By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA
Feeding children is one of the many aspects of parenting that seems pretty straightforward before you have kids of your own. But most parents will tell you that it can actually be mind-bogglingly difficult. That’s because “picky eating” is very common, so much so that it’s considered a normal developmental phase in early childhood. In fact, almost half of typically developing children go through a phase of “picky eating,” and the prevalence is even higher in children with neurodivergences, such as Autism Spectrum Disorder. The good news is that, as frustrating as picky eating can be, most children naturally outgrow this phase and eventually expand their diets to include more than chicken nuggets and buttered pasta. However, there is a subset of picky eaters for whom their selective food choices are part of a more serious problem that requires intervention.
In some case, highly selective eating may signal the presence of a condition called Avoidant Restrictive Food Intake Disorder or ARFID. A diagnosis of ARFID is made when an individual’s picky or selective eating is severe enough to cause secondary problems, such as nutritional deficiencies, reduced growth or weight loss, and/or social-emotional difficulties.
Unfortunately, little is understood about the underlying causes of ARFID. However, most people with ARFID fall into one or more of these three “subtypes,” each of which derives from different underlying factors.
- In some cases, anxiety about choking, vomiting, or allergies drives avoidance of certain foods. This appears to be a factor for up to half of all children with ARFID and may develop after a traumatic experience, such as an illness.
- Sensory sensitivities are another underlying factor for some individuals. These people may respond more intensely and/or have aversions to particular textures or flavors. Roughly one out of five of those with ARFID endorse sensitivities to flavors, textures, or smells. Interestingly, “supertasters”—people who have a higher concentration of taste buds—experience flavors much more intensely than is typical. These individuals may be more likely to develop ARFID as they avoid bitter foods.
- Additionally, some people simply experience fewer hunger cues and may forget to eat or simply have a low level of interest in and motivation for eating. In these cases, individuals may be willing to eat a broader range of foods but struggle to eat enough.
Importantly, unlike most other eating disorders, ARFID is NOT related to concerns about body image or a desire to lose weight. It’s also important to recognize that ARFID is NOT just extremely picky eating, and individuals with ARFID won’t simply “outgrow” it.
Regardless of the initial triggering factors, limited or restricted intake is maintained by avoidance. That’s why early identification and treatment is important. It is also critical in order to prevent the development of potentially serious health problems related to nutritional issues, which can, in turn, cause difficulties ranging from fatigue and poor concentration to anemia, reduced immune system functioning, stunted growth, and even delayed puberty. Individuals with ARFID are also at risk of experiencing diminished self-esteem, may struggle to take part in social situations that center around food (e.g., meals with others), and develop emotional distress.
Though ARFID can be challenging to address, there are effective treatments. The goals of treatment depend upon individual factors but typically involve restoring weight if necessary, reducing anxiety, and gradually introducing new foods. Specific treatment modalities include family-based treatment, cognitive behavioral therapy, and exposure and response prevention. Treatment may also involve working with a physician and/or dietician.
If you’re concerned that your child’s “picky eating” may be more than a phase, please reach out to a professional who can further assess the situation and provide direction. There are screening tools that may be helpful in providing direction. One such resource can be found here: https://equip.health/arfid-screener. You can also contact the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 or by texting NEDA to 741-741.
References/Resources
https://equip.health/conditions/arfid
https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
About the Author
Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.
Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.
Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.
Dr. Rodriguez lives north of Boston with her husband and three young children. She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.
To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.
NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
