ISSN 1756-6657
Journal of Health and Social Care Improvement 2021 Oct: Issue 4 Vol 1
Avoidant Restrictive Food Intake Disorder (ARFID) and School: A Review of the Literature Sarah E Halls, BSc, MSc, Trainee Counselling Psychologist University of Wolverhampton S.E.Halls@wlv.ac.uk
Abstract Avoidant Restrictive Food Intake Disorder (ARFID) is defined by an eating pattern characterised by a limited amount or variety of food (Thomas & Eddy, 2018). Literature states that children with ARFID often struggle to eat and drink well at school which can be due to a number of reasons, such as lack of availability of preferred food, changes in routine or sensory overload. These difficulties can affect growth, weight, concentration, energy and learning abilities. Additionally, school is an important factor in the success of ARFID interventions (Harris & Shea, 2018). Despite this, there is currently very little research around ARFID and schools.
What is ARFID Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis, added to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) in 2013 (Bourne et al., 2020). Prior to the introduction of this diagnosis patients were categorised into different presentations that did not fit the existing DSM-IV categories for example, selective eating or food-avoidance emotional disorder (Fisher et al., 2015). ARFID is characterised by persistent feeding difficulties that can result in a reliance on nutritional supplements or enteral feeding, weight loss or a failure to gain weight and significant interference with psychosocial functioning (Bourne et al., 2020). Defined by an eating pattern characterised by a limited amount or variety of food (Thomas & Eddy, 2018), people with ARFID may demonstrate avoidance towards new foods or the sensory characteristics of certain foods, show a lack of interest in eating and fail to meet their nutritional needs. In contrast to other eating disorders however, people with ARFID do not experience body image distortion or fear weight gain (de Souza et al., 2020).
Diagnostic Tools Currently the main diagnostic tool for ARFID is known as the Pica, ARFID and Rumination Disorder Interview (PARDI; Bryant-Waugh et al., 2019). The PARDI involves a screening questionnaire, introduction and diagnostic and severity items for ARFID. It is aimed at ruling out the presence of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder which may preclude a diagnosis of ARFID (APA, 2013). The PARDI is designed to support a multi-informant assessment and due to this there are four parallel versions; two parent/carer versions for different age ranges and two child versions for different age ranges. The vocabulary and response options have been adapted so that they are developmentally appropriate (BryantWaugh et al., 2019). Literature states that further research is needed, but initial studies suggest that this tool demonstrates acceptable validity and reliability in the diagnosis of ARFID and may even be able to be utilised to determine what type of treatment individuals may benefit from (BryantWaugh et al., 2019).
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