At our April Eating Disorders Community of Practice hosted by the King’s Maudsley Partnership, we shared the early clinical and research learning from the use of Family Therapy for Anorexia Nervosa with Emerging Adults (FT‑AN-EA) within adult eating disorder services. The presentation sparked a wide‑ranging discussion, bringing together clinicians and researchers across child, adolescent and adult services, and highlighting an area of growing consensus: emerging adulthood (18–25) requires a different clinical logic. 

Why focus on emerging adults? 

Emerging adulthood is a period marked by rapid transitions: legal adulthood, leaving school, entering higher education or employment, moving away from home, and developing intimate relationships. For emerging adults (EAs) with anorexia nervosa, these changes can significantly destabilise recovery. 

Ccurrent service structures often respond to these transitions with a hard boundary: turning 18 triggers a move from child and adolescent mental health services (CAMHS) to adult services. This shift is usually driven by age rather than clinical readiness, resulting in disrupted care and premature endings to effective treatments. 

The question posed was a simple but powerful one: rather than forcing young people and families to adapt to service thresholds, why not adapt evidence based treatments to the developmental needs of EAs? 

Why family therapy, beyond 18? 

Family Therapy for Anorexia Nervosa (FT-AN) has a strong evidence base in CAMHS. However, it is rarely offered once a young person reaches adulthood, often on the assumption that family involvement is no longer appropriate. 

We aim to challenge this assumption. In practice, many EAs remain closely connected to their families financially, practically and emotionally. Families often continue to play a key role in food provision, housing and day‑to‑day support. Excluding them at 18 risks removing a critical recovery resource. 

FT‑AN-EA was therefore developed not as “CAMHS therapy done later”, but as a developmentally adapted model that retains family involvement while firmly placing the EA at the centre of decisions.  

How FT‑AN is adapted for emerging adults 

Our research highlighted several adaptations to the traditional family therapy model: 

• Emerging adult–led engagement –  The EA is the central focus in therapy and actively chooses whether and how family members are involved. This reinforces agency and consent from the outset. Treatment adapts to their living situation and relational context.  

• Developmentally appropriate monitoring – Physical health and weight monitoring are typically led by the EA, with decisions about what is shared with family members negotiated collaboratively. This is respectful of the EA’s independence, confidentiality and motivation. 

• Flexible support –  Support with eating is tailored to real‑world contexts, including EAs living away from home, studying at university, or relying on remote support from parents or partners. 

• Returning responsibility to the emerging adult early on. – The right amount of support is offered flexibly by family, and once weight restoration is established, responsibility is returned to the EA quickly. This enables focus on motivation for recovery. 

• Earlier and more in-depth work around Issues of Individual Development   This aspect of therapy begins earlier than in CAMHS and includes more individual sessions, creating space to explore identity, relationships, sexuality, gender and future aspirations, topics that many EAs benefit from discussing alone with a therapist. 

• Intentional endings and relapse prevention Families are typically re‑invited towards the end of therapy to reflect on progress, celebrate achievements and support relapse prevention, acknowledging ongoing uncertainty rather than promising certainty. 

What did the early data show?

The retrospective case series presented showed encouraging findings: 

• Low dropout rates 

• Weight restoration outcomes similar to CAMHS family therapy  

• Outcomes compared favourably to FREED individual therapy data 

• Very low inpatient admission rates 

• High rates of discharge to GP care 

However, one of the most striking findings, and a key focus of the room discussion, related to EAs transitioning from CAMHS to adult services. For this group, treatment length in adult services often resembled a “restart”, suggesting that transitions themselves represent a significant therapeutic rupture. 

This strongly resonated with clinicians’ professional experience in the room. 

Key themes from the discussion 

Several areas of strong convergence emerged: 

• Age‑based transitions are clinically costly 
  Participants agreed that transitions driven by age rather than need undermine engagement, prolong treatment and increase anxiety for families and clinicians alike. 

• Relationship matters more than model 
  Across FT‑AN-EA and individual therapies, the therapeutic alliance, trust, continuity and collaboration, were repeatedly identified as a key active ingredient for change. 

• Family involvement needs reframing, not removal 
  Rather than “parental control” or sudden exclusion at 18, family involvement with EAs works best when it is chosen, flexible and negotiated with the EA. 

• Identity work is central to recovery 
  Weight restoration alone is not enough. Supporting EAs to build a meaningful identity beyond the eating disorder is essential for sustainable recovery. 

• Outcomes need to be broader than BMI 
  There was shared unease about narrow outcome measures that do not currently capture autonomy, functioning, identity development and relapse resilience. 

