54. ARFID vs Picky Eating - What's the Difference?
In this episode of the Nourishing Autism Podcast, join Brittyn, The Autism Dietitian, as she delves into the complexities of ARFID (Avoidant Restrictive Food Intake Disorder).
She explores the various types of ARFID, symptoms, prevalence rates, and strategies for providing support and treatment, especially for autistic children. This episode shows the importance of tailored care approaches, addressing underlying anxiety and sensory issues, and offers guidance for parents on fostering a positive eating environment and seeking professional support.
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TRANSCRIPT
Hi, I'm Brittyn, a Registered Dietitian and autism sibling. I have a passion for helping parents of neurodivergent kids navigate nutrition and wellness for their child, one small step at a time. Here we'll explore practical nutrition tips, learn from top autism experts, break down the newest research, and share inspirational stories that will empower you to utilize nutrition to help your child feel their best and thrive.
Listen in while picking kids up from school, sitting in a therapy waiting room, taking a quick walk or wherever you find yourself, looking for some inspiration and a friend to guide you along this journey. This is Nourishing Autism.
Brittyn: [00:00:00] We do see higher rates of ARFID in neurodivergent individuals. In the general population, there's so many different studies that say, okay, this only affects up to 1 percent of the population.
And then other studies who say it affects up to 15 percent of the general population. So there is a wide range, but we do have research to show that in the autistic population, we have rates up to 33%. So showing that even one in three children on the autism spectrum experience ARFID.
Brittyn: Hey everybody, welcome back to another episode of Nourishing Autism. Today we are going to be talking about a topic that is a really hot topic right now but for a really good reason and that is something called ARFID. Now a lot of people are confused about what ARFID is or incorrectly calling it AFRID and I just want to really explain about what ARFID is so you can actually [00:01:00] understand if this is something that you need to be considering
for your child on the autism spectrum. So ARFID is an acronym, and it stands for Avoidant Restrictive Food Intake Disorder. And this condition is actually an eating disorder, which a lot of people don't realize. So it's a mental health diagnosis. However, what's different about ARFID is that it actually doesn't take into account how you feel about your body.
In children, signs of ARFID include a sudden refusal to eat foods they previously enjoyed, a fear of trying new and unfamiliar foods, limiting the variety of foods that they eat, a lack of interest in eating or a low appetite, a fear of choking, vomiting, or pain associated with eating, or significant weight loss and/ or nutritional deficiencies.
So ARFID is actually more rooted in anxiety around food, severe sensory issues. And, again, not taking into account their [00:02:00] body size or type.
So there's actually three types of ARFID, which also a lot of people don't realize. So we have avoidant, aversive and restrictive.
One really common type of ARFID is avoidant. And in avoidant type ARFID, individuals are avoiding certain types of food in relation to the sensory experience from that food. So they may have a sensory sensitivity or overstimulation around certain sensory experiences of food. And this is typically where I see a lot of kids on the autism spectrum fall in if they do have ARFID.
So, ARFID, again, it's going to be an extremely limited number of foods and can even be so severe as to children who are losing weight or have some severe nutrient deficiencies. This is not just for the avoidant type, but for all types of ARFID. So, kids who are in this avoidant type, they may be really aversive to the smell [00:03:00] of foods, textures,
it could really impact the nutrient intake that they're getting from foods based on the avoidance of certain food texture types or food sensory types. So again, this is where I see a lot of autistic children falling into this avoidant type of ARFID. Now the second type of ARFID is called aversive type.
So this is going to be individuals who avoid types of foods or certain foods in general out of anxiety or fear. And this is typically linked back to some kind of traumatic experience with food, whether that was choking with food, being sick after eating food, so nausea or vomiting. It could be linked to pain after eating a certain food or maybe a traumatic experience that the child experienced of being forced to eat a food.
So this is more related in anxiety [00:04:00] and fear rather than the sensory experience around eating. Now lastly, we have restrictive type ARFID, which is those individuals who show little to no interest in eating food.
It can make them not want to eat altogether, not experience hunger,
we can also see autistic individuals falling into this camp. So interoception, which is our ability to detect if we're hungry, if we're full, if we need to go to the bathroom, basically all of those internal body sensations from our organs detecting hunger or fullness. So this could also loop into this restrictive type ARFID where they're not detecting if they're hungry and they have no interest in eating altogether.
So the three types: avoidant, restrictive, and aversive. So it's helpful to understand that. So some people are wondering, okay, well, what's the prevalence of ARFID in the [00:05:00] general population? And does autism increase rates of ARFID? So A, yes, we do see higher rates of ARFID in neurodivergent individuals. In the general population, there's so many different studies that say, okay, this only affects up to 1 percent of the population.
And then other studies who say it affects up to 15 percent of the general population. So there is a wide range, but we do have research to show that in the autistic population, we have rates up to 33%. So showing that even one in three children on the autism spectrum experience ARFID. Now I do keep saying children.
Typically we see ARFID develop in adolescence and childhood. We don't see it typically developing in adulthood, although people can experience ARFID their entire life if they're not receiving support and the right kind of support or feeding therapy. And still, even in those [00:06:00] situations, sometimes people can experience ARFID to an extent over their life.
You can go into recovery with ARFID, but that really deserves a very multidisciplinary approach, the correct type of feeding therapy that is going to, you know, help you be able to cope and manage. Also, typically taking into account, therapy that could help somebody address that kind of anxiety or fear that they have around food.
