Is it Picky Eating or ARFID?: What Parents Need to Know and How to Help
Sept 5, 2024 By Kelly Dunn, LCPC
Are mealtimes a struggle in your household? Is your child refusing to try new foods, leading to stress and anxiety for the whole family? If so, you’re not alone. Many parents face the challenge of managing their children’s picky eating habits. In some cases, these children may be experiencing symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID), a condition that can profoundly impact a child’s health and family dynamics. In this article, we’ll break down what ARFID is, how to recognize it, and information about a promising new parent-based treatment for ARFID.
Picky Eating vs ARFID
Picky eating typically involves a limited yet adequate diet, mild food preferences, and no significant health impacts or anxiety around food. By contrast, ARFID is characterized by clinically significant food avoidance, leading to nutritional deficiencies, weight loss, and a variety of psychological and social impacts. ARFID often results in considerable health and psychosocial impairments, requiring medical and/or psychological intervention. Parents are encouraged to seek professional help if their child shows signs of extreme picky eating, particularly if this restricted diet is associated with substantial weight loss, failure to make expected weight gains across development, nutritional deficiencies, or high anxiety and avoidance behaviors related to food.
Signs your child may be experiencing ARFID:
- Consistent refusal to eat most or all new foods: Your child might avoid a wide range of foods based on features such as texture, appearance, smell, or lack of familiarity.
- Very limited diet: A highly restricted range of preferred or “safe” foods, often lacking in nutritional balance.
- Physical symptoms: Weight loss, poor growth, or nutritional deficiencies without an apparent medical cause.
- Behavioral symptoms: Increased anxiety or distress around mealtimes, food avoidance, or ritualistic eating behaviors.
In contrast to other Feeding and Eating Disorders, ARFID symptoms are not typically associated with body image concerns or fears of gaining weight. Rather, the symptoms tend to be associated with feelings of anxiety, disgust, sensory sensitivities, and/or diminished interest in food.
Effective Parent-Based Treatments for ARFID
Evidence-based treatment for ARFID typically involves a combination of gradual, exposure-based therapy with the child experiencing ARFID symptoms, and working with caregivers to shift patterns in responding to ARFID symptoms at home. In some cases, children or teens with ARFID are unable or unwilling to participate in treatment, and parents may feel stuck or hopeless about getting their child the support they need. In these cases, interventions that offer parents support with managing and responding to ARFID symptoms, with or without their child’s buy-in, can be tremendously helpful. This is where the SPACE for ARFID program comes in.
Supportive Parenting for Anxious Childhood Emotions (SPACE)
SPACE is a parent-based intervention developed by Dr. Eli Lebowitz at the Yale Child Study Center. Initially designed to address childhood anxiety disorders and Obsessive Compulsive Disorder, SPACE has been adapted to support parents of children with various challenges, including ARFID. The core principle of SPACE is that by changing their own behaviors and response patterns, parents can significantly impact their child’s emotional and behavioral difficulties.
How SPACE Helps Children with ARFID
Children with ARFID often exhibit extreme picky eating, fear of choking, or aversions to certain textures, colors, or smells of food. These behaviors can cause distress for both the child and their family. SPACE helps by empowering parents to create a supportive environment that encourages flexible eating behaviors and reduces family stress. Key components of SPACE for ARFID include:
- Reducing Parental Accommodations: Parents often accommodate their child’s restrictive eating behaviors by preparing separate meals, allowing avoidance of feared foods, or providing reassurance. SPACE teaches parents to gradually reduce these accommodations, promoting the child’s exposure to a wider range of foods.
- Increasing Supportive Responses: Parents learn to respond to their child’s eating difficulties in ways that are emotionally supportive, but do not reinforce the problematic behaviors. This includes validating the child’s feelings without enabling avoidance and encouraging small, manageable steps towards trying new foods.
- Improving Parent-Child Communication: Effective communication is crucial in managing ARFID. SPACE emphasizes clear, empathetic communication that fosters trust and cooperation between parents and children. Parents are taught to express confidence in their child’s ability to face food-related challenges.
ARFID is a relatively new diagnosis; thus, research on efficacious treatments for ARFID is still emerging. A study by Shimshoni et al. (2020) has shown that parent-based interventions can lead to significant improvements in children’s eating behaviors and overall family functioning. Another study by Lebowitz et al. (2020) demonstrated that SPACE effectively reduced parental accommodation and improved child outcomes in various anxiety-related conditions.
SPACE for ARFID provides a structured, evidence-based approach for parents of children with ARFID. By focusing on reducing accommodations and promoting supportive responses, SPACE for ARFID helps foster healthier eating behaviors and resilience in children by building food-related flexibility and decreasing food stress, leading to improved family dynamics. For parents struggling with the challenges of ARFID, SPACE offers practical strategies and hope for positive change.
References
- Lebowitz, E. R., Omer, H., Hermes, H., & Scahill, L. (2020). Parent training for childhood anxiety disorders: The SPACE program. Cognitive and Behavioral Practice, 27(1), 168-178.
- Shimshoni, Y., & Lebowitz, E. R. (2020). Childhood avoidant/restrictive food intake disorder: Review of treatments and a novel parent-based approach. Journal of Cognitive Psychotherapy: An International Quarterly, 34(3), 200-216.
- Shimshoni, Y., Silverman, W. K., & Lebowitz, E. R. (2020). SPACE-ARFID: A pilot trial of a novel parent-based treatment for avoidant/restrictive food intake disorder. The International Journal of Eating Disorders, 53(10), 1623–1635.
Additional Resources
Are you located in IL and interested in exploring SPACE for ARFID treatment for your family? Contact us to get started.
