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Cited by 65Child Nutrition and Feeding IssuesEating Disorders and BehaviorsAutism Spectrum Disorder Research

Autism Spectrum Disorder and Avoidant/Restrictive Food Intake Disorder

Lucarelli, Jennifer, Pappas, Demetra, Welchons, Leah, Augustyn, Marilyn·2017·Journal of Developmental & Behavioral Pediatrics
DOI 10.1097/dbp.0000000000000362
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Abstract

CASE: Kendra is a 4-year-old girl with autism spectrum disorder (ASD) who presents for follow-up of feeding problems to her pediatric clinician. She is an only child in a family where both parents are scientists. Feeding concerns date to infancy, when she was diagnosed with Gastroesophageal Reflux Disease (GERD) associated with persistent bottle refusal and the acceptance of few pureed foods. At 13 months, milk and peanut allergies were diagnosed. Following a feeding clinic evaluation at 24 months, she was prescribed a soy milk supplement and an H2 blocker. There was no concern for oral-motor dysfunction. She was also referred to early intervention for feeding therapy. However, her parents terminated participation after 6 months because she became anxious and had tantrum prior to treatment groups. She was seen in another feeding program at 3 years; zinc, folate, thyroid, and a celiac panel were normal, and an endoscopy was negative for eosinophilic esophagitis. She began individual feeding therapy, where concerns for rigidity, difficulty transitioning, and limited peer interactions led to a neuropsychological evaluation. Kendra was diagnosed with an ASD and avoidant/restrictive food intake disorder (ARFID). Her cognitive skills were average, and expressive and receptive language skills were low average. Her diet consisted of French fries, Ritz crackers, pretzels, and 32 ounces of soy formula daily. She had stopped accepting Cheerios and saltines 2 months prior. She controlled other aspects of feeding, insisting on a specific parking spot at a fast food restaurant and drinking from a particular sippy cup. Her parents accepted these demands with concern about her caloric intake, which they tracked daily. Following diagnosis with ARFID, she resumed feeding therapy using a systematic desensitization approach with rewards. At the first session, she kissed and licked 2 new foods without gagging. Her mother appeared receptive to recommendations that included continuing the “food game” at home, replacing 1 ounce of soy formula by offering water each day, limiting between-meal grazing, and refusing specific feeding demands. Currently, her parents plan to discontinue feeding therapy with concerns that the treatment was “too harsh.” Her father produces logs of her caloric and micronutrient intake as evidence that she did not replace missed formula with other foods and reports that she subsequently became more difficult to manage behaviorally. Her father now demands to see randomized controlled trials of feeding therapy approaches. Her weight is stable, but she has now limited her pretzel intake to a specific brand. How would you approach her continued care?

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Crossref · 10.1097/dbp.0000000000000362

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  • Certain thought styles appear to co-occur with disturbed eating patterns in children and young people with autism, for example, a preference for routine, cognitive rigidity, and/or intolerance of uncertainty can manifest as a reluctance to participate in social mealtimes, a preference for the use of the same vessel, container, or cutlery, or insistence on the consumption of a particular brand of食品

    “Finally, certain thought styles appear to co-occur with disturbed eating patterns in children and young people with autism, for example, a preference for routine, cognitive rigidity, and/or intolerance of uncertainty can manifest as a reluctance to participate in social mealtimes, 57 a preference for the use of the same vessel, container, or cutlery, 31,47,58,59 or insistence on the consumption of”

    From Avoidant/Restrictive Food Intake Disorder and Severe Food Selectivity in Children and Young People with Autism: A Scoping Review (2022) · cites this paper as [31]

  • Just two of the papers reported specifically on individuals with a concurrent diagnosis of ARFID and ASD.

    “Just two of the papers reported specifically on individuals with a concurrent diagnosis of ARFID and ASD.31,32”

    From Avoidant/Restrictive Food Intake Disorder and Severe Food Selectivity in Children and Young People with Autism: A Scoping Review (2022) · cites this paper as [31]

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Authors
Lucarelli, J., Pappas, D., Welchons, L., & Augustyn, M.
Affiliations
  • Boston Children's Hospital (US)
  • The Kelberman Center, Utica, NY;
  • Boston University (US)
Corresponding author
  • Lucarelli, Jennifer
  • Pappas, Demetra
ORCID
Venue
Journal of Developmental & Behavioral Pediatrics
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-01
Volume
38
Issue
1
Pages
79-80
ISSN
0196-206X (ISSN-L)
DOI
10.1097/dbp.0000000000000362
OpenAlex
W2556364146
Cited by
65
References
10
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 8 · 2022: 5 · 2021: 8 · 2020: 10 · 2019: 3 · 2018: 21 · 2017: 3
FWCI
8.01
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Developmental & Behavioral Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
autism spectrum disorder, avoidant/restrictive food intake disorder, feeding therapy, systematic desensitization, picky eating, restrictive eating, gastroesophageal reflux disease, soy formula, parental anxiety, medication adherence
MeSH terms
Problem Behavior, Autism Spectrum Disorder, Feeding and Eating Disorders, Child, Preschool, Female, Humans

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