It’s not uncommon for autistic people to have ‘feeding problems’. This might be down to a number of different factors, including having sensory sensitivities towards certain foods, anxiety about certain foods, and having a preference for eating the same foods over and over again. There are many parallels in these behaviours when compared to the behaviours seen in ARFID.
Here, we will explore why some autistic people develop ARFID and what you can do to support someone with ARFID and autism.
Is ARFID common with autism?
Research has shown that ARFID and autism frequently co-exist, and people with ARFID are more likely to have autism than those who don’t struggle with this eating disorder. The BioPsychoSocial Medicine journal estimates that between 12.5% and 33.3% of people with ARFID are also on the autism spectrum, although research in this area is still ongoing.
Why do autistic people develop ARFID?
While people on the autism spectrum may often be characterised as having ‘picky’ or ‘fussy’ eating habits, those with co-occurring ARFID experience much more severe and restrictive behaviours.
Unlike other eating disorders, ARFID doesn’t cause people to have a distorted body image or concerns over weight gain. This means that people with ARFID don’t restrict their eating in order to lose weight or look a certain way. Rather, people with ARFID restrict their diet for other reasons, such as:
- Being sensitive towards certain types or textures of food, leading to sensory food aversion
- Being anxious about experiencing negative consequences as a result of eating, such as choking on their food
- A general lack of interest in food
This means that people with ARFID either don’t eat enough food to maintain their nutrition, or have to eat the same foods over and over again. These issues can have a lot of overlap with some autism traits. The main similarities in the eating patterns of people with autism and ARFID can be seen when it comes to sensory issues and the need for ‘sameness’.
- Social communication – challenges with processing language, verbal intonation and tone, figures of speech and literal thinking
- Social interaction – challenges with understanding non-verbal cues, unspoken social rules, forming friendships, making eye contact and appreciating social contexts. Autistic people are sometimes thought of as being 'socially awkward' and find many unwritten social rules difficult to manage
- Social imagination - experiencing challenges in viewing situations from another’s perspective, predicting and understanding feelings and reactions, and foreseeing consequences of events and actions
Sensory issues in autism and ARFID
Some autistic people experience sensory issues and sensory overload. This can therefore lead to heightened sensitivity when it comes to eating, resulting in the symptoms and behaviours of ARFID. However, there may be added complexities when someone on the autism spectrum also has ARFID, because they may be less able to communicate their difficulties with food, which can lead to these becoming worse.
Need for sameness and routine in autism and ARFID
Autistic people may also demonstrate repetitive behaviours and have a need for routine. When it comes to food, this might mean that they prefer to eat the same types and brands of food, eat food in a certain order, and eat at the same time each day. This rigidity can lead to the symptoms of ARFID, especially when it comes to only eating foods that the person see as being ‘safe’ or don’t have an aversion to.
Does everyone on the autism spectrum have ARFID?
Autism is a spectrum condition and the more severe the autism is, the more food-related challenges someone might experience. These might include behaviours such as:
- Intense aversions to certain types of food, based on things like texture, colour or taste
- A strong fear of choking or vomiting
- Not wanting to eat in front of other people
- A lack of interest in food
- Having certain routines and rituals when it comes to eating
- Feeling anxious when presented with new or unfamiliar food
While not everyone on the autism spectrum will have ARFID, and vice versa, it’s estimated that up to a third of people with ARFID are also autistic.
Supporting someone with autism and ARFID
If you think that your child or someone you know may be showing signs of autism and ARFID, it’s really important that they get professional help. A first port of call would be to speak to their GP about their behaviours, in order to receive a diagnosis or a referral for specialist services.
Depending on the severity of their condition, support for autism and ARFID might include elements of both autism support and eating disorder treatment. This might include interventions like specialised cognitive behavioural therapy (CBT) and carefully planned exposure therapy. These techniques can help people to overcome their sensitivities around food and gradually re-introduce certain types of food into their diet.
In addition, it can be useful to look out for events and support groups that can provide more information on the link between ARFID and autism, and how to support someone. For example, the eating disorder charity, Beat, hosts regular training, conferences and events, some of which focus on eating disorders and autism.
While there are a number of ways to support someone with autism and ARFID, it needs to be recognised that these conditions can co-occur in the first place. That’s why some researchers who have demonstrated the link between ARFID and autism are campaigning for autism screens and eating disorder screens to be conducted alongside each other, as routine. This means that the effects autism can have on ARFID, and vice versa, can be taken into account while the person is receiving support.