Dasha Nicholls

Dublin 2913: Dasha Nicholls

Towards a stepped care model for child and adolescent AN: the role of early intervention

Original presentation and abstract by Dasha Nicholls (Great Ormond Street Hospital, Child and Adolescent Psychiatry, London, UK) on developing a stepped model for anorexia nervosa (AN) and other child and adolescent eating disorders. This lecture was held at the ESCAP 2013 Congress in Dublin, Sunday 7th July 2013.


Most randomized controlled treatment trials for eating disorders (ED) show no differences, or differences that diminish over time, between treatment arms. The most likely explanation for this is that there is too much variability within the patient groups. For young people the evidence for the effectiveness of treatment is stronger than for adults, in that (probably) most young people (who have parental/carer support) with an ED (or at least with anorexia nervosa) should be offered family therapy (in conjoint, separated or multifamily format) as first line treatment on an outpatient (or if too sick, day patient) basis. In addition, research suggests that inpatient treatment is not best considered as the next step when outpatient treatment fails, and that specialist multidisciplinary Child and Adolescent ED services detect more cases, provide better continuity of care and reduce admissions. Clinicians need frameworks for practice based on research, clinical experience and the perspectives of patients and carers that facilitate problem solving at an individual patient level. Ideally a stepped care model will determine the level of care offered at each stage of presentation and provide clear thresholds for changing therapeutic direction or transfer to other services. Such a model may also facilitate a better understanding not simply of ‘does treatment X work?’ but ‘for who does it work?’ i.e. mediators and moderators of treatment response, thereby improving prediction of individual prognosis. This presentation will review what is known about treatment response in children and adolescents, with a focus on the early stages of presentation, and suggest factors to consider in developing a stepped model for child and adolescent eating disorders.
Keywords: feeding; eating disorders; stepped care model.

Download the full presentation here (pdf file, 31 slides).

Dasha Nicholls

Dr Dasha Nicholls is a Consultant Child & Adolescent Psychiatrist. She has worked at Great Ormond Street Hospital, London,  since 1995, first as a trainee psychiatrist, then a research fellow, and now as Joint Head of the Feeding and Eating Disorders, where she leads the Eating Disorders Team, Selective Eaters Clinic and contributes to the Bariatric Surgery service at UCLH.