Avoidant restrictive food intake disorder (ARFID)

In our practice, not only do we see children with “picky” or “preferred” food preferences we see children who are diagnosed with ARFID. Speech therapists do not diagnose ARFID, but we can be on a therapy team to support the treatment of ARFID. Speech pathologist can send children out for referrals as well. ARFID, avoidant/restrictive food intake disorder, is experiencing a disturbance in eating that is restrictive in nature (Davis, 2021). This may be related to color, texture, lack of interest in eating, or a fear of choking — it’s more than just “picky eating”. Currently, it appears in about 5% of children (more common in males than females), but this number is still being studied. Children with this disorder may not gain weight as easily as others and may have difficulty eating at a friend’s house. This may lead to inadequate social functioning and playtime. Researchers explain that “early-onset in childhood, early disease recognition, and early intervention are important factors for achieving better outcomes for patients with ARFID”. In comparison with restricting-type anorexia nervosa (R-AN), there is a higher history of family mental health in ARFID (Kurotori, I, et. al.).

Risk Factors for ARFID

People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.

An ARFID diagnosis is made by a psychologist in which the symptoms may be due to sensory characteristics of food, lack of interest in food, or concerns for the adverse consequences of eating. There also must be one or more of the following symptoms:

Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning (National Eating Disorders, 2021).

Key Signs of ARFID/ When to seek a psychologist opinion:

Children may only eat food that is one specific color, such as only eating brown foods.
Children may only eat food that is one specific texture, such as only eating crunchy food.
Children may only prefer to eat food from one group. For example, only enjoy eating carbohydrates.

How a Speech-Language Pathologist can help:

A speech-language pathologist can help your child with ARFID by exposing your child to new foods in a therapeutic way. During feeding sessions, we as speech-language pathologists play games, and allow your child to touch, feel and taste the food with a variety of textures. We offer guidance on texture and transitioning through food types.

Sources:

Kurotori, I., Shioda, K., Abe, T., Kato, R., Ishikawa, S., & Suda, S. (2019). An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan. Neuropsychiatric disease and treatment, 15, 3313–3321. https://doi.org/10.2147/NDT.S218354

https://www.eatingrecoverycenter.com/conditions/arfid/facts-statistics

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