Multidisciplinary Approach to the Diagnosis of Avoidant/Restrictive Food Intake Disorder in Children with Autism Spectrum Disorder: A Multistage Mixed-Methods Study.

BACKGROUND

Children with autism spectrum disorder (ASD) frequently exhibit restrictive eating behaviors that may meet the criteria for avoidant/restrictive food intake disorder (ARFID). This disorder is characterized not only by behavioral disturbances but also by somatic impairments and functional complications. Timely identification of ARFID allows for therapeutic and nutritional interventions aimed at restoring fully balanced nutrition in order to achieve the highest possible level of development and health for every child with ASD. Despite high prevalence of avoidant/restrictive eating behaviors in children, the associated adverse health outcomes, and the frequency of clinical encounters, ARFID is often underdiagnosed and inadequately addressed within both psychiatric and pediatric care settings, highlighting the need for a multidisciplinary diagnostic approach.

AIM: To develop and implement a multidisciplinary approach to the diagnosis of ARFID in children with ASD.

METHODS

A multistage mixed-methods design was applied to address the aim of the study. In the first stage, diagnostic criteria for ARFID were clustered. In the second stage, a conventional algorithm for examining patients with ASD to diagnose ARFID was developed. This was followed by a cross-sectional study, during which a comprehensive examination of patients with ASD was performed and approaches to the diagnosis of ARFID in children with autism were developed.

RESULTS

A behavioral pattern of selective/restrictive food intake was identified in 71 (88.8%) children with autism out of 80. Somatic disorders (deviation of body weight from the norm, carbohydrate and/or lipid metabolism disorders, vitamin deficiencies, anemia) were observed in 66 (82.5%) children, and functional impairment - in 11 (19.7%). This defines an additional criterion necessary for diagnosing ARFID as a comorbid disorder and for implementing therapeutic interventions aimed at treating the identified pathology and restoring a balanced diet.

CONCLUSION

This study proposes the identification of three diagnostic clusters of ARFID: behavioral, somatic, and functional impairment. These findings highlight the importance of a multidisciplinary approach and the need to assess somatic consequences when diagnosing ARFID and developing individualized treatment strategies.