At EDAC we are committed to making research accessible. Our Plain Speaking Summaries include plain language text on published papers and an interview with the authors. In this Plain Speaking Summary, Michelle Sader introduced her paper that was published in 2025 and is interviewed by Ellen Maloney (she/they), EDAC peer researcher. Michelle Sader is a postdoctoral research fellow at EDAC at the University of Aberdeen.
Paper Synopsis
The full paper may be read here.
AIMS:
ARFID is a relatively novel feeding and eating disorder (included within the DSM-5 in 2013) characterised by severe food avoidance or restricted food intake, resulting in significant physical and mental health consequences. ARFID can occur due to many reasons, but existing drivers of ARFID include a lack of interest in food, sensory sensitivities associated with food, and fear of adverse consequences during eating or mealtimes. Existing research demonstrates that ARFID is over-represented in Autistic populations and vice-versa, but little research has explored this relationship. This meta-analysis aimed to investigated the overlap, or co-occurrence, between avoidant/restrictive food intake disorder (ARFID) and autism. This involved determining the autism diagnostic prevalence in ARFID populations, and the ARFID prevalence in Autistic groups. Where available, an additional aim was to investigate the autism diagnostic prevalence across the three drivers explaining ARFID symptoms, and vice-versa.
METHOD:
This review systematically identified literature evaluating those with ARFID and Autistic individuals. Literature was searched for using SCOPUS, MEDLINE, and Web of Science. Selected publications included Autistic individuals and those with ARFID who either received a formal diagnosis of autism and/or ARFID, or met clinical threshold cut-off scores on validated autism and/or ARFID questionnaires. The reviewers also examined the quality of all included papers using a risk of bias assessment tool. The prevalence was reported in proportion-based values (i.e., "x / x Autistic people were classified with ARFID", or "x % of Autistic people were classified with ARFID").
KEY FINDINGS:
The meta-analysis identified 21 studies, in which 18 focused on individuals with ARFID, and 3 focused on Autistic study groups. The total sample size for the review was 7,442 participants (1,708 individuals with ARFID; 5,734 Autistic individuals). The prevalence of autism diagnoses was 16.27% in those with ARFID, and the prevalence of ARFID was 11.41% in Autistic groups.
An autism diagnostic prevalence of 16.27% is more than 15x as high as the autism diagnostic prevalence across the general population!
OTHER RESULTS:
There was insufficient data to investigate the autism diagnostic prevalence across the three underlying drivers of ARFID (lack of interest, sensory sensitivity, fear of aversive consequences), but some existing literature we found suggests that the sensory sensitivity and lack of interest drivers exhibit a higher autism diagnostic prevalence.
The meta-analysis also investigated factors that may contribute towards significantly different co-occurrence values. It was found that the presentation of both gender and ethnicity significantly impacted the rate of co-occurrence between ARFID and autism. Studies with a higher proportion of male individuals, as well as studies with participants from the UK relative to non-western participants presented with a higher rate of co-occurrence between ARFID and autism.
IMPACT:
This review highlights the significant overlap between ARFID and autism, which not only suggest implementing autism screening in clinical ED services, but also recommend the implementation of ARFID screening measures in Autistic individuals who require support for pathological disordered eating.
This meta-analysis also identifies areas requiring a far higher proportion of research. Firstly, findings from this meta-analysis suggest that further research investigating rates of ARFID across larger sample sizes, more diverse ranges of ethnic backgrounds as well as across gender would assist us in better understanding of ARFID prevalence, as well as it's co-occurrence with autism.
There were far fewer papers with Autistic groups rather than those with ARFID, and an important consideration is the challenge associated with when to identify or screen for ARFID in Autistic populations. Certain features of ARFID are often observed in autism, and thus clinicians may risk either incorrectly diagnosing Autistic individuals with ARFID, or overlooking the ARFID diagnosis entirely. To protect Autistic preferences and identity as well as prioritize health and wellbeing, this meta-analysis recommends to screening for ARFID when an individual shows signs of poor mental and/or physical health as reflected within the existing DSM-5 criteria.
Overall, ARFID requires a dedicated body of resources, support and attention. Increased awareness, specialised care, and evidence-based treatments are essential to improve outcomes for affected individuals, especially Autistic individuals with ARFID.
DISSEMINATION:
This paper has been published in the International Journal of Eating Disorders, within a special edition dedicated to ARFID. Feel free to read via our paper synopsis link above, or browse our publications section on the EDAC website!