It's important to understand the different types of ARFID and how that could be contributing to your child's aversion around foods, whether it's sensory, whether it's anxiety and fear, whether it's not detecting internal body signs and not having the urge to eat. All of these different things are going to require different approaches.
A restrictive eating is really based in sensory. We want to make sure that if we are going to do feeding therapy, that we're going to make sure that we are approaching it in a very sensory oriented way, which [00:07:00] I always recommend the SOS approach to feeding that is very sensory oriented.
And this the type of feeding that I have been trained in, and that I often teach families in my membership as well, how to bring this home. And then occupational therapists and speech therapists are going to be utilizing this type of feeding therapy. You can type into Google SOS therapist archive or SOS therapist finder and you can type in your zip code they have therapists all across the world and i really recommend this type of feeding therapy because just because a practitioner offers feeding therapy that doesn't mean that they're trained in sensory oriented approaches or autism or ARFID.
So we want to make sure that you're getting the right kind of feeding therapy for your child's needs. Now, if we do know that their ARFID is extremely based in traumatic experiences around food, well, yes, feeding therapy could be helpful. We also want to be making sure that we are addressing the root problem, which is that extreme anxiety and [00:08:00] fear around food, which could bring in maybe a counselor, a child psychologist to help them cope and also help them understand and process through that extreme fear and anxiety and how to move forward through that. So we want to make sure we're addressing that anxiety. Then when it comes down to the restrictive type ARFID, if a child isn't recognizing their body cues, that could also be really helpful to bring in a
child psychologist or therapist who's going to be able to help them identify what it feels like for them to feel hunger. Maybe getting on a really solid routine can also help your child, you know, be able to recognize some of those signs of hunger and fullness. We can also set up supports for the child in order to be able to help themselves understand when it's time to eat if they're not feeling those internal body signs.
They can still experience some physiological and biological side effects from not eating that could include behaviors when their blood sugar gets really low or [00:09:00] they could experience malnutrition and nutrient deficiencies which we know can contribute to other symptoms as well and just make them not feel their best.
So we want to make sure that we are addressing all of these different things and looking deeper into the reason or reasons as to why your child may be experiencing ARFID.
I think it's also important to note that we want to make sure that they are getting the nutrients their bodies need now. So, most individuals with ARFID do need some additional nutritional support, whether that means a multivitamin, some people do require tube feeding, or some other kind of nutritional support to make sure that their bodies are getting the right nutrients while they're also undergoing therapy or feeding therapy to make sure that they're getting the nutrients that their bodies need now while they're working on getting closer to ARFID recovery.
So you might be wondering, as a parent, how can I support my child with ARFID, or suspected ARFID? My number one thing would be to really [00:10:00] recommend, to not force them to eat. We want to make sure that we're creating an environment around eating that is going to be a positive and stress free environment, especially if your child experienced some kind of a traumatic event with eating, we want to make sure that they are able to add more and more positive experiences with food. So we want to make sure to follow their lead. Of course, we can provide opportunities for them to try new foods and present them in a way where there's no pressure to try, or maybe experiencing the food in other ways of just just taking a bite.
Maybe that means touching the food. Maybe it means smelling it. There are all these different types of ways that we can interact with foods that are not just eating. And if you need support with this, we have tons of resources inside of my membership called the Nourishing Autism Collective. And inside of the Collective, we just introduced a new feature, which is really exciting.
It's called Individualized Roadmaps. And what you do when you join the Collective, now there's a personalized onboarding experience. So, you take a quiz, you tell us your main [00:11:00] nutrition concerns, where you are in your journey, and we will sort you into your individualized roadmap. And for those of you who are really working on expanding your child's diet, and that's your biggest concern right now, not only do we help you identify which foods are going to be the most successful to introduce given your child's current preferences, but we also teach you how to introduce those foods in a very sensory friendly way, and then how to expand from there. So all the approaches that we utilize are appropriate for children with ARFID
and autism and help you understand how to create a mealtime that is going to be low stress, no pressure, and as positive as possible.
If your child does have ARFID, we also suggest bringing this up with your pediatrician and getting referrals to either feeding therapists or a child therapist to be able to help your child work through this. One on one support with ARFID is really important as well.
So I would recommend finding additional resources where your child can also get the support that they need one on one.
I hope this [00:12:00] episode helped you learn more about ARFID and raise awareness about this condition so that you can identify if your child has ARFID, if this is worth bringing up to your pediatrician, or also just increasing empathy for those who share about ARFID and experience this on a daily basis.
Thanks so much for tuning in to this episode of Nourishing Autism. I will see you next Wednesday when we drop our next episode.
[00:13:00]
Transcribed by Descript
About Brittyn Coleman, MS, RDN/LD
Brittyn Coleman, MS, RDN/LD, is a distinguished Registered Dietitian and Autism Nutrition Expert, known for her innovative, sensory-friendly feeding approach to nutrition for children on the autism spectrum. As the founder of the Nourishing Autism Collective, and as an autism sibling herself, Brittyn brings both professional expertise and personal understanding to her work. She empowers families with her expert guidance, helping children receive essential nutrients for optimal health and development. Her strategies are tailored to the unique dietary needs and sensory preferences of each child.
Brittyn's influence extends beyond her membership site through her active social media presence and her popular podcast, 'Nourishing Autism'. Her educational content on Instagram, YouTube, and other platforms has established her as a leading voice in autism nutrition, providing valuable resources, practical advice, and a supportive community for parents and professionals.