What does this mean for services? 

The discussion concluded with a clear message: 
The challenge is not a lack of effective clinical approaches, but a mismatch between developmental need and service architecture. 

Implications include: 

• Designing emerging‑adult pathways that are developmentally appropriate and span traditional CAMHS–adult divides. 

• Prioritising continuity of treatment over age thresholds. 

• Supporting clinicians in adult services with training and supervision to engage flexibly with families and emerging adults. 

• Implementing outcome frameworks to reflect what recovery looks like at this life stage, beyond weight restoration. 

Looking ahead 

FT‑AN-EA offers a compelling example of how services can respond intelligently to complex emerging adulthood needs by adapting family focused treatments. As Danilen’s presentation and the subsequent discussion made clear, adapting service delivery to context appropriate developmental needs is not just preferable, it is essential in improving outcomes for emerging adults with eating disorders. 

If you want to learn more about our work in this area please contact us on KMPCYP@slam.nhs.uk. Learn more about the Pears Maudsley Centre for Children and Young People. 

Learn more about Danilen Narsigadoo and his work. 

References: 

Dodge, E., Baudinet, J., Austin, A., Eisler, I., Le Grange, D., & Dimitropoulos, G. (2024). Family therapy for emerging adults with anorexia nervosa: Expert opinion on evidence, practice considerations, and future directions. European Eating Disorders Review, n/a(n/a). https://doi.org/10.1002/erv.3129 

Nursigadoo, D., Dodge, E., Allen, K., Schmidt, U., & Baudinet, J. (2026). Family Therapy for Anorexia Nervosa with Emerging Adults: A Retrospective Case Series in Routine Clinical Care. European Eating Disorders Review. https://doi.org/10.1002/erv.70107 

With this new funding, researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London will test whether a repetitive form of transcranial magnetic stimulation (TMS) – a technology which can alter brain waves – can reduce thinking and attention difficulties associated with ADHD by targeting theta wave activity.

The findings will determine whether theta brain waves could be a target for future ADHD interventions, and may provide evidence for TMS as a new, drug-free intervention to support people with ADHD.

The study, led by Dr Gráinne McLoughlin at the IoPPN with co-investigators Professor Katya Rubia, Dr Luke Mason and Dr Máté Gyurkovics (now at University of East Anglia), will use the new Electroencephalography (EEG) Suite and Transcranial Magnetic Stimulation (TMS) facilities at the Pears Maudsley Centre for Children and Young People.

Brain waves are rhythmic patterns of neural activity in the brain which are thought to play a crucial role in the communication between brain cells (neurons), cognitive processes and overall brain function.

There are different types of brain waves which occur at different frequencies. When these waves are dysregulated, it can lead to cognitive or behavioural difficulties. These challenges are often seen in ADHD – in particular, cognitive control which allows people to regulate their thoughts, emotions and behaviours to achieve everyday goals.

The new funding will allow the researchers to explore how a specific type of brain wave (known as theta waves, which have a frequency of 4-8 Hertz) might be involved in the challenges faced by people with ADHD, and whether this could represent a new target for intervention.

They will investigate whether repetitive TMS can improve cognitive consistency in young adults with ADHD (ages 18 to 25), compared to neurotypical young adults, through targeting theta wave activity.

The research will take place at the new Clinical Research Facility at the Pears Maudsley Centre, which is set to be the leading facility in the UK dedicated to the investigation and treatment of mental health in children and young people. The Clinical Research Facility will be a space where children of all ages, from babies up to young adults, can participate in research to identify the root of mental health and neurodevelopmental conditions, and use this research to implement and monitor groundbreaking interventions.

The research, published in Biological Psychiatry, is the first proof that evidence-based parenting programmes are accompanied by specific changes in children’s brain activity and decision‑making processes, and underscores the value of offering such programmes early in life.

78 boys with conduct problems (CPs) aged 5 to 10, and 35 matched controls, completed a reward‑learning task while undergoing functional MRI scanning. Families in the CP group then took part in a 10 -12‑week group parenting programme designed to encourage positive behaviour with warmth and praise.

At the end of the program, the participants were then sub-classified as either “improvers” or “persistent” based on whether they displayed an improvement in antisocial behaviour. All children then repeated the task and scan at a follow‑up session.

In the initial scans, researchers found that the insula, an important brain region that helps to anticipate whether something good (a reward) or bad (a punishment) might happen when we do something, was not activating or “lighting up” as much as it should when expecting a reward. However, after having taken part in the parenting programme, researchers found that the insula in the improvers group responded more like that of typically developing children, especially when they expected a reward.

