There is a high degree of overlap between avoidant/restrictive food intake disorder (ARFID) and autism spectrum disorder (ASD). ARFID profiles can be broken down into three distinct types: sensory sensitivity, lack of interest, and fear of aversive consequences. Sensory sensitivity, in particular, is important to consider when conceptualizing the possible overlap between ARFID and autism. Because individuals on the spectrum have a higher degree of sensory sensitivity to sounds, smells, and, yes, tastes, special consideration should be given to this propensity in treatment.
preference vs. aversion
Treatment for ARFID may be more challenging in autistic folks. Preexisting challenges such as rigidity around routine, difficulty with interoception, and struggles with social communication all bring potential barriers to effective treatment for ARFID. Therefore, it is important to construct treatment planning, including exposure hierarchies, based on a thorough sensory assessment of the client. Part of this assessment will entail parsing out what is a preference vs. what is an aversion. Autistic folks and folks with ARFID are allowed to have preferences. What we’re trying to determine is if true aversion is present, which then would likely need to be treated with a combination of occupational therapy and traditional talk therapy.
The importance of nervous system regulation
An additional consideration in the treatment of ARFID in neurodivergent individuals is the importance of regulating the nervous system. In order to create a sense of true safety in the body while challenging new and potentially scary foods, we must first learn to regulate into a rest/digest state. This can be achieved by gradually incorporating new, challenging foods rather than going all in at once. This can also be accomplished by intentionally regulating the body and tapping into the parasympathetic nervous system through somatic exercises such as belly breathing, vagus nerve stimulation, or sensory grounding exercises.
When treating ARFID in autistic folks, it should be made clear that we are not treating the neurodivergence, but the eating disorder. Because there is such a high degree of overlap between ARFID and ASD, it is critical to take the time to conduct a thorough functional behavioral assessment of the food/eating-avoidant behaviors to determine whether they are a function of preference or aversion, and tailor your treatment plan accordingly.
ARFID challenges and PDA
When working with neurodivergent folks, in particular, personal autonomy is a huge component of any successful treatment plan. Remind clients that they have choice every step of the way, and consider taking a values-based lens to your work together to foster a sense of personal stake in the treatment process. Also, you may find it helpful to bring a playful, curious approach to food challenges rather than a demanding, clinical one. Get curious about the texture, smells, and colors of foods, without the end goal of actually eating. This supports the aforementioned importance of choice and brings a renewed sense of curiosity to the relationship with food and eating.
Once again, a huge thank you to Jenna Stone, LMSW at Zen Psychological Center for sharing their expertise on the topic of eating disorders in neurodivergent folks.
If you’re interested in seeking support for an eating disorder, reach out to us today! We offer SLP, individual psychotherapy, nutrition counseling, and eating disorder assessment/consultation.
References:
ARFID & Autism, by ARFID Awareness UK
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