Avoidant/Restrictive Food Intake Disorder in Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), Restrictive Subtype in Early Childhood: The Assessment of Parent-Child Feeding Interactions and the Use of the Lausanne Triadic Play

Objectives: The main aim of this research was to investigate early child- hood mother-child dyadic interactions and mother-father-child triadic interactions in families with a child diagnosed with DSM-5 avoidant/ restrictive food intake disorder (ARFID), restrictive subtype (“lack of in- terest in food or eating”). Methods: The study involved five families with children (mean age 1⁄4 42 months) with a DSM-5 diagnosis of ARFID, restrictive subtype, extracted from a larger group of 51 families with a child diagnosed with ARFID, and compared to non-clinical families. Families were assessed during: 1) dyadic, and 2) triadic interactions, through the Scala di Valutazione dell’Interazione Alimentare Madre-Bambino (SVIA), the Italian validated version of the Feeding Scale, and the Lausanne Trilogue Play procedure. Triadic interactions were evaluated through the Family Alliance Assessment Scales. Results: During dyadic feeding interactions, all the subjects reported scores above clinical normative cut-offs on the SVIA subscales (i.e., mother’s affective state, food refusal, interactive conflict, dyad’s affective state). During triadic feeding interactions, families with children diagnosed with ARFID showed significant differences (p < 0.05) compared to non-clinical families. They presented specific difficulties in the areas concerning posture and gaze, coconstruction of a joint activity, interactive mistakes and their resolution JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017 during activities, family warmth, validation of the child’s emotional experience, and child’s involvement and self-regulation. Conclusions: Findings highlight the importance of considering the family interactions during the assessment of feeding disorders in early child- hood. The adoption of a comprehensive perspective, through the inves- tigation of both dyadic and triadic dynamics will be useful in the clinical understanding of the role played by interactive difficulties in the onset and in the maintenance of the restrictive subtype feeding disorder. Dysfunctional family interactions are a critical issue, stressing the impor- tance of an articulated diagnostic assessment in order to target effective treatment.