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Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management

Research output: Contribution to journalArticlepeer-review

Fadila Farag, Annemarie Sims, Katy Strudwick, Janette Carrasco, Amy Waters, Vicki Ford, Julia Hopkins, Gabriel Whitlingum, Michael Absoud, Veronica B Kelly

Original languageEnglish
Pages (from-to)176-182
Number of pages7
JournalDevelopmental Medicine and Child Neurology
Issue number2
PublishedFeb 2022

Bibliographical note

Funding Information: We would like to thank the tertiary feeding team for their contributions to this research, as well as all patients and their families for agreeing to take part in this study. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2021 Mac Keith Press

King's Authors


AIM: We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management.

METHOD: Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records.

RESULTS: Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy.

INTERPRETATION: Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.

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