Sprouts Child Occupational Therapy are experienced working with children who have a diagnosis of Avoidant / Restrictive Food Intake Disorder (ARFID). We hope that this will provide you with a bit more information about what ARFID is.
What does ARFID stand for?
ARFID stands for Avoidant/Restrictive Food Intake Disorder. This is a diagnosis in the DSM 5 that is used to describe a child, young person or adult who has disturbance in their feeding or eating that causes them to persistently fail to meet their required nutritional and/or energy needs.
Why have I not heard about ARFID much until recently?
ARFID is a relatively new diagnosis with the DSM 5 being released in 2013. The ARFID diagnosis replaces and extends the previous term from the DSM 4 of ‘Feeding Disorder of Infancy or Early Childhood’ which was previously used by professionals to describe children with selective eating patterns. This change was made as the old ‘Feeding Disorder of Infancy or Early Childhood’ diagnosis was restricted to younger children whereas we know older children, adolescents and adults can have similar feeding and eating problems. In addition, the previous ‘Feeding Disorder of Infancy and Childhood’ diagnosis was not very useful as it was too general and placed an over-emphasis on weight.
So is ARFID an eating disorder?
ARFID is classified as an eating disorder, however this diagnosis is different from the eating disorders Anorexia Nervosa and Bulimia Nervosa. The key factor that distinguishes ARFID from other eating disorders is the presence of avoidant or restrictive eating habits in the absence of apparent weight or shape concern. Young people with a diagnosis of ARFID are generally younger than those with an eating disorder, with the onset of ARFID typically occurring during childhood but it can also have an adolescent or adult onset and can present or persist into adulthood. ARFID also has a higher proportion of males than other eating disorders, with it being reported that the ratio of male to female being 2:1.
What is the DSM-5 diagnosis criteria?
- An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- 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.
- The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Does my child have ARFID?
There are a number of reasons why a child or young person might be avoiding food or restricting his or her intake. Individuals with ARFID may present with one or more of the following:
- Extreme food selectivity
- Feeding/eating aversions
- Lack of interest in eating or food
- Medically unexplained weight loss
- Avoidance based on the sensory characteristics of food
- Concern about aversive consequences of eating (e.g. worry that they may be sick or choke).
- Tube dependency
- Lack of interest in food
- Avoidance of social situations with food involved
If there are medical, neurological or structural problems that primarily account for the individual’s feeding difficulties (e.g. unmanaged dysphagia), a diagnosis of ARFID may not be appropriate.
How can ARFID affect young people?
When your child is diagnosed with ARFID it is likely that they are not getting enough nutrition or energy through their diet. Younger children may not experience weight loss but their growth and development might be affected, meaning that they may not grow or gain weight at the expected rate for their age. However, it is important to note that many children with ARFID might be within normal limits of growth and weight but this in itself does not mean they don’t have a problem.
Young people with ARFID may also experience social problems as a result of their food selectivity. Food is a very social event and therefore children may feel socially isolated when they have a diagnosis of ARFID. Children might have difficulty engaging in parties, play dates, overnight trips, or eating out with their family. Their food preferences may also have an impact on their ability to participate in school as they may not take in adequate nutrition to have the energy to last a whole school day.
Can ARFID be treated?
Yes ARFID can be treated, however as the diagnosis is relatively new there is limited evidence yet to inform clinical best practice. Experienced clinicians use their clinical experience to set appropriate treatment goals. It is important that all aspects of feeding is considered prior to treatment being commenced. General treatment goals should be to increase range of foods, anxiety management and addressing any other diagnoses that the child may have in the context of their feeding challenges. Treatment may include behavioural intervention, exposure therapy, sensory based intervention, dietetic intervention, and occasionally cognitive behavioural approaches.
Please take a look at our website for more information on the feeding therapy services that are offered by Sprouts Child Occupational Therapy Services.