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It is high time we recognise feeding difficulties and eating disorders in children with autism

post by Elisabet Wentz 11th July 2017

 

2013 saw the publication of the fifth edition of the American Psychiatric Association's diagnostic manual, DSM. Among many other updates, it outlined a new kind of eating disorder, known as avoidant/restrictive food intake disorder, abbreviated as ARFID. Many of the eating problems included as symptoms in the description of this diagnosis are consistent with issues found in children, teenagers and adults with autism. However, the diagnosis is fairly unknown to most people working with autism. A common approach when encountering these issues is to simply avoid asking the person with autism or his/her parents about food-related/eating difficulties, due to uncertainty as to how those problems should be addressed.

Avoidant/restrictive eating disorder refers to abnormal eating behaviour resulting from disinterest in food, lack of hunger sensations, fear of swallowing due to previous choking incidents or negative reaction to the food's sensory characteristics, such as scent, appearance, taste and texture. This in turn causes either underweight, nutrition deficiency, need for nutrition supplementation and/or clear impact on psychosocial function. The eating disorder must not be identical to anorexia nervosa; for example, the diagnosis cannot be applied to individuals suffering from distorted body image. Likewise, diagnosis also requires absence of underlying somatic disease as the proximate cause of the poor food intake.

People with autism, who are very limited in their food repertoire, and engage in so-called selective eating, may frequently meet the diagnostic criteria for Avoidant/restrictive eating disorder. If the affected individual has an overly one-sided diet, he/she might end up developing a nutrition deficiency. People with abnormal senses of perception might not recognise hunger, or might otherwise react strangely to the food's smell, taste or texture, causing food intake to be so limited that it causes underweight.

So, then, what is the point of diagnosing someone with Avoidant/restrictive eating disorder? How does the person with autism or either of his/her parents benefit from yet another diagnosis? Can anything be done about it? The fact that we as clinicians feel uncertain about how this new eating disorder diagnosis should be treated, does not mean that we should sweep it under the rug. For a child or teenager especially, the eating disorder may be very significant, as it may influence their growth. Clinical experience shows that slow, gradual change may be successful, as is so often the case whenever autism is involved. We must all learn more about this eating disorder, in order to help these individuals and support those closest to them.

For the seventh Birgit Olsson lecture, scheduled for November 16 of this year, Rachel Bryant-Waugh, one of the world's most prominent researchers of child and adolescent eating disorders, will, among other things, be talking about Avoidant/restrictive eating disorder. Rachel Bryant-Waugh is the architect behind Avoidant/restrictive eating disorder in DSM-5 and her research covers for example how to screen for Avoidant/restrictive eating disorder using questionnaires, but also how to treat the condition. At her clinic at Great Ormond Street Hospital in London, dieticians, paediatricians and psychologists work in teams, providing cognitive behavioural therapy and following the child's growth and nutrition status.

It is high time we take parent-provided information about feeding difficulties seriously. The fact that we feel inadequate regarding how to treat Avoidant/restrictive eating disorder does not mean we can ignore these issues. Studies have shown that parents of children with autism most frequently identify feeding difficulties as the first symptom to make them concerned that the child was developing abnormally. Let's not miss these kinds of notifications from parents!

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Photo: Josefin Bergenholtz

Page Manager: Anna Spyrou|Last update: 8/15/2017
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