1
|
Kinnaird E, Oakley M, Lawrence V, Shergill S, Tchanturia K. A peer interview qualitative study exploring support for carers of people with comorbid autism and eating disorders. J Eat Disord 2021; 9:42. [PMID: 33789761 PMCID: PMC8010292 DOI: 10.1186/s40337-021-00397-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/17/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Carers of people with eating disorders (EDs) are known to experience a lack of support, high levels of unmet needs and resulting distress. Specific support and interventions for carers may benefit both the carer, and their loved one with an ED. Individuals with co-occurring autism and EDs may present with additional needs and difficulties relating to their Autism Spectrum Condition (ASC) that impact their carers. However, there is a lack of research exploring whether carers of people with ASC and EDs have specific support needs, and what kinds of support may be most beneficial for this population. METHODS This study used a qualitative interview design, utilising peer interviews. Eleven carers participated in interviews about their experiences as a carer, and their views on existing support systems and potential improvements. As the study took place during the initial UK coronavirus lockdown, the impact of the lockdown also emerged as a topic during the interviews. Interviews were transcribed and analysed using thematic analysis. RESULTS Five themes were identified: challenges associated with co-occurring Autism and EDs, a lack of existing support for carers from healthcare services, the personal impact of caring for someone with both ASC and EDs, ideas for how carers can be best supported, and the impact of the coronavirus on carers. CONCLUSIONS Carers of loved ones with both ASC and EDs described the experience as having a significant personal impact on their lives, but also experienced a lack of support from healthcare services. There was a perception that caring for someone with both an ASC and EDs presents additional challenges compared to caring for someone with an ED only, and that this population therefore requires specialised support. Recommendations for possible support options, and for further research, are outlined.
Collapse
Affiliation(s)
- Emma Kinnaird
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Madeleine Oakley
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Vanessa Lawrence
- King's College London, Health Services and Population Studies Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sukhi Shergill
- King's College London, Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK. .,National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK.
| |
Collapse
|
2
|
White HJ, Haycraft E, Williamson I, Meyer C. Disturbance at the dinner table: Exploring mothers’ experiences of mealtimes when caring for their son or daughter with anorexia nervosa. J Health Psychol 2020; 27:637-648. [PMID: 32031002 PMCID: PMC8832548 DOI: 10.1177/1359105320904756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined mothers’ ( n = 9) mealtime experiences when caring for their son or daughter with anorexia nervosa through semi-structured interviews. Interpretative Phenomenological Analysis identified three themes: (1) managing mealtime combat through accommodation and acceptance; (2) feeling isolated, inauthentic and ill-equipped and (3) a need for understanding and to be understood. The overarching concepts of ‘combat’ and ‘distortion’ also underpin the analysis, uniquely outlining how mothers come to understand this daily situation. Mealtime-related interventions need to be developed which prioritise promoting skills and confidence in managing mealtimes and helping carers to address the emotional challenges of these occasions.
Collapse
Affiliation(s)
| | | | | | - Caroline Meyer
- University of Warwick, UK
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| |
Collapse
|
3
|
Herscovici CR, Kovalskys I, Orellana L. An Exploratory Evaluation of the Family Meal Intervention for Adolescent Anorexia Nervosa. FAMILY PROCESS 2017; 56:364-375. [PMID: 26596997 DOI: 10.1111/famp.12199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty-three AN adolescents aged 12-20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6-month duration. Their outcome was compared at the end of treatment (EOT) and at a 6-month posttreatment follow-up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.
Collapse
Affiliation(s)
- Cecile Rausch Herscovici
- Committee on Nutrition, Health and Quality of Life, International Life Sciences Institute (ILSI Argentina), Buenos Aires, Argentina
| | - Irina Kovalskys
- Committee on Nutrition, Health and Quality of Life, International Life Sciences Institute (ILSI Argentina), Buenos Aires, Argentina
| | | |
Collapse
|
4
|
Cook-Darzens S. The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications. Eat Weight Disord 2016; 21:383-393. [PMID: 26932829 DOI: 10.1007/s40519-016-0263-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40 years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.
