Why is there often an overlap between autism and ARFID?

Neurodiversity exists in the general population and refers to the notion that there are neurological differences in every individual’s brain function and behavioural traits that influence how the individual interprets and interacts within the environment they live.

Neurodevelopmental differences such as autism, Attention-Deficit/Hyperactivity Disorder (ADHD), and learning difficulties have a greater neurodiversity due to differences in the development of the nervous system.

Autism is characterised by qualitative differences in communication and social interactions; restrictive, repetitive patterns of behaviour; and sensory sensitivities. Autism is a neurodevelopmental condition which is on a spectrum, and there is a male: female (assigned at birth) diagnosis ratio of 3:1. Approximately 1 in 100 Australians identify as autistic.

Autism affects how a person thinks, feels, interacts with others, and experiences their environment. Along with many daily living tasks, eating and the consumption of food can be an area for an autistic person that causes great challenge, distress, and discomfort. It is not uncommon for an autistic person to also have feeding or eating problems. Not all autistic people will develop ARFID, but the presence of the following autistic features increases the likelihood of the development of significant feeding or eating concerns found in ARFID presentations.

Features of autism that make feeding or eating challenging for some individuals include:

• Highly sensitive to the sensory properties of food and eating such as taste, temperature, visual presentation, texture, smell, and feel of food. Food avoidance may result.

• A preference for routine, rituals, and highly selective feeding or eating patterns, such as eating time and environments, order and types of food, and presence of other people. Change of mealtime routine can be distressing and overwhelming, causing further restriction. Clinicians working with autistic people need to be aware that some clients may resist or become distressed if suggested interventions if done too quickly.

• Social interactions associated with eating can be problematic, making social eating challenging. A preference to eat alone or with a select few may result.

• Autistic people often have difficulties in identifying and expressing emotions and associate them to what is happening in their environment. This often results in them displaying their emotions as behaviours and they may struggle to identify coping methods or have problems identifying and describing emotions.

• Interoception is having a sense of the internal states of the body. This includes being able to recognise hunger and fullness cues and distinguish them from thirst, worry, or anxiety. An autistic person may not be able to distinguish between hunger, fullness, and anxiety. Assessment of this is therefore required.

• Non-verbal or low verbal communication skills may make understanding and communicating food preferences challenging.

• High prevalence of co-occurring physical or medical issues, including oral or gastrointestinal problems, can make eating unpleasant.

For more information on autism visit the following websites:

https://www.autismspectrum.org.au/

https://www.autismawareness.com.au/