When Anxiety Stops Kids with Autism and ARFID from Attending Feeding Therapy: What Next?
Feeding therapy, though it may progress slowly, holds the potential to be a life-changing intervention for children diagnosed with Autism Spectrum Disorder (ASD) and struggling with Avoidant / Restrictive Food Intake Disorder (ARFID). These children, often with a severely restrictive variety of foods (most have no more than 3-6 foods in their diet for 10+ years), are at high risk for developing an early onset of multiple chronic health problems and very poor outcomes through life. However, the journey can be challenging when high anxiety and Autism traits make attendance or participation in feeding therapies impossible, leaving devastating nutrition deficiencies unresolved for years. As parents and therapists, it is heartbreaking to see no progress for these children.
When children find it difficult to attend or engage productively in feeding therapies, it can feel like the opportunity to experiment with behavioural and lifestyle strategies for anxiety has disappeared. In these stuck situations, anxiety medications can step in as a crucial and supportive tool to explore.
Some children respond quickly to the first one or two medications prescribed for their anxiety. However, if this is not your child, you may need to seek out a higher level of expertise via a paediatric psychiatrist who has passion, determination and advanced skills in resolving anxiety among children with complex presentations of neurodivergence. Be mindful that it may take many cycles of ‘trial-learn-refine’ before a meaningful breakthrough unfolds—expertise matters in these situations. Frustratingly, many parents don’t have easy access to this type of expertise in their local healthcare system, so persistence and patience are also vital.
Anxiety medications don’t replace therapies, but sometimes, they lower anxiety just enough for children to engage with feeding therapists and others. It can be the bridge that finally connects children to effective therapy, helping them—and their families—move forward with less stress and better outcomes.
It is a long journey for children with Autism, anxiety and severe ARFID. Yet, it is urgent to resolve enormous nutrition gaps. Therefore, along the way, ensure you engage an experienced paediatric dietitian to develop a daily nutrition script with products that are safe, effective, practical and accepted by your child. For instance, these could be prescription vitamin/mineral products, tasteless protein powders, tasteless prebiotic fibres, meal replacement drinks and fortified snacks.
