Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review.

Many autistic children have severe eating difficulties called ARFID, which can seriously affect their health. The main reason appears to be sensitivity to food textures, tastes, or smells. Some children also avoid foods due to fears or simply lack interest in eating. Behavioral therapy approaches show promise for helping these children. However, more research is needed to understand how common ARFID is in autism and develop better treatments.

This scoping review examined 56 studies on avoidant/restrictive food intake disorder (ARFID) in autistic children and young people. The review found that ARFID-like presentations are common in this population, with severe physical and mental health consequences. Three key drivers were identified: sensory-based avoidance (most common), fear/phobia-based restriction, and lack of interest in eating. Behavioral interventions showed feasibility and potential effectiveness.

However, significant research gaps exist regarding prevalence, underlying drivers, and adapted treatments. The review highlights ARFID as an under-researched but impactful condition in autism, emphasizing the need for rigorous clinical trials and prevalence studies.

Clinicians should routinely assess for ARFID in autistic children, particularly focusing on sensory sensitivities. Behavioral interventions may be beneficial but require adaptation for autism. Multidisciplinary approaches addressing physical and mental health consequences are essential. Further research is urgently needed to establish prevalence and develop evidence-based treatments.

This scoping review identifies significant research gaps including lack of prevalence data, limited understanding of underlying mechanisms, and insufficient rigorous clinical trials. The evidence base is described as currently under-researched, limiting definitive conclusions about treatment effectiveness.

To assess the extent of the scientific literature on avoidant/restrictive food intake disorder (ARFID) in children and young people with autism in order to evaluate and synthesize the evidence on (a) the nature of feeding and eating difficulties in children and young people with autism; (b) the consequences of a severely restricted diet; and (c) what is known about effective treatment approaches. PubMed and PsycInfo databases were searched, identifying 56 studies and a narrative synthesis was effected. The literature suggested that ARFID-like presentations are common in children and young people with autism, with severe consequences for physical and mental health. The three drivers mentioned in the DSM-5 criteria, namely a sensory-based avoidance, fear- or phobia-based restriction, and a lack of interest in eating, are present in this population, although sensory sensitivities are currently the most commonly described.

Research suggests that ARFID symptoms in children and young people with autism can be amenable to treatment, with evidence that behavioural interventions are feasible and potentially effective in this population. ARFID is a common and impactful problem among young people with autism but is currently under researched. Work is required to (a) identify the prevalence of ARFID in children and young people with autism; (b) uncover the key drivers of ARFID in this population; (c) adapt currently available interventions for use with children and young people with autism; and (d) rigorously test these interventions in clinical trials. Significant food restriction is common in children and young people with autism.

Sensory sensitivities are frequently cited as a reason for food restriction. The prevalence and causes of avoidant/restrictive food disorders in children and young people with autism need further research.