examine the current eating disorder ARFID research.

1. Describe three common worries parents have related to a child’s eating
2. Describe “responsive” feeding and how it differs from authoritarian or permissive feeding styles
3. List possible reasons (in addition to fear of choking or vomiting) why we might observe an individual avoiding eating
4. List three common tactics parents use to try to “get” children to eat more or different foods
5. Consider how research focused on intensive ED treatment may impact protocols and refeeding as it relates to weight trajectory and subtypes of ARFID

Session Two:

Session two builds on the foundation from Session 1 to consider the range of common pediatric feeding therapies that your clients may have experienced, and the philosophies behind them. We then transition to clinical application: an overview of the STEPs+ approach of Responsive Feeding Therapy (RFT), assessment, addressing parental or teen/adults’ worry and frustration, supporting interoception, appetite and curiosity, and navigating the potential negative complications of non-responsive feeding and therapies. We touch on trauma and neurodiversity, and set the stage for session three’s panel of presenters as we dive more into treatment.

Objectives:

1. List two common pediatric feeding therapy approaches and briefly discuss how autonomy and internal motivation are supported or not
2. Describe how feeding and eating disorder therapy can pressure, and may recreate non-responsive feeding and resistance cycle
3. Describe why reducing anxiety and conflict helps appetite
4. Describe how goal-setting, anticipatory guidance and pointing out progress helps parents avoid counterproductive feeding
5. List some “tools” RDs may use from their treatment toolbox that fit in with a responsive approach

 

Speaker Bio:

Katja Rowell MD is a responsive feeding specialist, described as “academic, but warm and down to earth.” She was a clinical faculty member of the Ellyn Satter Institute and has joined a group of multidisciplinary experts to develop, research and promote “responsive feeding therapy” as an approach to selective/avoidant eating.

Rowell has a special interest in sharing this work with eating disorder providers: viewing ARFID from a lifespan understanding, bringing together child development, nutrition, and relational feeding dynamics, with a trauma-informed lens and with cultural humility.

Rowell has co-authored articles including, Self-Determination Theory as a Theoretical Framework for Responsive Approach to Child Feeding(JNEB 2020), and a recently released White Paper on  Responsive Feeding Therapy: Values and Practice. With Grace Wong, RD, CEDRD-S, she co-wrote articles on Responsive treatment approaches to ARFID for NEDIC (National Eating Disorder Information Centre) and provided clinical supervision to RDs. Her books include: Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders, Conquer Picky Eating for Teens and Adults

 

Session Description: This workshop will discuss common therapy approaches used in ARFID treatment and introduce the Responsive Feeding Therapy (RFT) framework.  Participants are encouraged to integrate learning from the previous session and evaluate how different therapy modalities address concerns related to ARFID.  Participants are invited to reflect critically in how to approach treatment as our understanding of ARFID evolves and grows.

Learning objectives:

• Identify key elements of the following treatment approaches (family-based treatment, cognitive behavioral therapy, sensory-based therapy)
• Describe the application of RFT to ARFID treatment (child and adult)
• Discuss alignment of treatment approaches with case conceptualization as well as practice values and ethics

Speaker Bio: Grace is a registered dietitian in Canada specializes in feeding and eating disorders.  She has been practicing as a dietitian for over 17 years, primarily in eating disorders, pediatrics, and mental health.  Grace works with clients of all ages living with feeding and eating disorders through a developmental lens.  She is experienced in working with co-existing conditions such as attention-deficit/hyperactivity disorder, autism spectrum disorder, sensory-based challenges, complex medical conditions, addictions and trauma.  Besides her clinical practice, she provides training and supervision for professionals in Canada and overseas.  She has written and developed various professional guidelines and papers on ARFID.  Grace is currently working with a group of multidisciplinary colleagues in developing the Responsive Feeding Therapy framework and resources to support this therapy approach.

Session Description: In this segment, Nicole will provide a practical guide and scope for RDs as they work with individuals diagnosed with ARFID and their families.  She will discuss how to fully understand feeding history and how feeding history can help the RD and the client move towards their feeding and eating goals.  Nicole will discuss concrete language to use and strategies that RDs can use to support the client, as well as strategies families can use to support the client.  Nicole will discuss common nutrition concerns in the context of ARFID, when to address these concerns and when to consider the feeding and eating relationship over nutrition.  Lastly, Nicole will outline when and who to refer to in the community for additional or continued care.

