A recent review by Willmott et al. (2023) examined what is currently known about psychological interventions for avoidant/restrictive food intake disorder (ARFID) in children and adolescents. It highlights a wide range of approaches, including behavioural, cognitive, and family-based strategies. Although evidence is still developing, many interventions share common elements that can guide clinical care. A clear psychological formulation remains essential to tailoring treatment, and emerging tools offer useful ways to track progress and inform decisions.
Understanding the condition
Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnosis, first defined in DSM-5, characterised by persistent restriction of food intake not motivated by body image concerns. It refers to people who avoid eating for a variety of reasons, including sensory sensitivity, lack of interest in eating, or fear of aversive consequences (such as choking or vomiting). Children and adolescents with ARFID may experience poor growth, nutritional deficiencies, or social isolation.
Prevalence estimates vary widely—from 0.3% to 15.5% depending on the setting—with higher rates in specialist eating disorder services, suggesting the condition is common both in services and the wider population. (Sanchez-Cerezo et al., 2023). It often co-occurs with anxiety or neurodevelopmental conditions such as autism (Bourne et al., 2022)
ARFID affects more young people than we might expect—and it often comes with complex challenges.
Which treatments are showing promise?
Although ARFID is associated with significant physical, nutritional, and psychosocial challenges, there are currently no formal evidence-based treatment guidelines to inform care (NICE, 2017; APA, 2023). This is partly due to the relatively recent recognition of ARFID as a distinct diagnosis, which has limited the availability of clinical trial data (APA, 2023). Still, a range of psychological interventions is being developed and adapted to support young people with the condition.
A recent systematic review highlights several promising therapies. Behavioral techniques have been effective in helping young children, especially those under six years old, broaden their food intake and eat more consistently (Sharp et al., 2017; Taylor et al., 2019). For older children and teens, cognitive-behavioral therapy has been adapted into a specific version for ARFID (CBT-AR), which early research suggests is both practical and acceptable across different presentations of the disorder (Thomas & Eddy, 2019; Thomas et al., 2020; Thomas et al., 2021). Family-based approaches are also being used, with adaptations of the original FBT model to fit the needs of ARFID patients and their families (Lock, Robinson, et al., 2019). While none of these methods are yet part of formal treatment guidelines, experts often draw from strategies used in other eating disorders, such as focusing on medical and nutritional support alongside psychological care (Hay, 2020; Hay et al., 2014).
There’s promising work happening, but we’re still in the early stages of building strong evidence.
How is progress measured?
One key issue highlighted in the field is the need for better ways to track outcomes in psychological interventions for ARFID in children. Most studies focus on physical health outcomes such as weight restoration or nutritional status, but do not reflect the broader psychological and social challenges faced by individuals with ARFID.
Fewer studies use validated ARFID-specific measures, such as The Eating Disturbances in Youth Questionnaire (EDY-Q), which is a brief self-report measure for children aged 8-13 that screens for ARFID-related symptoms, including low interest in eating, avoidance due to sensory sensitivities, or fear of negative consequences like choking (Hilbert & van Dyck, 2016). The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a clinician-administered tool that offers a comprehensive assessment of ARFID and related feeding issues (Bryant-Waugh et al., 2019), though its length may limit its use in routine care. A shorter version (the PARDI-AR-Q) has been developed for children and parents to complete, focusing on ARFID symptoms and their impact, with early evidence supporting its reliability (Bryant-Waugh et al., 2022).
Most studies still rely on basic health data, but ARFID affects much more than just weight.
What can clinicians take from this?
Given the lack of formal guidelines and the diversity of presentations, clinicians are encouraged to develop a formulation-based approach for each young person with ARFID
There’s still much to learn about what works best, but a number of strategies are already being used in practice, often combining cognitive-behavioural techniques with active involvement from families. These approaches are most effective when grounded in a clear psychological formulation (e.g., Bryant-Waugh et al., 2021), which helps clarify what’s driving the eating difficulties and what might be maintaining them. This includes considering the child’s age, physical health, emotional well-being, and any co-occurring conditions that may influence treatment.
Another important consideration is how to monitor progress. While weight and nutritional improvements are important, they don’t tell the whole story. Using outcome measures that reflect the focus of treatment and incorporating tools specific to ARFID, such as the EDY-Q or PARDI-AR-Q, can provide a fuller picture of change and support shared decisions along the way.
In the absence of formal guidelines, clinicians are drawing on emerging tools and adapting what we know from other areas. Ongoing research and collaboration will be essential to build a stronger evidence base and improve care.
In the absence of clear guidelines, careful formulation and tailored tools can guide the way.
Research Gaps and Future Directions
This review outlines several priorities for future research on ARFID in children and young people. One key gap is the lack of diversity, since most studies are from Western countries and include predominantly White participants. Expanding research to reflect a broader range of cultural and socio-economic backgrounds will be essential.
There is also room to strengthen study designs. Much of the current evidence comes from small-scale or descriptive studies, which can limit the conclusions that can be drawn. Larger trials using consistent and validated outcome measures would be valuable, alongside research that explores how and why different interventions may be effective.
