Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating and feeding disorder marked by an ongoing disturbance in eating or feeding that results in inadequate nutritional or energy intake, without the cognitive features of body image distortion or fear of weight gain seen in anorexia nervosa. Individuals with ARFID may avoid or restrict food intake due to sensory sensitivities, a lack of interest in eating, or a fear of negative consequences such as choking or vomiting. This avoidance leads to significant weight loss (or inadequate growth in children), nutritional deficiencies, dependence on enteral feeding or supplements, and/or interference with psychosocial functioning.
Although ARFID can occur at any age, it often emerges in childhood or early adolescence. It is distinct from typical “picky eating” in its severity and functional impact. Individuals may consume only a very limited variety of foods, avoid entire textures or food groups, and experience distress or impairment in social situations involving food.
ARFID is a heterogeneous condition with multifactorial origins. Identified risk factors and potential causes include:
1. Sensory sensitivity: aversions to food texture, smell, taste, or appearance
2. Traumatic feeding experiences: choking, vomiting, or severe reflux episodes
3. Low appetite or limited interest in food, often biologically based
4. Anxiety disorders, including generalized anxiety and specific phobias
5. Neurodevelopmental disorders, particularly autism spectrum disorder and ADHD
There is no single biological or psychological cause of ARFID. Instead, it arises from an interplay of individual temperament, neurodevelopmental profile, and environmental or experiential factors.
ARFID can lead to serious medical and developmental consequences, particularly in children and adolescents. These may include weight loss, growth delays, micronutrient deficiencies, and reliance on nutritional supplements. Psychosocially, children with ARFID often avoid eating in social settings, struggle with school meals, and withdraw from celebrations involving food. Without treatment, ARFID can persist into adulthood and, in severe cases, require hospitalization to address medical instability.
For SLPs, ARFID is a key concern within pediatric feeding and swallowing practice. SLPs contribute to multidisciplinary care by assessing sensory, oral-motor, and behavioral aspects of feeding and guiding desensitization efforts. Differentiating ARFID from dysphagia or other feeding disorders is essential, as is collaborating with psychologists, dietitians, and occupational therapists to implement targeted interventions. A trauma-informed, individualized approach allows SLPs to support nutrition, promote oral feeding skills, and address the broader impacts of ARFID on communication and psychosocial development.
Effective treatment of ARFID requires a multidisciplinary approach tailored to the individual’s presentation. Key components of intervention include:
1. Nutritional rehabilitation, often guided by a dietitian, to address growth, weight, and micronutrient deficiencies
2. Cognitive-behavioral therapy for ARFID (CBT-AR) to reduce fear-based avoidance, improve motivation to eat, and increase dietary variety
3. Feeding therapy led by SLPs or OTs using gradual, non-coercive exposure to novel textures and foods
4. Family-based intervention, empowering caregivers to support feeding without escalating conflict or pressure
5. Sensory integration strategies for children with sensory hypersensitivity, often embedded within play-based approaches
Treatment may take place in outpatient, intensive day-treatment, or inpatient settings, depending on severity. Success is measured not only by weight or nutritional gains but by increased flexibility, decreased mealtime distress, and improved participation in social eating. Long-term follow-up is often necessary, especially in individuals with co-occurring neurodevelopmental conditions or high anxiety.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, (2013).
Thomas, Jennifer J., et al. “Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults.” Cambridge University Press, (2019).
Zucker, Nancy L., et al. “Psychiatric Comorbidity and Other Psychological Factors in ARFID: A Collaborative Study.” International Journal of Eating Disorders 52, no. 1 (2019).
Sharp, William G., et al. “Feeding Problems and Nutritional Status in Children with Autism Spectrum Disorders.” Pediatrics 124, no. 2 (2009).
Norris, Melanie L., and Debra K. Katzman. “Update on Eating Disorders: Current Perspectives on Avoidant/Restrictive Food Intake Disorder in Children and Youth.” Neuropsychiatric Disease and Treatment 12 (2016).