Learning Objectives:

• Understand  the scope of RD working with clients with ARFID.
• Identify when and who to refer to in the community.
• Learn how to collect feeding history and how to use feeding history to help the client with their goals .
• Identify language and strategies to use to support the client and how to teach the family to support the client
• Explore how to address common nutrition concerns in the context of ARFID.

Speaker Bio: Nicole Wavra is a Registered Dietitian who works with individuals and families to develop strong yet flexible relationships with food and their bodies.  For 10 years she has worked in all levels of care in the Eating Disorder field and specializes in working with children, adolescents, young adults and their families.  During her time working at a nationally recognized Eating Disorder facility, she encountered many clients who experienced eating/feeding difficulties but that did not fit traditional Eating Disorder diagnoses nor respond to the traditional Eating Disorder treatment models.  Since then she has started her private practice in part, to provide a place for these individuals and families to receive support and guidance, including using Responsive Feeding Therapy.

Session Description: Feeding challenges are commonly observed in neurodivergent children. This presentation will explore some of the common nutrient concerns and “eating behaviours” seen in autistic children and teens  and children with sensory processing challenges. The focus will be on feeding skills and their relation to eating difficulties.

The social model of disability will be reviewed as a crucial piece to providing inclusive care for ARFID clients. Practical strategies to support clients will be highlighted. The content covered will be presented through the lens of a trauma-sensitive and pro-neurodiversity practice.

Learning objectives:

• Understand the basics of building an inclusive practice.
• Identify three challenges that autistic children face that make feeding difficult.
• Understand how sensory processing differences can impact feeding
• Explore the social model of disability and how it intersects with ARFID.
• Provide practical strategies for improving feeding and eating while maintaining inclusion as a priority.

Speaker Bio: Naureen Hunani is a pediatric dietitian with over 15 years of clinical experience. After overcoming feeding difficulties with her own children, she was inspired to help other families by specializing in picky eating and feeding disorders. She currently treats children and families struggling with a variety of feeding challenges through her trauma-informed private practice in Montreal. She has developed a unique child-led, play-based feeding therapy program focusing on sensory exploration of food.

Naureen has extensive experience working with neurodivergent families, including autism spectrum disorder, ADHD, sensory processing disorder and anxiety disorder. She is a supporter of early diagnosis of feeding problems and advocates for inclusion and acceptance in schools and daycares for children with limited feeding abilities. Naureen shares her knowledge and experience at national and international conferences as well as in trainings for healthcare professionals, therapists, teachers, and parents. She has been featured as a nutrition and feeding expert on such media as Breakfast television, CBC radio, CBC kids and Huffington Post Canada.

Session Description:  Avoidant/Restrictive Food Intake Disorder (ARFID) is a lesser understood clinical diagnosis for many providers.  Psychologists have pulled from various clinical treatment modalities in order to create therapeutic techniques to work with children with feeding therapies while trying to make sense of them within the context of the mental health world.  A Responsive Feeding Therapy approach can embrace tenets of 1) motivational interviewing work, 2) common factors theory and support 3) patient centered behavioral interventions.  Participants will understand how pieces of these three paradigms can work together to help align provider-patient goals and make progress in the treatment of ARFID in clinical practice.

Learning Objectives:

1. Describe how to use motivational interviewing in goal setting with ARFID
2. Name the four common factors of what works in therapy
3. Describe aspects of patient centered behavioral approaches

Speaker Bio:  I am a pediatric psychologist with treatment expertise in eating disorders, anxiety and OCD.  Using a common factors approach, I have developed my practice of treating kids with ARFID/SED using the principles of Responsive Feeding Therapy.  My goal is to build trust and create a safe space to help a child reduce their anxiety around trying new foods and rely on their own intrinsic motivation to help guide exposure-based work.  In addition, I work with parents to create a non-pressured feeding environment at home.  We reframe the pressured goal of expanding variety to reducing stress around feeding and mealtimes a home. Through this trusting, bidirectional relationship, we reduce anxiety around novel foods while building a supportive and empowered family structure to continue the work outside of the therapeutic walls.