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Cited by 110Child Nutrition and Feeding IssuesEating Disorders and BehaviorsAutism Spectrum Disorder Research

Avoidant/Restrictive Food Intake Disorder and Severe Food Selectivity in Children and Young People with Autism: A Scoping Review

Open access
Bourne, Laura, Mandy, William, Bryant‐Waugh, Rachel·2022·Developmental Medicine & Child Neurology
DOI 10.1111/dmcn.15139
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Abstract

Aim: 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. Method: PubMed and PsycInfo databases were searched, identifying 56 studies and a narrative synthesis was effected. Results: 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. Interpretation: 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. What this paper adds: 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.

Integrity signals

Registry

Crossref · 10.1111/dmcn.15139

Cites

101 of 101 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 88 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The majority of the 56 studies were case studies or case series (n=38, 68%).

    “the majority of which were case studies or case series (n=38, 68%)”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    ARFID symptoms in children and young people with autism can be amenable to treatment.

    “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.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.
  • Findingown data

    Other study designs identified included retrospective chart reviews, qualitative interviews, and randomized controlled trials (n=38, 32%).

    “although various other studies were also identified, including retrospective chart reviews, qualitative interviews, and randomized controlled trials (RCTs) (n=38, 32%)”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    ARFID research, and in particular the literature regarding ARFID in ASD, is still limited.

    “ARFID research and in particular the literature regarding ARFID in ASD, is still limited.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.
  • Findingreasoning

    Sensory sensitivities are the most commonly described driver of food avoidance/restriction in children and young people with autism.

    “The three drivers mentioned in the DSM-5 criteria, namely a sensorybased 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.”
    • Also stated in: § R E SU LTS · plain
      “Although the literature on children and young people with autism reliably evidences the three main reasons of food avoidance and restriction in ARFID, as per the original diagnostic guidelines, 8 sensory sensitivities are currently the most cited.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.
  • May combine two claims. 23
  • Classified as probably not a substantial claim. 20
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    ARFID-like presentations are common in children and young people with autism, with severe consequences for physical and mental health.

    “The literature suggested that ARFID-like presentations are common in children and young people with autism, with severe consequences for physical and mental health.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.

  • May combine two claims.

    Findingown data

    Behavioural interventions are feasible and potentially effective for ARFID symptoms in children and young people with autism.

    “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.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The search yielded 56 studies.

    “The search yielded 56 studies (see Table S1)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The three DSM-5 ARFID drivers (sensory-based avoidance, fear/phobia-based restriction, and lack of interest in eating) are present in children and young people with autism.

    “The three drivers mentioned in the DSM-5 criteria, namely a sensorybased 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.”
    • Also stated in: § R E SU LTS · boosted
      “Although the literature on children and young people with autism reliably evidences the three main reasons of food avoidance and restriction in ARFID, as per the original diagnostic guidelines, 8 sensory sensitivities are currently the most cited.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.

  • May combine two claims.

    Findingcitation

    Additional serious health concerns cited in this population include chronic constipation, ulcers, visual impairment as a result of vitamin A and B12 deficiencies, arthritis, laboured breathing, movement difficulties, and liver dysfunction.

    “These include chronic constipation, ulcers, visual impairment as a result of vitamin A and B 12 deficiencies, arthritis, laboured breathing, movement difficulties, and liver dysfunction.40,52,56,62,[71][72][73]”
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  • May combine two claims.

    Findingcitation

    ARFID can markedly impair psychosocial functioning if the individual can only tolerate eating alone and avoids social situations where food is served, leading to difficulty integrating at school or in the workplace and often resulting in social isolation.

    “ARFID can also markedly impair psychosocial functioning if the individual can only tolerate eating alone and avoids social situations where food is served.This can lead to difficulty integrating at school or in the workplace and often results in social isolation.53,57”
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  • May combine two claims.

    Findingcitation

    The most observable consequence of a severely restricted diet is low weight or significant weight loss, which in children tends to manifest as a persistent inability to meet expected growth or developmental expectations.

    “Arguably, the most observable consequence of a severely restricted diet is low weight or significant weight loss, which in children tends to manifest as a persistent inability to meet expected growth or developmental expectations.41,53,54,66,67”
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  • May combine two claims.

    Findingcitation

    Other studies describe participants who engage in slow eating and have difficulty sitting at the table for a full meal, both of which may be driven by a low interest in food or eating.

    “but other studies do describe participants who engage in slow eating 55 and have difficulty sitting at the table for a full meal, 56 both of which may be driven by a low interest in food or eating.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of studies were from the USA (n=38, 77%).

