Avoidant/Restrictive Food Intake Disorder (ARFID) and Autism

What is ARFID?

ARFID is a relatively new eating disorder that was added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013. ARFID is characterised by a persistent avoidance of food or restriction of food intake without the use of compensatory behaviours, such as purging or overexercising. It is a disorder that affects individuals of all ages, including children and adolescents, and can have serious consequences for their physical and psychological well-being.

ARFID and autism

Studies have shown that individuals with autism spectrum disorder (ASD) are at higher risk of developing ARFID compared to those without autism. It is estimated that up to 40% of individuals with autism may have symptoms of ARFID. The reasons for this increased risk are not yet clear, but some theories suggest that individuals with autism may have sensory sensitivities, difficulties with social interactions, or other challenges that can contribute to the development of ARFID.

Symptoms of ARFID in individuals with autism can include:

  1. Avoidance or restriction of certain foods or food groups due to fear of discomfort or injury, such as choking or gastrointestinal distress.
  2. Refusal to eat in social situations, such as at school or with family and friends.
  3. Extreme pickiness or selective eating, leading to a very limited diet.
  4. Weight loss or failure to gain weight appropriately.
  5. Delayed growth or developmental milestones.
  6. Nutritional deficiencies, such as low iron levels or vitamin deficiencies.
  7. Increased anxiety or stress around food and mealtime.

Why can the consequences of ARFID in individuals with autism be serious?

The consequences of ARFID in individuals with autism can be serious and long-lasting. Malnutrition can lead to physical and developmental delays, as well as decreased immune function and increased susceptibility to illness. In addition, ARFID can have significant psychological effects, such as increased anxiety and depression, decreased self-esteem, and social isolation.

What strategies may be helpful to treat ARFID in individuals?

Treatment for ARFID in individuals with autism should be individualised and may involve a multidisciplinary approach, including a dietitian, psychologist, and occupational therapist.

The following are some strategies that may be helpful in treating ARFID:

  1. Gradual exposure to new foods: Gradual exposure to new foods can help individuals with autism to overcome their food aversions and expand their diets. This can be done by introducing small amounts of new foods, starting with familiar textures and gradually increasing the variety of foods offered.
  2. Sensory-based interventions: Occupational therapists can provide sensory-based interventions to help individuals with autism become more comfortable with different textures, tastes, and smells of food. This may include playing with food, using different utensils, or playing
  3. with different types of food in a fun and non-threatening way.
  4. Food desensitisation: Food desensitisation is a process where individuals with autism are gradually exposed to new foods in a controlled environment. This process can help to reduce anxiety and increase the individual’s comfort with new foods.
  5. Social stories and social skills training: Social stories and social skills training can help individuals with autism understand the importance of eating a variety of foods and the social aspects of mealtime.
  6. Positive reinforcement: Positive reinforcement, such as rewards or praise, can help to increase the individual’s motivation to try new foods and overcome their food aversions.
  7. Cognitive-behavioural therapy (CBT): CBT can help individuals with autism identify and change negative thought patterns and behaviours related to food and mealtime.
  8. Nutritional education: Nutritional education can help individuals with autism understand the importance of a balanced diet and the role of different food groups in maintaining health.
  9. Medication management: In some cases, medication may be necessary to manage anxiety, depression, or other mental health conditions that may contribute to ARFID.

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