Canadian Practice Guidelines for the Treatment of Children and Adolescents with Eating Disorders

By Couturier, Jennifer; Isserlin, Leanna et al. | Journal of Eating Disorders, February 1, 2020 | Go to article overview

Canadian Practice Guidelines for the Treatment of Children and Adolescents with Eating Disorders


Couturier, Jennifer, Isserlin, Leanna, Norris, Mark, Spettigue, Wendy, Brouwers, Melissa, Kimber, Melissa, McVey, Gail, Webb, Cheryl, Findlay, Sheri, Bhatnagar, Neera, Snelgrove, Natasha, Ritsma, Amanda, Preskow, Wendy, Miller, Catherine, Coelho, Jennifer, Boachie, Ahmed, Steinegger, Cathleen, Loewen, Rachel, Loewen, Techiya, Waite, Elizabeth, Ford, Catherine, Bourret, Kerry, Gusella, Joanne, Geller, Josie, LaFrance, Adele, LeClerc, Anick, Scarborough, Jennifer, Grewal, Seena, Jericho, Monique, Dimitropoulos, Gina, Pilon, David, Journal of Eating Disorders


Author(s): Jennifer Couturier[sup.1], Leanna Isserlin[sup.2], Mark Norris[sup.2], Wendy Spettigue[sup.2], Melissa Brouwers[sup.2], Melissa Kimber[sup.1], Gail McVey[sup.3], Cheryl Webb[sup.1], Sheri Findlay[sup.1], Neera Bhatnagar[sup.1], Natasha Snelgrove[sup.1], Amanda Ritsma[sup.1], Wendy Preskow[sup.4], Catherine Miller[sup.5], Jennifer Coelho[sup.6], Ahmed Boachie[sup.3], Cathleen Steinegger[sup.3], Rachel Loewen[sup.7], Techiya Loewen[sup.8], Elizabeth Waite[sup.8], Catherine Ford[sup.9], Kerry Bourret[sup.10], Joanne Gusella[sup.11], Josie Geller[sup.6], Adele LaFrance[sup.12], Anick LeClerc[sup.13], Jennifer Scarborough[sup.5], Seena Grewal[sup.3], Monique Jericho[sup.14], Gina Dimitropoulos[sup.14] and David Pilon[sup.11]

Plain English summary

The objective of this project was to develop Canadian Practice Guidelines for the treatment of children and adolescents with eating disorders. We reviewed the literature for relevant studies, rated the quality of the scientific information within these studies, and then reviewed this information with a panel of clinicians, researchers, parents and those with lived experience from across the country. The panel came up with a list of recommendations regarding specific treatments. These recommendations included strong recommendations for the provision of Family-Based Treatment, as well as care provided in a least intensive environment. Weak recommendations were determined for Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga, and atypical antipsychotics. The panel also identified several areas for future research including the development of new treatments for severe and complex eating disorders.

Introduction

Eating disorders are common and serious conditions affecting up to 4% of the population [1]. The mortality rate, particularly for Anorexia Nervosa (AN) is high [2, 3], and has been shown to increase by 5.6% for each decade that an individual remains ill [4, 5]. It is well-documented that interventions targeted at earlier stages of illness are critically important, given the evidence showing that earlier treatment leads to better outcomes [6, 7]. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. We systematically reviewed and synthesized the knowledge available on treatments for children and adolescents with eating disorders to develop our guidelines.

Review of existing guidelines

In the United States, practice parameters have been published by the American Academy of Child and Adolescent Psychiatry for youth with eating disorders [8]. These parameters reflect good clinical practice rather than making statements as to the strength of the evidence to support the recommendations. Clinical practice guidelines have also been developed by the National Institute of Health and Care Excellence [9], however, grading of the evidence is also not presented in these guidelines. The Academy for Eating Disorders has also published guidelines on their website that focus on medical management, but do not focus on psychotherapeutic/psychopharmacological interventions, nor the strength of the evidence (http://aedweb.org/web/downloads/Guide-English.pdf). In summary, guidelines that are currently available tend to focus on medical stabilization, and neglect psychotherapeutic/psychopharmacological approaches to treating eating disorders. Furthermore, they do not rate the strength of evidence. No Canadian guidelines focused on eating disorders in the pediatric age group exist.

Objectives

Our aim was to synthesize the best available evidence on treatments for children and adolescents with eating disorders resulting in the production of a practice guideline. The research questions to drive this knowledge synthesis were discussed by our research team and guideline development panel, and are listed below. …

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