Recently, I have been learning about ARFID, an eating disorder that is prevalent in those with ADHD and autism. It can occur in children as young as 2, as well as adults and it can be very serious. While a person with ARFID may seem like just a picky eater, it is far more serious. Those who experience ARFID are often told they should just eat more, but it isn’t that simple.
What is ARFID?
Avoidant Restrictive Food Intake Disorder, ARFID, is an eating disorder that can affect children and adults. It is generally not related to body image issues or a desire to lose weight, unlike other eating disorders. ARFID generally appears early in childhood with “picky eating” but can progress to be life-threatening. Eating too few calories or nutrients for long enough can result in a wide variety of health concerns.
What causes ARFID?
ARFID does not have a simple, known cause, but it often occurs in children with Sensory Processing Disorder, ADHD, or autism. Children may have previously eaten foods, but then stop. They restrict the list of foods they will eat down to a short list they consider “safe.” This list often lacks nutrients, and people with ARFID may avoid meat, vegetables, and fruits. The reasons for avoiding these can be because of texture, flavor, or even associations. For example, if a child ate blueberries on a day they got sick, they may refuse to eat them again. They may struggle with foods like grapes because each small fruit can have a different texture and flavor. Snacks like crackers may be preferred because they always have the same flavor and texture.
Those with ARFID may not experience hunger in a typical fashion and have poor interoception. Because they don’t experience the typical feelings of hunger, they don’t seek out snacks and meals like a typical person. Their body doesn’t remind them to eat, so they need to learn to eat meals and snacks on a schedule, even if they are not experiencing hunger. They may also find the feeling of “fullness” after a meal uncomfortable or difficult to identify. This can mean they do not know when to stop eating. For this reason, they may underfeed themselves even when trying to eat. We have a society obsessed with weight, so images of plates with too little food are common. Dieting advice about eating small servings can be dangerous for those with ARFID. If you don’t feel hunger and fullness, how do you figure out how much to eat?
They may have a history of illness or vomiting that has triggered the food aversions. Bad experiences with food allergies, food poisoning, or even stomach viruses can cause a downward trend for those dealing with ARFID. Their brains can associate food with illness, and then simply try to avoid food to avoid a recurrence. This is not a simple lack of appetite after illness, but a mental health issue. They create a negative association with food and their brains insist they can just not eat. Not eating means no vomiting, right? Just like those with OCD cannot simply stop their irrational thoughts, neither can those with ARFID.
Some medications may also reduce appetite. Stimulants such as Adderall and Ritalin, commonly given to those with ADHD, can decrease appetite in a dangerous way. For those who were already predisposed to ARFID, these drugs can make things SO much worse. If your child is on one of those medications, be sure to monitor that they are eating enough each day. Keep an eye on their weight too, as weight loss is a common side effect, but can indicate a dangerous trend. If your child loses too much weight, it can damage their organs. Not eating enough food, can also make all the symptoms of ADHD much worse. You can’t concentrate if your body doesn’t have enough calories to get through the day.
Treatment for ARFID
Treatment for ARFID can include seeing an occupational therapist for either treatment for sensory processing disorder or feeding therapy. There are also speech-language pathologists who do feeding therapy and can help. These therapies may address the whole child, and not just the feeding aspect, as the issues of SPD are often best approached with a variety of techniques. There are also therapists who specialize in feeding therapy who can focus on ways to encourage children to eat more with techniques to expand the diet. They can help parents introduce similar foods to those the child finds safe, or come up with games or ideas to help make mealtime more enjoyable.
For older children and teens, seeking ARFID treatment should include seeing a therapist experienced with eating disorders and a nutritionist. Your child may also need to see a psychiatrist. Anxiety is part of the challenge for many with ARFID, and medications to treat anxiety without reducing appetite may help. Food-related anxiety is real, and treatment for that anxiety is critical to long-term success.
In addition to telehealth treatments, there are in-person groups, in-patient treatment centers, and other options to help those with ARFID. If you suspect you or your child may have ARFID, don’t be afraid to seek treatment. It can be embarrassing to admit your child won’t eat. We often call a baby “good” if they are a healthy eater, but it isn’t a failure on the part of you or your child if they are struggling. The underlying issues of ARFID are complex and your child may need an entire team of therapists and doctors to help them get back to good health.
Treatment may be hard to find, so be persistent. Be open to starting treatment with whichever professional you can find. Often one professional can often help you find another.
About the Author
Laura Sowdon, OTR/L is an occupational therapist, writer, speaker, educator and creator of the Five Senses Literature Lessons homeschool curriculum. She has worked as an occupational therapist with children in public and private schools, as well as private practice. Laura has taught and managed homeschool co-ops as well as homeschooling her own three children. Laura is dedicated to the idea of educating children at a pace that aligns with brain and physical development milestones and respects neurodiversity in all its forms.