Further work is also needed to clarify which treatment elements contribute most to progress, and how outcomes are defined and assessed. Understanding change from the perspectives of young people and families may help ensure that findings are relevant and applicable in clinical settings. Research that looks more closely at specific ARFID presentations could also support more tailored approaches to care.
To move forward, we need more inclusive, rigorous research that reflects the real world.
Final thoughts
This review brings together what we’ve learned over the past decade about treating ARFID, especially in children and young people. A range of psychological approaches, like behavioural strategies, CBT, and family-based work, are being used across different settings.
Most interventions share a few common elements: psychoeducation, gradual food exposure, support for managing anxiety, and meaningful involvement of parents or caregivers. A key takeaway is that treatment should be guided by a thoughtful psychological formulation, tailored to each child’s needs and context.
It’s also important to consider how progress is tracked. While physical outcomes like weight gain are important, they don’t always tell the full story. Using tools that capture the emotional and social impact of ARFID can help build a more accurate understanding of recovery.
Looking ahead, further research is needed to refine these interventions, understand what works for whom, and develop more consistent ways to measure outcomes.
These early strategies represent an initial framework for advancing evidence-based interventions for ARFID.
Where next?
This webinar, with Dr Rachel Bryant-Waugh and Dr. James Lock, internationally recognised experts in the field, will offer complementary approaches to support practitioners working with children and adolescents with ARFID. Dr. Bryant‐Waugh will explore the latest insights into ARFID’s development, clinical assessment and tailored, multi-modal treatments, using a formulation-based approach that adapts to each individual presentation. Dr. Lock will explore how Family-Based Treatment (FBT), an evidence-supported approach for youth eating disorders, can be adapted for ARFID. He will outline the core principles of FBT-ARFID and illustrate key therapeutic strategies through clinical case examples, including adaptations for younger children. Together, the speakers aim to strengthen clinicians’ confidence in assessment and treatment planning, offering a comprehensive view of current best practices in working with ARFID in young people.
Use the interactive programme below to gain an overview of the topic, meet the speakers, test your knowledge, and a whole lot more!
NB: This blog has been peer reviewed
References
Willmott, E., Dickinson, R., Hall, C., Sadikovic, K., Wadhera, E., Micali, N., Trompeter, N., & Jewell, T. (2023). A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID). International Journal of Eating Disorders, 57(1), 27–61. https://doi.org/10.1002/eat.24073
American Psychiatric Association, APA. (2013). Diagnostic and statistical manual of mental disorders ( 5th ed.). Arlington, VA: American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
American Psychiatric Association. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders ( 4th ed.) Washington, DC: American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890424865
Bourne, L., Mandy, W., & Bryant-Waugh, R. (2022). Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review. Developmental Medicine & Child Neurology, 64(6), 691–700. Portico. https://doi.org/10.1111/dmcn.15139
Bryant-Waugh, R., Loomes, R., Munuve, A., & Rhind, C. (2021). Towards an evidence-based out-patient care pathway for children and young people with avoidant restrictive food intake disorder. Journal of Behavioral and Cognitive Therapy, 31, 15–26. https://doi.org/10.1016/j.jbct.2020.11.001
Bryant-Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Development of the pica, ARFID, and rumination disorder interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22. International Journal of Eating Disorders, 52(4), 378–387. https://doi.org/10.1002/eat.22958
Bryant-Waugh, R., Stern, C. M., Dreier, M. J., Micali, N., Cooke, L., Kuhnle, M. C., Murry, H. B., Wang, S. V., Breithaupt, L., Becker, K. R., Misra, M., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2022). Preliminary validation of the pica, ARFID and ruminations disorder interview ARFID questionnaire (PARDI-AR-Q). Journal of Eating Disorders, 10(1), 179. https://doi.org/10.1186/s40337-022-00706-7
Farag, F., Sims, A., Strudwick, K., Carrasco, J., Waters, A., Ford, V., Hopkins, J., Whitlingum, G., Absoud, M., & Kelly, V. B. (2021). Avoidant/restrictive food intake disorder and autism spectrum disorder: Clinical implications for assessment and management. Developmental Medicine & Child Neurology, 64, 176–182. https://doi.org/10.1111/dmcn.14977
Hilbert, A., & van Dyck, Z. (2016). Eating disorders in youth-questionnaire. English version. Retrieved from https://nbn-resolving.de/urn:nbn:bsz:15-qucosa-197246
Sanchez-Cerezo, J., Nagularaj, L., Gledhill, J., & Nicholls, D. (2023). What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. European Eating Disorders Review, 31(2), 226–246. https://doi.org/10.1002/erv.2964
Zickgraf, H. F., & Ellis, J. M. (2018). Initial validation of the nine item avoidant/restrictive food intake disorder screen (NIAS): A measure of three restrictive eating patterns. Appetite, 123, 32–42. https://doi.org/10.1016/j.appet.2017.11.111
