On 22 June 2026, ACAMH will host ARFID in Autistic Young People: Assessment, Overlap and Practical Clinical Management. We caught up with one of the presenters – Dr. Rachel Bryant-Waugh, an eating disorders clinician and researcher based at the Maudsley Hospital and King’s College London – about the topic itself, her career, and her hopes for the event.
How did you become interested in the overlap of autism and ARFID (Avoidant/Restrictive Food Intake Disorder)?
Having spent nearly my entire career in the field of feeding and eating disorders, I’ve been consistently struck by the number of neurodivergent children we see in clinical settings who are struggling with their eating, and face barriers to accessing the care that’s routinely available.
I also noticed early on that as clinicians, we have a tendency to jump to conclusions, and I thought: we just need to understand what’s happening for this particular young person and this particular family a little better. If you can get the level of focus and support right, it can make such a difference.
One common assumption is that ARFID in autistic young people is primarily driven by sensory issues. Is that right?
No. There are three main drivers for ARFID, and they can be seen in both autistic and non-autistic young people: low interest in eating; sensory-based avoidance; and then concern or fear around the foods or of what might happen when eating. The assumption that it’s predominantly sensory-based for autistic children just isn’t borne out in practice. The fear-based driver can be just as pronounced, or more so.
Behaviours can also fluctuate considerably. A young person having a really difficult time at school and putting enormous energy into masking, for example, may experience a significant dip in eating. When things are calmer and more predictable, eating may pick up again. We often see young people who eat a particular food enthusiastically for a period, then stop. That variability is part of the picture.
Research suggests many clinicians don’t feel confident assessing or treating autistic young people with ARFID. Why is that?
I think part of it is that there are established, evidence-based treatments for eating disorders, and clinicians are trained to deliver them in a particular format.
Often, it’s necessary to make adaptations for the individual in front of you. It’s that bit that people sometimes feel less confident about: how far can you go off-piste with the evidence-based treatment? Which adaptations does this young person actually need, and why?
There’s also very little in formal clinical guidelines about how to treat ARFID generally, which is itself a consequence of the limited research evidence. That lack of guidance leaves clinicians without a clear framework to draw on, which doesn’t help.
On that note, ARFID is a relatively new diagnosis, what can you tell us about developments in the field?
ARFID was first included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in 2013, and then in 2019 it was added into the International Classification of Diseases (ICD-11).
We don’t yet have strong evidence-based treatments that can be straightforwardly recommended. However, we do have a number of approaches showing promise, and a reasonable understanding of what works for particular types of presentation, for instance fear-based avoidance. But there is a long way still to go.
It was the inclusion of ARFID in ICD-11 that prompted NHS England to commission the National ARFID Pilot, which I led. The pilot placed a trial site in each region to explore what it would mean in practice to include ARFID within community eating disorder service provision, exploring both the opportunities and the challenges.
You talked about adapting treatments to a child – can you give us an example?
I find real joy when I can work out how to use a child’s special interests to engage them. I’m thinking of one child in particular who had a strong interest in Spider-Man, so we framed the whole intervention in Spider-Man terminology, Spidey sense and all that. It meant the child could understand what we were doing in a way that felt familiar and engaging, rather than alien and demanding.
Another boy was fascinated by military manoeuvres, so we framed the work around introducing new foods in terms of tactical operations, attacks from the left flank, and that kind of thing.
I’ve also always made a point of asking children, or their parents, how I’ll know when things are getting too much. Everyone’s different in what they’ll tell you, but if you can understand when a child is at their limit, you can take a break, do something else, and then come back to it.
You’re the first of three speakers in this session – can you talk us through what each section will cover?
I’ll be opening with the assessment and diagnostic side: what the overlap between autism and ARFID looks like, when to diagnose ARFID in an autistic young person, and some of the misconceptions. I’ll be offering very practical tools to help structure assessment and deciding which adaptations a young person may need.
Next Zoe Connor, a dietitian, will address the nutritional side of what we commonly see in autistic young people with ARFID. She’ll cover some practical considerations in real depth – for example, a young person may never have been able to swallow a pill, so suggesting an over-the-counter supplement isn’t going to work.
Then Dr. Elizabeth Shea will focus on treatment delivery and what adaptations look like in practice when you’re working with autistic young people, and how to do it in a neuro-affirmative way. She’s done great work in this area developing practical workbooks that are straightforward to use.
What would you most like attendees to take away from the session?
I’d like attendees to walk away feeling that working with autistic young people with ARFID is genuinely within their reach – and feeling motivated to make sure these young people get the confident, well-informed practitioners they deserve.
That means tackling what I’d call the ‘complexity’ problem – and I’ll admit I’m on something of a personal crusade about this. The word ‘complexity’ gets used a lot in this area and I think it closes doors – it scares clinicians off when it needn’t. If you take the time to understand what’s going on for a young person and what’s driving their behaviour, this is no more or less complex than working with anybody else.
Full details of the webinar
Find more content on ARFID and a range of other topics on ARFID on ACAMH Learn, our completely free, online learning resource.
