ARFID and Autism: Are They Connected?
According to a recent study, between 12.5% and 33.3% of people with ARFID are on the autism spectrum, so ARFID is a disorder that affects many kids who have autism. [1] While there is still much we don’t know about treating ARFID, there are some promising strategies to help children with ARFID and autism.
What is ARFID?
ARFID stands for Avoidant/Restrictive Food Intake Disorder. It is a feeding disorder that results in food intake being severely limited, which can lead to malnutrition and low body weight. It’s often labeled as “picky eating”, but it is not the same as picky eating.
It’s important to note that ARFID is not driven by a desire to lose weight or distorted body image. It is often caused by fear of new foods, leading a child to only eat a handful of foods and having anxiety around eating.
5 Types of ARFID
Avoidant: This is the most common type, characterized by avoiding foods based on smell, texture, or other sensory aversions.
Aversive: A child might avoid food out of fear of choking, nausea/vomiting, or difficult swallowing. This could stem from a past traumatic experience around food such as getting sick after eating a certain food (even if it was unrelated), having an allergic reaction, or choking on a food as a child.
Restrictive: This type of ARFID results from a very limited interest in food. A child with restrictive ARFID may not experience hunger cues, and often shows little or no interest in eating.
Adult ARFID: As the name states, some adults experience ARFID, and often have the same symptoms as children experience.
ARFID plus: Some children and teens with ARFID may also experience concerns about body image and intentionally restrict calories as well as experience symptoms of ARFID such as sensory avoidance and fear of new foods. Since they show signs of anorexia in addition to ARFID, this is referred to as ARFID plus.
Is ARFID a neurodivergence?
ARFID is linked to many disorders that are considered neurodivergent, such as autism and ADHD. ARFID itself, with its altered way of thinking about food and eating, could be considered a neurodivergence as well.
Is ARFID a sensory issue?
ARFID can certainly look like a sensory issue, but is not simply a dislike of certain smells, tastes and textures. Instead, avoidant ARFID involves fear and anxiety around trying new textures, resulting in an extremely limited intake of foods.
Causes of ARFID
It is not known exactly what causes ARFID, but there are some potential links between genetic factors, a child’s temperament, traumatizing events such as choking, and co-existing disorders such as anxiety and autism. Like so many other disorders, there is probably not just one cause for ARFID, but instead a variety of factors that influence whether a child will develop ARFID.
Symptoms of ARFID
How can you tell if your child might have ARFID? Here are some red flags that may indicate your child should be evaluated for ARFID:
Only eats a few foods, and will not try any new foods
Eating is stressful, with child exhibiting fear or anxiety around eating
Avoids entire groups of foods, such as meat, vegetables, fruit
Difficulty gaining weight
There are some symptoms of ARFID that overlap with autism, such as a need for sameness with foods, sensory aversions, and fear around foods. What makes ARFID different is how extreme and restrictive eating behaviors are.
How are Autism and ARFID connected?
Is ARFID associated with autism?
Autism and ARFID can co-occur, but not all individuals with autism have ARFID. In a large study of children with autism, 21% also displayed avoidant-restrictive behaviors typical of ARFID, indicating that it is relatively common for both to be present. [2]
In addition, more than half of those with ARFID have other neurodevelopmental or psychiatric disorders as well. [2] So, while autism and ARFID can co-occur, more research is needed to fully evaluate the link between the two.
Disorders associated with ARFID
ARFID is often present along with other disorders, such as depression, anxiety, autism, ADHD, IBS, OCD, sleep disorders, learning difficulties, and eating disorders, so it is important that evaluation and treatment include addressing any other conditions that are present as well. A healthcare provider or licensed mental health professional can help you find which personalized care is best for your child.
Getting Support if your Child has ARFID and Autism
If you suspect your autistic child may have ARFID, a healthcare or mental health provider can help to evaluate your child and make recommendations for treatment. Each child is unique, so treatment can vary depending on your child’s needs.
Treatment Options for ARFID
ARFID requires specialized treatment, with one of the main treatments being Cognitive Behavioral Therapy, which is usually provided by a licensed mental health professional. In some situations, medications and/or tube feedings may be utilized as treatment options as well.
In addition, having a dietitian or feeding specialist who specializes in ARFID can be a great addition to your child’s healthcare team. Having a supportive community is invaluable for those with autism and ARFID. The Nourishing Autism Collective is a great place to find information, support, and a great group of moms who encourage each other.
Here are some additional resources that provide information and encouragement for ARFID:
Podcast Episodes:
ARFID Explained: Insights from ARFID Dietitian Lauren Sharifi
"He's a Completely Different Kid": Henry's ARFID & Nutrition Journey with Sarah Phillips
Blog Posts:
References
[1] Inoue, T., Otani, R., Iguchi, T. et al. Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder. BioPsychoSocial Med 15, 9 (2021). https://doi.org/10.1186/s13030-021-00212-3
[2] Keski-Rahkonen A, Ruusunen A. Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome. Curr Opin Psychiatry. 2023 Nov 1;36(6):438-442. doi: 10.1097/YCO.0000000000000896. Epub 2023 Aug 29. PMID: 37781978.
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Blog Written by Kalee Lundmark, MS, RDN, IFNCP
Kalee Lundmark is a Registered Dietitian Nutritionist who enjoys sharing her passion for nutrition with other moms. She has spent the last 20 years working with children to optimize their nutrition and help them overcome feeding challenges.
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