Other brain areas also changed, including the ventromedial prefrontal cortex and the hippocampus, both of which are involved in making decisions and learning from outcomes. Again, these areas also showed more normal activity in the second scan after the intervention in children who improved.

The study also found changes in how these children learn from their experiences. After the parenting programme, the improved boys became slower to change their expectations after just one good or bad outcome, which may help them make more balanced decisions over time. They were also less likely to act impulsively and became more sensitive to the difference between reward and punishment.

Dr Arjun Sethi, the study’s lead author from King’s IoPPN said, “Using computational modelling, we found that responders learned more gradually and were less driven by a reflex to act. That combination – slower learning and reduced action bias – appears to support more thoughtful choices and fewer antisocial behaviours.”

Professor Stephen Scott, Professor and Consultant Child and Adolescent Psychiatrist at King’s IoPPN and one of the study’s authors said, “Evidence based parenting programmes like the ones explored in this study promote what I consider to be “love and limits”. They focus on developing closer relationships between parent and child, but also providing clear boundaries and expectations that reinforce good behaviour.

“This study, which is a world first, demonstrates not only that these programmes can impact the inner working of a developing child’s brain, but also provides valuable evidence of the value of programmes like these.”

Dr Bruce Clark, Medical Director of the King’s Maudsley Partnership said, “Issues relating to young people’s behaviour are amongst the most common we see being referred into our clinical services. This study highlights the importance of intervening early with evidence-based treatments, so that brain and behavioural changes are mitigated early. Within the King’s Maudsley Partnership we are testing and piloting interventions to provide support in the most timely and cost effective way.”

This study was funded by the Medical Research Council (MRC).

Successful Evidence-Based Parenting Programs are Associated With Brain Changes and Improved Reward Processing in Boys With Conduct Problems (DOI10.1016/j.biopsych.2025.06.008) (Sethi, Craig et al) was published in Biological Psychiatry.

For more information, please contact Patrick O’Brien (Media Manager)

You can also find this press release on King’s College, London website

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London has found that providing 16-18 year olds with a day-long course in Cognitive Behavioral Therapy (CBT) was both a clinically and cost-effective means of improving their mental health.

The trial, known as Brief Educational workshops in Secondary Schools Trial (BESST) and published in The Lancet Psychiatry, was successfully adapted from the DISCOVER program, which was designed to help adults manage their feelings of stress. The study has been funded by the National Institute for Health and Care Research (NIHR).

Around one in 12 young people in England currently experience anxiety or depression. Despite this, the large majority remain untreated, and almost a quarter (24%) have no contact with specialist Child and Adolescent Mental Health Services (CAMHS).

This study recruited 900 students from 57 schools in England. Half were provided with signposting to mental health services and the standard care their school would usually provide. The other half were invited to a day-long workshop on CBT coping techniques for managing mood, anxiety, and stress, and provided with follow up phone calls to help incorporate those skills into real-life situations.

Researchers found that participants who attended the workshop showed significant improvements in their depression, anxiety, wellbeing and resilience after a six-month follow up.

Dr June Brown said, “One of our main challenges was to adapt an adult therapeutic intervention which would be attractive and engaging for teenagers. In addition, previous studies have either been aimed at all students, some of whom aren’t necessarily in need of assistance, while others have taken a more targeted approach that potentially stigmatises those who might need support. Giving students the opportunity to self-refer means that we work with students who recognise that they’d like help.

“Our study shows that this intervention can be delivered at low cost by mental health professionals who can bridge the gap between schools and CAMHS.”

Professor Ben Carter, “The ultimate success of this has laid the groundwork for these workshops to be rolled out nationwide to provide an early intervention against depression and anxiety.” 

Karen Crowe, Senior Tutor for the Sixth Form & Curriculum Leader for Psychology at St Nicholas Catholic High School in Cheshire said, “Our school seeks to prioritise mental wellbeing and promote strategies that improve students’ mental health. We believe it is important to teach students how to become self-regulating individuals who can manage their own stress, which is why the school fully supported the BESST trial. We value techniques that provide students with skills to resolve problems, cope better with expectations, and build confidence, so the trial’s aims perfectly complement our school’s mission and ethos.”

Olivia Black, a student at St Nicholas Catholic High School who took part in the BESST trial said, “The study gave me new ways to manage my stress and remain productive during my studies. It was such a helpful process that allowed me to develop my personal strategies for maintaining good mental health. The skills and confidence gained from this trial motivated me to help start up our ‘breathing space’ initiative where sixth formers support younger students with their mental health.”

