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About Sickkids
About SickKids

February 25, 2014

COPE means hope for families

February 24 to March 2 is Eating Disorders Awareness Week

By John Berwick

The Eating Disorders Program in the Division of Adolescent Medicine at SickKids has launched a new clinic to treat children who are 12 years and younger. COPE, which is short for Children’s Outpatient Program for Eating Disorders, reflects the growing trend of younger children presenting with eating disorders. According to data collected by the Eating Disorders Program at SickKids, the number of young children seen in 2008-2010 increased by 60 per cent in 2011-2013.

Spearheaded by psychologist Dr. Melissa Lieberman, COPE offers a multi-faceted approach to the treatment of eating disorders among children under 13. The COPE team conducts a comprehensive eating disorder assessment with each family including psychological, medical and nutritional components, and the resulting diagnosis and treatment plan are discussed with the family. Treatment includes individual FBT (a specific family-based treatment for eating disorders in teens) modified for younger children, in addition to the new and innovative COPE group.

Traditionally, older children in the mid-to-late teens were the focus for treatment in paediatric eating disorder programs. Little is known about the treatment of younger children, and Lieberman believes the COPE initiative is a good opportunity to document the efficacy of treatment for this age group. Couple the lack of research with the fact that eating disorders are particularly dangerous in young children (the effects of starvation and dehydration can develop much sooner and can lead to more severe medical complications) and there is a clear need for programs like COPE, she says.

SickKids research data indicates that younger children in the eating disorders program are more likely to present with concurrent anxiety disorders than older teens. To serve this age group, Lieberman and Dr. Brooke Halpert developed COPE which empowers parents to re-nourish their child and teach children strategies to cope with anxiety. Parent and child groups are held separately and simultaneously, joining together during the final portion of the session so parents can be introduced to the strategies covered by their children. This gives parents the information they need to support and promote the COPE strategies at home. According to Lieberman, the role of the parent in the treatment process cannot be understated.

Parents ensure daily exposure to a variety of foods by maintaining regular meal and snack times. Consistent with a type of anxiety treatment called “exposure and response prevention,” parents expose their children to the nutrition they need and prevent them from responding in the way that eating disorders would elicit (e.g., food refusal). This type of parent-directed exposure and response prevention is one component of treatment that leads to a reduction in anxiety caused by eating-disordered thoughts, thereby making it easier for eating patterns to normalize.

Lieberman, who runs the parent group, says the group allows participants to realize that they are not alone, that others have had similar experiences living with a child suffering with eating difficulties. The group teaches strategies that empower parents with the knowledge needed to better handle conflict when feeding their child and to understand and tolerate their child’s distress.

Meanwhile, Halpert’s youth sessions provide a targeted opportunity for patients to learn coping skills using cognitive behavioural therapy and mindfulness. Using different forms of drama and art, the children learn and practice a variety of strategies to fight their eating-disordered thoughts and general anxiety.

There is good preliminary evidence indicating the program’s success. Standardized questionnaires completed by children after they participated in the group suggest higher levels of self-efficacy and optimism, greater distress tolerance, and fewer physical symptoms of anxiety. Staff members have also received positive feedback from families, and an overall weight improvement in their patients has been observed.

The group meets on Wednesday afternoons. The meetings run for 10 weeks and can accommodate six to eight families at a time.