Effective Treatments for Co-Occurring ARFID & Autism

About one in 44 children are diagnosed with autism. [1] Many of these children develop significant food rituals that are hard to break. Sometimes, those habits are significant enough to merit a diagnosis of avoidant restrictive food intake disorder (ARFID).

To them, there are no safe foods. Autism has changed their relationship with eating.

Treatment teams can address co-occurring autism and ARFID. With therapy, people can expand their meal choices and nourish their bodies.

Understand ARFID and Autism 

ARFID and autism are closely related, but they’re not synonymous. Understanding the differences and similarities could help you make informed decisions about your treatment.

What is Autism?

Autism is a developmental disorder affecting how individuals think and interact with others.

Those with autism may have repetitive or very focused behaviors, interests, and sensitivity to sensory experiences. These sensory experiences can (and often do) involve how food tastes, feels, or smells. As a result, selective eating disorders in autism are relatively common.

What is ARFID?

Avoidant restrictive food intake disorder involves food avoidance and rigidity, which results in insufficient calorie intake. This disorder can occur throughout the lifespan.

Food avoidance may be a result of the following:

• Inaccurate information or incorrect beliefs about food intolerance and nutrition
• Rigidly held beliefs about food that conflict with empirical evidence
• Aversion to the smell, taste, temperature, or texture of foods
• Traumatic avoidance related to food, such as choking or painful esophageal spasms due to dysphagia

ARFID is similar to anorexia, as both involve limiting food intake. But unlike people with anorexia, people with ARFID aren’t worried about their size, shape, or fat distribution. [2] Instead, they’re concerned about the food itself.

The Connection Between ARFID & Autism

People with autism often develop avoidant restrictive food intake disorder. Their rigidity and worries about sensory experiences can blossom into disordered eating patterns that are difficult to shift.

People with autism also have difficulty communicating with others, so they can’t explain why they limit their food intake. [3] To outsiders, they may seem stubborn and not ill.

When a person avoids consistently aversive sensory experiences, they tend to consume a limited variety of foods, causing:

• Low energy
• Malnutrition
• Arrested growth
• Weight loss

People with autism-related ARFID are at risk of these complications.

Researchers say autism and eating disorders often intertwine. [4] People with either condition experience the following:

• Difficulty understanding and interpreting social cues
• Fixation on tiny details that make it difficult to see the big picture
• The desire for rules, routines, and rituals

Genetic studies have also shown overlaps between autism and anorexia. Some studies show that as many as 20% of individuals with anorexia also have autism. [4]

Effective Treatment for ARFID & Autism

We all must eat to survive, but meals can be challenging or terrifying for people with avoidant restrictive food intake disorder and autism. Treatment can help.

If hospitalization is not needed, outpatient treatment can be highly effective. A full treatment team is recommended, including a:

• Psychiatrist
• Psychologist
• Dietitian
• Adolescent medicine doctor
• Nurse
• Social worker

Teams can create a treatment plan to help address the patient’s needs.

Medical Stabilization

ARFID can cause some children and teens to lose significant weight due to restrictive food intake. If an individual is at an extremely low weight or medically unstable, hospitalization may be the first step in treatment.

Therapy Options

Cognitive behavioral therapy (CBT) is a highly effective, empirically-based therapy for ARFID that can challenge rigid beliefs around food, including fear of choking.

ARFID is often treated through anxiety management and systematic desensitization, gradually rewarding the introduction of new foods. Relaxation therapy can also be used to minimize stress.

Practice Meals 

It is essential to have a safe environment where fear foods are slowly integrated into the eating plan. Consuming a meal together with meal processing, visualization, art therapy, and psychotherapy can be extremely useful in treatment.

Further treatment can include exposure therapy for nutritional recovery. A core component in exposure therapy for ARFID is exposing the individual to varied textures, smells, tastes, and sensations.

Good Nutrition

Proper nutrition and exposure can nourish the brain and permit habituation to anxiety-provoking stimuli. A nourished brain is more flexible in treatment than a malnourished one, so improved nutrition is central to treatment for those with co-occurring ARFID and autism.

Get Help Today

It can be challenging to distinguish early-onset anorexia from avoidant restrictive food intake disorder in children under 12, particularly when an individual also falls on the autism spectrum. If you notice warning signs in your child, know that treatment is available, and you can reach out for support today.

If you have ARFID or think autism is changing your eating, talk with your doctor about what to do next.

References

1. Data and Statistics on Autism Spectrum Disorder. (2022). Centers for Disease Control and Prevention. Accessed September 2022.
2. Avoidant Restrictive Food Intake Disorder (ARFID). (n.d.). National Eating Disorders Association. Accessed September 2022.
3. ARFID and Autism. (2022). ARFID Awareness UK. Accessed September 2022.
4. Arnold C. (2016). The Invisible Link Between Autism and Anorexia. Spectrum News. Accessed September 2022.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on January 11, 2023 and Reviewed By Jacquelyn Ekern, MS, LPC.
Published on EatingDisorderHope.com