    “although the majority were from the USA (n=38, 77%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Fear- or phobia-based avoidance or restriction of intake has been evidenced amongst children and young people with autism, with anxieties relating to swallowing, contamination, fears of trying new foods, and choking preceded by a traumatic event.

    “The second example of ARFID presentation, a fear-or phobia-based avoidance or restriction of intake, has also been evidenced amongst children and young people with autism, with anxieties relating to swallowing, 53 contamination, 6 fears of trying new foods, 49 and choking preceded by a traumatic event.54”
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    Findingown data

    Participants ranged in age from 3 to 20 years.

    “Participants ranged in age from 3 to 20 years”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    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”
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    Findingcitation

    Various studies report on the medical management of children and young people with autism with severe food restriction, including assessment and management of gastroesophageal reflux disease, gut disturbances, underlying nutritional deficiencies, enteral or parenteral nutrition to increase weight, and intravenous or oral nutritional supplementation to treat severe malnutrition.

    “Various studies report on the medical management of children and young people with autism with severe food restriction, including assessment and management of gastroesophageal reflux disease, gut disturbances (vomiting, constipation), underlying nutritional deficiencies that drive certain behaviours (e.g.iron deficiency, anaemia, and pica), enteral or parenteral nutrition to increase weight, 59,67”
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  • May combine two claims.

    Findingown data

    This is likely to be a highly prevalent and impactful problem amongst children and young people with autism.

    “our review shows that this is likely to be a highly prevalent and impactful problem amongst children and young people with autism.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    ARFID in autistic youth is currently being researched.

    “TIAER é um problema comum e impactante entre jovens com autismo, mas está sendo pesquisado atualmente.”
    • Also stated in: § Additional information · plain
      “Los trastorno por evitación/restricción de la ingesta son un problema común y de gran impacto a la salud entre los jóvenes con autismo, pero actualmente se continua investigando sus características.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The findings appear to support family/parent-led approaches, with reported increases in dietary diversity, food acceptance, and participation in meal and snack times, as well as reduced parental anxiety and improved family quality of life.

    “The findings appear to support family/parent-led approaches, with reported increases in dietary diversity, food acceptance, and participation in meal and snack times observed, as well as reduced parental anxiety and improved family quality of life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Behavioral interventions for ARFID symptoms in children and young people with autism are feasible and potentially effective.

    “A pesquisa sugere que os sintomas do TIAER em crianças e jovens com autismo podem ser passíveis de tratamento, com evidências de que as intervenções comportamentais são viáveis e potencialmente eficazes nesta população.”
    • Also stated in: § Additional information · hedged
      “La investigación sugiere que los síntomas de TERIA en niños y jóvenes con autismo pueden ser susceptibles de tratamiento, con evidencia de que las intervenciones conductuales son factibles y potencialmente efectivas en esta población.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    ARFID is a common and impactful problem among young people with autism but is currently under researched.

    “Interpretation: ARFID is a common and impactful problem among young people with autism but is currently under researched.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The literature on severe food restriction in autism is relevant to ARFID.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingnone given

    Much of our current understanding of ARFID is based on case reports or cross-sectional studies, which are limited by small sample sizes and tend to represent the most notable or extreme examples.

    “Much of our current understanding of ARFID is based on case reports or cross-sectional studies, which are limited by small sample sizes and tend to represent the most notable or extreme examples.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    This review highlights a clear need for further research on ARFID in children and young people with autism.

    “In summary, this review highlights a clear need for further research on ARFID in children and young people with autism.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DSM-5 diagnostic criteria for ARFID identify three example drivers of avoidance/restriction: lack of interest in eating, sensory-based avoidance, and concern about aversive consequences of eating.

    “the original DSM-5 diagnostic criteria acknowledge three features that have been frequently observed in clinical practice and serve to represent examples that may drive the avoidance/restriction: (a) an apparent lack of interest in eating; (b) an avoidance based on the sensory characteristics of food; and/or (c) a concern about the aversive consequences of eating.8”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Individuals with ASD are at a heightened risk of long-term physical health conditions and premature mortality.

    “Evidence suggests that individuals with ASD are at a heightened risk of long-term physical health conditions and premature mortality, [19][20][21] but the reasons for this remain unclear.”
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    Study design and conductcitation

    The reporting of this scoping review was guided by the standards of PRISMA-ScR.

    “The reporting of this scoping review was guided by the standards of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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    Interpretationreasoning

    Feeding problems and dietary restriction affect nutrition and may be an important contributing factor in health status.

