Avoidant/ Restrictive Food Intake Disorder (ARFID): What it is and how to support it
By Dr. Marina Heifetz, C.Psych
Many of our neurodivergent clients tend to be “picky eaters.” What many families may be surprised to learn is that this “picky eating” may actually be part of the newer DSM-5 diagnosis Avoidant/ restrictive food intake disorder (ARFID). ARFID is defined by an avoidance or restriction of food intake that results in one of the following:
1) significant weight loss (or failure to achieve expected weight gain)
2) significant nutritional deficiency
3) dependence on nutritional supplements
4) marked interference with psychosocial functioning (e.g., avoiding social gatherings that involve food, not eating at school/ work)
ARFID occurs for various possible reasons, which include:
Sensory sensitivity to foods (e.g., textures, smells, food colours)
A lack of interest in eating
Concern about the potential of something negative happening when they eat (e.g., choking)
Importantly, ARFID appears to be a fairly common disorder. A recent systematic review and meta-analysis study found a prevalence ranging between 4.5-11% of ARFID (across the life span), with higher prevalence in children than in adults. Another important research finding is that ARFID tends to be more common among autistic individuals. For example, studies show that up to 21% of autistic people have a diagnosis of ARFID. While further research is needed on this topic, particularly given the continuous understanding of ARFID and its presentation, there is an identified genetic link (ZSWIM6) that has been found between autism and ARFID.
What helps:
Since children with ARFID may experience strong reactions and possible worries and discomfort around food, it is important to approach ARFID from a compassionate and intentional perspective. Here are some helpful strategies:
If you are concerned about your child having ARFID and have not had a formal assessment, contact your doctor for guidance. Our team would be happy to guide you to the appropriate services.
Creating a comfortable, low pressure environment, such as flexible seating (e.g., allowing your child to sit/ stand/ move around) and sensory friendly supports (e.g., reduced noise).
Parent modeling by serving and eating a variety of foods.
Making routines around meals/ snacks (e.g., regular times of day when the family eats).
Never force your child to eat but provide opportunities for exploration.
Be flexible; allow your child to move around or have some screen time if it helps them regulate during meals.
If there are sensory differences that play a role in the child’s eating, predictability will foster feelings of safety; starting with safe foods and building small changes within these foods over time.
Mindful eating may be a helpful approach (e.g., using senses to explore food).
*Bottom line: the goal is to help the child feel regulated around food while increasing feelings of safety, predictability, and sensory tolerance.