Can a brief accessible CBT programme in schools improve the mental health of 16–18-year-olds? Clinical and cost-effectiveness of a cluster randomised controlled trial in Brief Educational Workshops in Secondary Schools Trial (BESST) (DOI 10.1016/S2215-0366(24)00101-9) (June Brown, Kirsty James, Stephen Lisk, James Shearer, Sarah Byford, Paul Stallard, Jessica Deighton, David Saunders, Jynna Yarrum, Peter Fonagy, Timothy Weaver, Irene Sclare, Crispin Day, Claire Evans, Ben Carter) was published in Lancet Psychiatry. 

For more information, please contact Patrick O’Brien (Media Manager)

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with the University of Greenwich, has found that there is a direct socioeconomic impact of loneliness in early adolescence.

The research, published in Social Science and Medicine, found that lonely young adults are more likely to be out of education, employment, or training (NEET) and consider themselves less employable and lower on the economic ladder than their less lonely peers.

Sourcing data from the Environmental Risk (E-Risk) Longitudinal Twin Study, researchers followed the progress of 2,232 individuals born in England and Wales during 1994-1995. Participants were assessed at ages 12, 18 and 26 for levels of loneliness, as well as being asked to rate their social status. Participants’ employment status and employability were assessed at age 18.

Researchers found that young adults who had experienced loneliness earlier on in life experienced difficulties in young adulthood, even if they were no longer lonely. Researchers suggest that this demonstrates that loneliness impacts a person’s long term economic prospects and suggests that addressing loneliness in early adolescence could yield economic benefits through increased productivity.

Previous research in this field has suggested a two-way relationship between loneliness and social standing. By using data collected over time, this research showed that feeling lonely negatively influenced a person’s social standing down the line, but social standing did not affect their future loneliness.

The study’s researchers argue that their findings highlight the importance of effectively tackling loneliness in order to help both the individual and society.

This study was possible thanks to funding from the Colt Foundation and the Medical Research Council, with additional support from the National Institute of Child Health and Human Development and by the Jacobs Foundation.

The socioeconomic consequences of loneliness: evidence from a nationally representative longitudinal study of young adults (DOI 10.1016/j.socscimed.2024.116697) (Bridget T. Bryan, Katherine N. Thompson, Sidra Goldman-Mellor, Terrie E. Moffitt, Candice Odgers, Sincere Long Shin Soa, Momtahena Uddin Rahman, Jasmin Wertz, Timothy Matthews, Louise Arseneault) was published in Social Science and Medicine.

For more information, please contact Patrick O’Brien (Media Manager, King’s IoPPN) 

The research, published today in the journal Archives of Disease in Childhood shows that children with the neurodevelopmental disorder are twice as likely to see their GP, go to hospital for an admission, and even have operations, compared to children without ADHD.

The researchers say the results support the need for healthcare professionals to consider a potential diagnosis of ADHD in children who use their services frequently. This is especially important in cases where the primary reason for attendance is not a mental or behavioural symptom, where ADHD may already be suspected. Children with ADHD use healthcare services for a wide range of common medical symptoms, such as tonsillitis, asthma, or eczema.

The research was carried out by Dr Vibhore Prasad and other researchers working at the University of Nottingham and King’s, funded by the Academy of Medical Sciences.

The study looked at medical records of children and young people aged between four and 17 years old from the Clinical Practice Research Datalink, a primary care database containing the records of around 15 million people from 730 GP practices and representing seven per cent of the population of the UK. The findings were based on around half of the patients from England who also had linked hospital medical records.

The research focused on the reasons why children see their GP, receive prescriptions from the GP, attend hospital for overnight admissions and have operations in hospital. It showed that children with ADHD make twice as much use of all these services in the two years before diagnosis compared to children without ADHD.

Children and young people with ADHD regularly see healthcare professionals but guidance from organisations such as the National Institute for Health and Care Excellence (NICE) and the American Academy of Pediatrics does not currently detail how to detect ADHD earlier. Many parents or carers report needing to know about ADHD in order for the professionals to consider this as a diagnosis.

The researchers say this study shows that more should be done to develop and test interventions to identify ADHD earlier in primary care. There is also a need to urgently review how the health services cater for young people with undiagnosed ADHD.

The full study can be found here.

For more information, please contact Emily Webb (School Communications Manager – School of Academic Psychiatry)