    “Indeed, feeding problems and dietary restriction affect nutrition and, as such, may be an important contributing factor in health status.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Scoping reviews are useful for addressing broad questions as they map the extent and nature of available research.

    “Scoping reviews are an approach to knowledge synthesis that are useful for addressing broad questions as they map the extent and nature of available research.30”
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    Study design and conductown data

    Records were independently reviewed by two experts in the field and conflicts were resolved by all reviewers.

    “Records were then independently reviewed by two experts in the field (RB-W and WM) and all reviewers met to resolve any conflicts and to ensure that selected papers were in line with the aims of the review.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atypical sensory processing is associated with ASD.

    “This is perhaps unsurprising given the atypical sensory processing associated with ASD.[33][34][35]”
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    Study design and conductreasoning

    It is possible that the search did not adequately identify all literature relating to the topic.

    “it is possible that the search did not adequately identify all literature relating to the topic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Core ARFID treatments may be implementable and effective in children and young people with autism.

    “which may be implementable and effective in children and young people with autism.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The authors have no interests that might be perceived as posing a conflict or bias.

    “The authors have stated that they had no interests that might be perceived as posing a conflict or bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review restricted inclusion criteria to full-text journal articles, excluding dissertations, conference proceedings, and book chapters.

    “First, we restricted our inclusion criteria to full-text journal articles, therefore excluding dissertations, conference proceedings, and book chapters that may have provided a valuable insight into the topic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Just two databases were searched.

    “Similarly, just two databases were searched.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Current national and international guidelines advocate the use of psycho-behavioural therapy, typically on an outpatient basis, for all eating disorders, including ARFID, as well as treatment which addresses important nutritional, physical, and mental health comorbidities.

    “Current national and international guidelines advocate the use of psycho-behavioural therapy, typically on an outpatient basis, for all eating disorders, including ARFID, as well as treatment which addresses important nutritional, physical, and mental health comorbidities.94”
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    Interpretationown data

    Such studies are unlikely to be fully representative of the larger population and provide little basis for generalizability of results.

    “Such studies are unlikely to be fully representative of the larger population and, therefore, provide little basis for generalizability of results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    It is likely that existing ARFID measurement tools are appropriate but that reasonable adjustments are needed to accommodate particular sensitivities or preferences and to ensure best fit.

    “As above, it is likely that existing ARFID measurement tools are appropriate but that reasonable adjustments are needed to accommodate particular sensitivities or preferences and to ensure best fit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The scoping review was conducted according to PRISMA-ScR guidelines.

    “Flow diagram of reviewed studies according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.”
    Quote in the paperNot a substantial claim
36 of 36

  • The paper relies on this without support.

    The literature on severe food restriction in autism is relevant to ARFID.

    “Consequently, we chose to extend the inclusion parameters to accept literature on children and young people with autism with severe food selectivity or restriction consistent with ARFID.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • US study percentage does not match the reported total

    Minor

    With 56 studies in the review, 38 US studies would be approximately 68%, not 77%.

    Reported 77 · recomputed 67.857143

  • Study-type counts exceed the total number of studies

    Minor

    The review reports 56 studies, but the 38 case studies or case series and 38 other studies add to 76. The latter count also cannot represent the reported 32% of 56 studies.

    Reported 56 · recomputed 76

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Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. National Institute for Health and Care Excellence (NICE), 2017, Eating disorders: recognition and treatment Full guideline

Cited by

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Related

Authors
Bourne, L., Mandy, W., & Bryant‐Waugh, R.
Affiliations
  • University College London (GB)
  • South London and Maudsley NHS Foundation Trust (GB)
Corresponding author
Bourne, Laura
ORCID
Venue
Developmental Medicine & Child Neurology
Publisher
Wiley
Published
2022-02-02
Volume
64
Issue
6
Pages
691-700
ISSN
  • 0012-1622 (ISSN-L)
  • 1469-8749
DOI
10.1111/dmcn.15139
OpenAlex
W4210255295
Semantic Scholar
793db201dbce490b14a122b51a29e391681fb9b2
Cited by
110
References
101
Citations by year
2026: 19 · 2025: 36 · 2024: 27 · 2023: 22 · 2022: 6
FWCI
3.92
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Developmental Medicine & Child Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
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
avoidant/restrictive food intake disorder, autism spectrum disorder, picky eating, feeding difficulties, sensory sensitivity, restrictive diets, behavioral interventions, children and young people, prevalence, treatment options
MeSH terms
Avoidant Restrictive Food Intake Disorder, Adolescent, Feeding and Eating Disorders, Autistic Disorder, Child, Eating, Humans, Retrospective Studies, Prevalence

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