Collapse
Affiliation(s)
- Solange Cook-Darzens
- Department of Child and Adolescent Psychiatry, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France. .,, 10 Grande Rue, 60460, Blaincourt, France.
| |
Collapse
|
5
|
Favez N, Frascarolo F, Grimard N. THE PICNIC GAME: PRESENTATION OF A SITUATION OF OBSERVATION TO ASSESS FAMILY INTERACTIONS. Infant Ment Health J 2016; 37:235-46. [PMID: 27098206 DOI: 10.1002/imhj.21561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this article is to present a situation of observation designed for the assessment of family interactions: The PicNic Game (PNG). In this situation, families are invited to play at having a picnic together. This can be done with any number of children, aged from a few weeks to adolescence. A companion assessment tool, the Revised-Picnic Assessment Scale (Re-PAS), allows evaluation of interactions in the family on several dimensions. This article presents the PNG and a preliminary study of the validation of the Re-PAS dimensions in a sample of families (N = 67) with 18-month-old infants and their siblings. The PNG was well-received by the families. Construct validity of the Re-PAS was tested, first against self-reported data by mothers and fathers regarding marital satisfaction, coparenting behavior, and division of household tasks, and then against observed maternal and paternal sensitivity and controlling behaviors assessed during free-play. Results show satisfactory preliminary reliability and validity. Two contrasting cases are presented to illustrate the different interactions highlighted in the PNG. This situation is useful for researchers and clinicians, particularly as a basis for video-feedback work with the family.
Collapse
Affiliation(s)
| | | | - Nathalie Grimard
- University Hospital Center and University of Lausanne, Switzerland
| |
Collapse
|
6
|
White HJ, Haycraft E, Madden S, Rhodes P, Miskovic-Wheatley J, Wallis A, Kohn M, Meyer C. How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment. Int J Eat Disord 2015; 48:72-80. [PMID: 24965701 DOI: 10.1002/eat.22328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/23/2014] [Accepted: 06/14/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the range and frequency of parental mealtime strategies used during the family meal session of Family-Based Treatment (FBT) for adolescent anorexia nervosa, and to explore the relationships between parental mealtime strategies, mealtime emotional tone and parental 'success' at encouraging adolescent food consumption. METHOD Participants were 21 families with a child aged between 12 and 18 years receiving FBT for adolescent anorexia nervosa. Video recordings of the family meal session (FBT session two) were coded using the Family Mealtime Coding System adapted in this study for use with adolescents (FMCS-A) to identify frequency of parental strategies, emotional tone of the meal (measured by adolescent positive and negative vocalisations) and frequency of prompted mouthfuls consumed by the adolescent (measured by the number of mouthfuls consumed by the adolescent immediately following parental interactions). RESULTS A range of parental mealtime strategies were in use. Those used repeatedly included direct eating prompts, non-direct eating prompts, physical prompts, and providing information or food-related choices. Several parental mealtime strategies (direct and non-direct eating prompts) were found to be consistently associated with the tone of adolescents' vocalisations and the number of mouthfuls consumed in response to a parental prompt. DISCUSSION Despite associations with negativity from the adolescent, the use of food-related prompts (both verbal and physical) seems to be associated with increased eating. This indicates the potentially important role of parental control of eating. Following replication, these findings might provide a focus for therapists when supporting and coaching parents during the family meal session.
