ARFID...or Pediatric Feeding Disorder
Hi, I am Scurv. I am a Speech Language Pathologist who is trained in SOS Approach to Feeding therapy to address the underlying physical and sensory needs of children who struggle to eat a varied diet. I am in my fourth year of practice and I primarily serve autistic children. The SOS Approach to Feeding therapy was pioneered by Dr. Toomey, a psychologist who has spent decades working with families of children with a myriad of feeding needs.
This is a topic that is very important to me because while ARFID - Avoidant Restrictive Food Intake Disorder - is a very real, very impactful condition, it is often used in place of Pediatric Feeding Disorder, PFD. What is the difference? ARFID is a psychological disorder where the root cause of the restriction is psychological, and therefore not physical. PFD is a physiological disorder where the root cause of restriction is physical - including sensory dysregulation. Mixing up these two, specifically diagnosing ARFID before ruling out PFD, results in the psychopathologization of a physical disorder and therefore the patient does not receive the appropriate treatment or support.
Now, ARFID and PFD can and do co-occur, but the SOS Approach to Feeding therapy and Dr. Toomey (who is a psychologist, I remind you), suggests that ARFID develops from improperly treated PFD. Let's walk trough a case: Andy is a 3 year old autistic child who does not eat vegetables, true meats (only chicken nuggets), and will ONLY eat strawberries if they are red enough. Andy's main sources of nutrition are chips, chicken nuggets, Chip's Ahoy cookies, and crispy French Fries. Andy certainly has a restrictive diet...but does tis mean the 3 year old as a psychological disorder based on food? Not until we rule out physical reasons. Further investigation shows the following: Andy is a sensory seeking child and will often overstuff their mouth with cookies, has poor core strength and frequently leaves the table, and hates wet things on their fingers. An oral motor exam shows that Andy has trouble moving his tongue quickly and efficiently enough to support eating more mature foods. Now does THIS sound like a psychological disorder? No! It's Pediatric Feeding Disorder! By looking at the physical things going on with Andy, we can see they need sensory and oral motor support to improve diet variety.
The reason I bring this up is because PFD is not nearly talked about enough compared to ARFID. This is NOT to diminish the seriousness of ARFID, but to also bring awareness to a feeding disorder vs an eating disorder.
I also want to say - treatment for PFD is possible, especially from a neuroaffirming approach. I worked with a client with PFD who only drank Pediasure and ate soft cookies - he's now eating steak, carrots, and cantaloupe and he is SO HAPPY about it (he makes his little happy vocal stims during meal time, it's great)! I also want to say PFD is NOT limited to Autism. Plenty of non-autistic children have PFD.
I will reblog this with some links to resources about PFD.