Food Selectivity
Assessing and treating picky eating, food aversion, and complete oral food refusal in children with autism and related developmental disabilities through a relaxed, choice-driven treatment model.
What Is Food Selectivity?
Eating problems are common among children with and without disabilities, and they can be highly stressful for families. A child can be diagnosed with a formal diagnosis such as Avoidant Restrictive Food Intake Disorder (ARFID) or a Pediatric Feeding Disorder (PFD). However, children and families may still struggle with selective eating and mealtimes, but not meet the criteria for a formal diagnosis.
Autism and food refusal often go hand in hand, and food refusal autism presentations can range from mild food avoidance to a near-total restriction. Despite how disruptive these patterns can be, they're highly amenable to treatment.
Food Selectivity Exists on a Continuum
Among children with autism, an intellectual disability, or other developmental disabilities, the severity of their food selectivity exists on a continuum.
Picky Eating
Picky eating is the mildest and most common form, a child eating a narrow but still functional range of foods. In children with autism or other developmental disabilities, this pattern often persists longer and narrows further than it would otherwise, which is why it's worth addressing rather than assuming it will resolve on its own.
Food Aversion and Selective Consumption
Food aversion, or aversion to food, refers to strong resistance to specific foods, textures, smells, or categories of food, often accompanied by gagging, crying, or refusal to come near the food at all. Autism food aversion and food aversion autism presentations are especially common given the sensory sensitivities often associated with autism, and can range from avoiding a single texture to refusing entire categories of food.
Complete Oral Food Refusal
The most severe form is complete oral food refusal, where a child consumes no solid food by mouth and may rely on tube feeding or nutritional supplements instead. This level of food avoidance is most often seen in children with autism, an intellectual disability, or a co-occurring medical condition, and requires a more structured, closely supported treatment process.
Eatings Disorders vs. Pediatric Feeding Disorders vs. ARFID
The most severe forms of food selectivity and refusal often meet clinical criteria for ARFID (Avoidant/Restrictive Food Intake Disorder), sometimes called a selective eating disorder. ARFID and autism overlap significantly: many of the sensory and behavioral features used to diagnose the ARFID eating disorder are the same ones that drive food refusal in autism.
Unlike eating disorders such as anorexia or bulimia, autism and eating disorders like ARFID generally aren't driven by body image or weight concerns, they're driven by sensory sensitivity, anxiety around new foods, or a lack of interest in eating. FTF's approach addresses the underlying behavior directly, whichever diagnostic label applies.
Who Is Affected
Food selectivity is common among children with and without disabilities, but it occurs more frequently, and often more severely, among children with autism, an intellectual disability, or other developmental disabilities.
FTF's Approach: Relaxed-Environment Feeding Therapy
FTF's approach centers on creating a relaxed environment in which children are motivated to interact with and eventually eat and enjoy new foods. Children are given the choice to participate in treatment, and always have the option to leave or take a break. Rather than forcing progress on a fixed timeline, the children teach us the pace at which to progress expectations. The goal is to increase children's willingness to try new foods, not just eat the target foods. Sessions are designed to be fun, supportive, and focused on helping children feel successful while making steady progress.
At FTF, we primarily support practitioners working with children who are picky eaters or food selective eaters. That is, they can and do safely chew a variety of textured foods. Children who do not consume any food orally or rely on a liquid only diet should be seen by an interdisciplinary clinical team and would not be appropriate for the approach described here.
Our Three-Step Process
At FTF, we train professionals and caregivers in the assessment and treatment of food selectivity. Our aim is to build capacity in your personnel to provide support to parent and caregiver implementers, delivered through the same three-step process: training, synchronous assessment support, and asynchronous treatment support.
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Step 1: Training
The first step is training on the assessment and treatment of food selectivity as they relate to a particular client's needs, delivered via Zoom meeting or through a workshop.
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Step 2: Synchronous Assessment Design and Implementation Support
FTF Consultants guide your team through designing both the assessment and treatment process for three children or clients served by your organization. Consultants then provide synchronous consultation while your staff implement the assessment. The treatment process is then outlined for each client, with treatment often starting the same day.
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Step 3: Asynchronous Treatment Design and Implementation Support
From there, support continues through weekly consultation via video conferencing, completed within a 12-week period. An FTF Consultant supports your organization's personnel with implementing the food selectivity treatment.
Frequently Asked Questions
Is food selectivity common in autism?
Yes. Autism and food selectivity frequently occur together, though children without a diagnosis can also exhibit concerning food selectivity.
What's the difference between picky eating and food refusal?
Picky eating usually involves a narrow but still functional range of foods. Food refusal is more severe, ranging from strong food aversion to eating no solid food by mouth at all.
What is the difference between ARFID and food selectivity?
ARFID is a clinical, mental health diagnosis that often applies to the more severe end of food selectivity. Food selectivity is an umbrella term to describe an eating pattern. All children with an ARFID diagnosis are food selective, but not all children who are food selective meet the ARFID criteria. FTF's approach treats the underlying behavior either way.
Does treatment force children to eat foods they don't like?
No. FTF's approach is built around choice. Children can leave or take a break at any time and the treatment components rely on gradually increasing expectations with respect to engaging with food.
How long does treatment usually take?
Every child progresses differently. In the published literature, most participants began eating the target foods between 1-4 months. At FTF, we support professionals for an average of 12 weeks, to get them the skills they need to confidently run assessment and treatment sessions on their own.
Get Support / Work With FTF
Whether you're a clinic looking to build internal capacity for treating food selectivity or a school supporting a family navigating food aversion, FTF can help your team do it well. Get in touch to talk through your organization's needs.
Tell Us How We Can Help
To help us design an organizational training, provide on-site implementation support for your staff, and schedule follow-up video conferencing, tell us about you, your organization, and your goals.
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