Collapse
Affiliation(s)
- Hannah J White
- Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Berge JM, Hoppmann C, Hanson C, Neumark-Sztainer D. Perspectives about family meals from single-headed and dual-headed households: a qualitative analysis. J Acad Nutr Diet 2013; 113:1632-9. [PMID: 24238144 PMCID: PMC3871516 DOI: 10.1016/j.jand.2013.08.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
Abstract
Cross-sectional and longitudinal research has shown that family meals are protective for adolescent healthful eating behaviors. However, little is known about what parents think of these findings and whether parents from single- vs dual-headed households have differing perspectives about the findings. In addition, parents' perspectives regarding barriers to applying the findings on family meals in their own homes and suggestions for more widespread adoption of the findings are unknown. The current study aimed to identify single- and dual-headed household parents' perspectives regarding the research findings on family meals, barriers to applying the findings in their own homes, and suggestions for helping families have more family meals. The current qualitative study included 59 parents who participated in substudy of two linked multilevel studies-EAT 2010 (Eating and Activity in Teens) and Families and Eating and Activity in Teens (F-EAT). Parents (91.5% female) were racially/ethnically and socioeconomically diverse. Data were analyzed using a grounded theory approach. Results from the current study suggest that parents from both single- and dual-headed households have similar perspectives regarding why family meals are protective for healthful eating habits for adolescents (eg, provides structure/routine, opportunities for communication, connection), but provide similar and different reasons for barriers to family meals (eg, single-headed=cost vs dual-headed=lack of creativity) and ideas and suggestions for how to increase the frequency of family meals (eg, single-headed=give fewer options vs dual-headed=include children in the meal preparation). Findings can help inform public health intervention researchers and providers who work with adolescents and their families to understand how to approach discussions regarding reasons for having family meals, barriers to carrying out family meals, and ways to increase family meals depending on family structure.
Collapse
Affiliation(s)
- Jerica M. Berge
- University of Minnesota Medical School, Department of Family Medicine and Community Health
| | | | - Carrie Hanson
- University of Minnesota, Family Social Science Department
| | | |
Collapse
|
8
|
Fishman HC. Juvenile anorexia nervosa: family therapy's natural niche. JOURNAL OF MARITAL AND FAMILY THERAPY 2006; 32:505-14. [PMID: 17120522 DOI: 10.1111/j.1752-0606.2006.tb01624.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Juvenile Anorexia Nervosa (AN) is a severe problem both in terms of presenting symptomatology and its tendency toward chronicity. Researchers have consistently shown that family-based approaches are superior to individual approaches for the treatment of juvenile AN. This article addresses the capacity deficit of trained family therapists to treat this disease. The author reviews the effectiveness of Structural Family Therapy as a treatment of juvenile AN and the essential concepts and skills required by the family therapist to treat this disorder. The concepts of therapeutic crisis induction, enactment, and therapeutic intensity are discussed in detail. Recommendations are made for future research.
Collapse
|
9
|
Neumark-Sztainer D, Wall M, Story M, Fulkerson JA. Are family meal patterns associated with disordered eating behaviors among adolescents? J Adolesc Health 2004; 35:350-9. [PMID: 15488428 DOI: 10.1016/j.jadohealth.2004.01.004] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2004] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine associations between family meal patterns (frequency, priority, atmosphere, and structure of family meals) and disordered eating (unhealthy weight control behaviors, binge eating, and chronic dieting) in adolescent girls and boys. METHODS Survey and anthropometric data were collected from 4746 ethnically diverse adolescents from public middle and senior high schools who participated in the Project EAT study (Eating Among Teens). Variables of interest included family meal patterns and disordered eating behaviors. Logistic regressions were performed to examine associations between family meal patterns and disordered eating behaviors adjusting for body mass index, sociodemographic characteristics, family connectedness, and weight pressures within the home. RESULTS In general, adolescents who reported more frequent family meals, high priority for family meals, a positive atmosphere at family meals, and a more structured family meal environment were less likely to engage in disordered eating. For example, 18.1% of girls who reported 1-2 family meals/week engaged in extreme weight control behaviors compared with 8.8% of girls who reported 3-4 family meals/week. Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating. Associations between family meal patterns and disordered eating behaviors tended to be stronger among girls than among boys. Family meal patterns were more consistently associated with unhealthy weight control behaviors than with chronic dieting and binge eating. Although associations between family meals and disordered eating were weakened after adjusting for more global familial factors, including family connectedness and weight-specific pressures within the home, a number of the associations remained statistically significant, suggesting an independent relationship between family meals and disordered eating. CONCLUSION Family meals have the potential to play an important role in the prevention of unhealthy weight control behaviors among youth. Findings suggest that attention needs to be directed toward increasing family meal frequency and creating a positive environment for family meals.
Collapse
Affiliation(s)
- Dianne Neumark-Sztainer
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
| | | | | | | |
Collapse
|