Autism is a neurodevelopmental condition affecting how people interact with others, the world around them, and how they understand and respond to sensory information. Sometimes other medical conditions can be linked to autism, making them more challenging to manage and treat.

In this article we’ll take a look at the relationship between autism and a condition called ARFID; how the two are linked, how sensory issues can affect autistic people when eating, how autism relates to pica disorder, and much more.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest. So if you have questions about autism or ARFID, whether for yourself or a loved one, remember we’re here to help.  

Let’s take a look at ARFID in more detail, and how it relates to autism.

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder, and the term is used to describe a condition where someone will avoid certain foods, limit how much they eat, or both. The condition was previously known under the umbrella term Childhood Feeding Disorders, which was often used to describe children with particular eating and drinking habits.

While studies show around 46% of young children struggle with ‘picky eating’, ARFID is a specific kind of food avoidance or restriction that may need to be assessed by a health professional in order to prevent malnutrition.

Why is ARFID a problem?

If an adult does not take in enough calories they will usually lose weight, and a child doing the same may not gain the weight they should at their age and height. This can affect their long-term growth, so it’s important to monitor. Similarly, both adults and children require certain nutrients to maintain good health, and with ARFID sometimes these nutritional requirements are not met. If deficiencies develop, or a person loses too much weight, treatment may be required.

Health aside, ARFID can be tough on a person’s mental health too, since limited food options often mean it can be difficult to restrict certain experiences with family, friends, schoolmates, colleagues, etc. People with the condition may find it difficult to attend social gatherings or go on holiday where their restricted food items are not available.

What causes ARFID?

Possible reasons for the development of ARFID are sometimes categorised as:

• Pickiness/Sensory: Having negative feelings about the taste, smell, texture or temperature of certain foods
• Fear: Having negative past experiences with food, such as choking or vomiting after eating
• Appetite: Having a lack of appetite, a general lack of interest in eating, or not recognising hunger cues in the body in the same way others do

Reasons for ARFID can vary from person to person, and are different for autistic people too. People with ARFID may find they have only one of the above reasons, or several.

...wait, isn’t that just anorexia?

No, ARFID is different from anorexia due to one key reason; people with ARFID do not want to eat due to the sensory, fear-based or appetite reasons mentioned above, whereas people with anorexia typically do not want to eat due to a fear of gaining weight or body image concerns.

ARFID is different from anorexia due to the driving factors behind each condition, however the resulting eating behaviours are often similar, and can cause the same health risks and mental health distress.

Is there a link between ARFID and autism?

Yes. Research shows autistic people are much more likely to develop ARFID, and a meta-analysis of prospective studies found autistic children are 5 times more likely to develop an eating concern than other children their age. In fact, while the rate of autism in the general population is thought to be 1.5%, the rate of co-occurring ARFID and autism is thought to be as high as 12.5 - 33.3%, so there is certainly a correlation.

Why is there a link between the two?

Recent research has shown that autistic children tend to have higher oral oversensitivity than their peers. A similar oral oversensitivity is also present in those with ARFID, which is when certain tastes, textures or temperatures of food may not feel nice to eat, and may provoke feelings of anxiety or even fear.

Research on autism and food selectivity has mostly been focused on this oral oversensitivity as it seems the most likely reason for comorbidity, however restricted and repetitive behaviours are also thought to be a factor, though they have not yet been studied to the same extent. These might include, for example, eating from a very small range of foods, only eating certain brands of foods, or not eating foods they haven’t tried before.

Does autism make ARFID more challenging?

It can do. Common treatment approaches for ARFID include things like:

• Cognitive Behavioural Therapy - A talking therapy to help manage emotions
• Responsive Feeding Therapy - An approach to feeding and eating interventions using the discovery of internal cues, curiosity and motivation
• Applied Behavioral Analysis - An approach to understand how behaviour works in real situations, to increase helpful behaviours and decrease non-helpful ones
• Sequential Oral Sensory Therapy - An approach integrating motor, oral, behavioural, medical, sensory and nutritional factors to manage children with feeding issues
• Family Based Therapy - An approach to support families, parents and carers

The above options can help individuals with ARFID and may be beneficial for autistic people too.

How is ARFID currently treated in autistic people?

ARFID can be a serious condition, and if weight loss or nutrition is a concern either for yourself or an autistic person you care for, treatment may be required. As treatments for ARFID continue to develop, the correlation between the condition and autism is now being considered. Therapy options like the ones listed above will usually take into account typical issues faced by autistic people — such as cognitive rigidity and oral oversensitivity — so these can be addressed.

One example of this is Cognitive Behavioural Therapy for people with ARFID that deals with sensory issues when eating using a number of cognitive interventions and carefully planned exposure therapy. In these sessions, people with ARFID will be encouraged to look first at a food, then touch it, then smell the food, then taste it, then chew it. By taking it slowly, people with ARFID (including autistic people) can start to see their food possibilities expand over time.

Working through this treatment with a qualified professional means you can benefit from their experience with eating disorders and/or autism, and gives you the best chance of seeing small improvements over time. It is also beneficial to work with a professional to stay up to date with the latest treatment advice for the condition.  

Is there a risk of other eating disorders for autistic people?

Yes, and this is certainly worth keeping in mind if you are autistic, or someone you care for is. As well as the connection between autism and ARFID, researchers have found links between autism and anorexia. Some female adolescents with anorexia have been found to have elevated autistic traits, such as the systemising of food.

Of course, this does not suggest that every autistic person with an eating issue is likely to develop anorexia. The connection is simply worth knowing about so food intake and health can be monitored if signs of ARFID or other eating issues arise.

What about autism and pica?

Autistic people can sometimes show signs of a condition called pica, which is when people eat non-food items. Pica can affect people of all ages, however it is most commonly found in young children (one study found 12.3% have engaged with pica behaviours at some point in their lives), pregnant women (a meta-analysis of studies found an estimated 27.8% of pregnant women reported experiencing pica), and neurotypical individuals.

The condition can be very serious as it has the potential to cause harm to the body from the first instance. Examples of items eaten by people with pica include paper, wood, plastic, stones, soil, metal and faeces.

It is not clear what causes this or why people engage in pica, but some of the possible reasons include a lack of awareness around what is and isn’t food, for sensory feedback, or it might be used as a stress-relief tactic.

Treatment of the condition is important in order to limit the ingestion of dangerous items. For autistic people, this may include managing their sensory needs and controlling access to certain items in order to maintain their health. In some cases, a doctor may also be able to prescribe medication to help minimise the desire to engage in pica.

If you are autistic or caring for someone who is, and you believe ARFID or pica may be an issue, you can speak to your GP about this in order to learn more about these potentially co-existing conditions and the treatment options available.

You can also use Augmentive’s free 15 minute consultation to help point you in the direction of an autism specialist who may be able to answer more of your questions.

Want to read more? Here are some other articles that may be of interest:

• Autism in adults: What to expect from an autism assessment
• Diagnosing Autism: Understanding the Complexities of Identifying Autistic Traits in Children
• What is the Triad of Impairments in autism?

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private autism assessment or review, to broader mental health care: join us today.