Introduction: is picky eating a psychological disorder? Is ARFID and autism linked?
Witnessing your child’s dissatisfaction and lack of interest in food day in and day out, may well have you feeling concerned about their psychological well-being.
We’re not surprised if you’ve started to wonder if these behaviours around food may point towards a psychological disorder.
It’s important to know that with any aspect of development, some degree of variation from one person to the next is normal. We all experience the world a little differently and have our own preferences and quirks.
Think of sleep, speech, or even walking - children all develop at different paces. Some children may develop on a different timeline to the majority of their peers and sometimes this leads to further assessment and support.
It’s helpful to think about eating challenges on a spectrum or continuum. Rather than thinking of whether your child’s eating falls into “disordered eating” or “typical eating”, think about it as a spectrum with every degree from mild picky eating to significant eating challenges along the way.
No matter where your child falls on this continuum, you and your child still deserve access to good-quality information and support.
Picky eating & child development
Many cases of picky eating are considered a part of typical child development.
Most children go through a phase called “neophobia” somewhere around 18 months to 2 years of age where they become more selective about their food choices. This phase goes along with changes in growth rate, appetite, and physical development which may all contribute to changes in eating behaviours.
Toddlers are also developing fast when it comes to their identity and social development. They are figuring out their place in the world and how they relate to other people. This can all lead them to experiment with being more assertive about their food preferences.
Setting clear boundaries and structured mealtimes, while also respecting childrens’ autonomy can help to move through this stage smoothly. But for many families, this period becomes a time filled with worry, tension and food battles which can end up in a vicious cycle of more food refusal and more worry.
Many children start eating a wider variety of food again as they move out of the toddler phase.
For other children this may take longer and picky eating behaviours can persist throughout childhood - particularly if there are other factors at play such as sensory differences or medical issues.
Selective eating & neurodiversity
Selective eating is common amongst neurodiverse children and there is a significant overlap between selective eating, ADHD and autism.
To give you a better idea of what we’re talking about here - while the rate of eating challenges is estimated to be between 25 - 45% in the neurotypical population, this figure increases to 46-89% in autistic children.
There are lots of reasons for this association between selective eating and neurodiversity. It may differ from one person to the next, but some explanations include: a preference for rituals and repetitive patterns of behaviour, sensory differences in how food and eating environments are experienced, as well as differences in emotion regulation and social interactions around food.
Selective eating alone is unlikely to indicate ADHD or autism. However, if your child is encountering difficulties in other areas such as sleep, toileting, motor skills, emotions, communication and social skills, then it may be worthwhile looking into this further.
You can bring up what you have noticed with your GP, health visitor, or school staff to get additional perspectives and a referral for an assessment.
Avoidant Restrictive Food Intake Disorder
ARFID (or Avoidant Restrictive Food Intake Disorder) is gaining increasing press attention and public awareness and it’s not uncommon for parents to ask us “Do you think my child has ARFID?”.
ARFID is not characteristically different in nature from extreme picky eating but represents the more severe end of the selective eating continuum. ARFID refers to eating that is restricted to the degree that it impacts the child’s weight, nutrition, and psychological or social wellbeing.
ARFID represents avoidant or selective eating due to:
· Sensory characteristics of the food
· A fear of negative consequences (such as vomiting or choking) and/or
· Lack of interest in eating/food (low appetite, lack of enjoyment)
Diagnostic criteria for ARFID
So what is a diagnosis of ARFID based on?
To be diagnosed with ARFID, a person’s eating must be associated with one or more of the following:
· Significant weight loss or slowed growth
· Nutritional deficiencies
· Dependence on tube feeding or energy dense supplements
· Significant impact on psychosocial functioning (e.g. participation in day-to-day activities)
A person will not get a diagnosis of ARFID if their restricted eating is:
· due to lack of available food or cultural norms
· motivated by dissatisfaction with body weight or shape (as is seen in eating disorders such as anorexia nervosa or bulimia nervosa), or
· if the limited eating is better explained by another medical condition or disorder
Pros & cons of a diagnosis
You may experience conflicting feelings about considering a diagnosis in relation to your child’s eating. There are some positive sides to getting a diagnosis, for instance it may help to:
· Understand your child’s eating better
· Feel better understood by others (relatives, teachers etc.)
· Access support you need from school and health care services
· Find support from other families going through the same thing
On the other hand, some families find that:
· They do not want to put a “label” on their child’s eating
· Even with a diagnosis, it can sometimes be hard to access services
· With some guidance around routines and strategies to support their child, they start to notice improvements and no longer feel that a diagnosis is necessary
Where to get a diagnosis
Only certain professionals are qualified to diagnose ARFID - and this usually includes paediatricians, clinical psychologists, and psychiatrists.
If you are visiting a health professional to explore a diagnosis, it is worth asking if this is something they are familiar with, and are qualified to diagnose, before your appointment.
It may also be helpful to bring some information about ARFID with you, along with a list of the concerns you have about your child’s eating.
Next steps
Be reassured that picky eating is extremely common, and the majority of cases do not indicate a psychological disorder. Only a small number of cases fall towards the more significant end of the continuum.
If you think your child’s eating may point towards ADHD, autism, or ARFID, take some time to weigh up the pros and cons of pursuing an assessment for your child.
See the degree of your child’s eating challenges and the impact on your family using our FREE picky eater quiz .
Begin to understand the underlying reasons behind your child’s unique relationship with food using the Picky Profile .
References
Råstam, M., Täljemark, J., Tajnia, A., Lundström, S., Gustafsson, P., Lichtenstein, P., ... & Kerekes, N. (2013). Eating problems and overlap with ADHD and autism spectrum disorders in a nationwide twin study of 9-and 12-year-old children . The Scientific World Journal, 2013.
Vissoker, R. E., Latzer, Y., Stolar, O., Rabenbach, A., & Gal, E. (2019). Eating problems and patterns among toddlers and young boys with and without autism spectrum disorders . Research in Autism Spectrum Disorders, 59, 1-9.
