SUPPORT AND DIAGNOSIS FOR CHILDREN AND FAMILIES WITH ARFID OR COMPLEX FEEDING DIFFICULTIES

What is ARFID

Avoidant and Restricted Intake Disorder (ARFID) is a relatively new eating disorder and was previously known by other names including ‘selective eating’. It is classified as an eating or feeding disturbance that leads to a persistent failure to meet appropriate nutritional and/or energy needs and is to be associated with one (or more) of four criteria including significant weight loss (or failure to achieve expected weight gain or faltering growth in children), significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, or marked interference with psychosocial functioning.

 

Unlike other eating disorder diagnoses (such as anorexia or bulimia) people with ARFID do not typically worry as much (if at all) about how much they weigh or how they look.

 

Common Symptoms of ARFID

Avoiding particular types of food such as foods of a certain texture, smell, colour or shape.

Only eating certain brands of food.

Anxiety or disgust at new foods, including a gagging response.

Being unwilling or frightened to try new foods and 'safe' foods becoming rejected over time.

Fear of choking or vomiting.

Taking a long time over mealtimes.

Avoiding eating in social situations or with the family.

Displaying a lack of interest in food and not being aware when you are hungry.

Nutritional deficiencies or difficulties maintaining a healthy weight or poor growth.

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What We Offer

We are one of the UKs specialists in ARFID diagnosis and support, offering access to multi-disciplinary team including Clinical Psychologists, Dietitians and Speech and Language Therapists that have significant training and experience working privately and in the NHS developing services for children with complex feeding difficulties and ARFID. We offer a range of diagnostic and support options which are detailed below, but also please contact us if you are looking for something more bespoke. We offer:

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Clinical Assessments

A thorough assessment of clinical and support needs that can be used to inform the ongoing support required for the client, family, school or other teams supporting the client. These assessments can also be used to help inform EHCP assessments for ARFID needs and include the assessment session, review of previous reports (either virtual or face to face) and a follow up report. There are three options for a clinical assessment:

• An assessment with a clinical psychologist only. This is appropriate for those clients who already have dietetic input or who no longer need this and do not have any physical chewing or swallow difficulties. This costs £200.

• An assessment with a clinical psychologist and dietitian (offered over two appointments). This is appropriate for those without any physical chewing or swallow difficulties. This costs £350

• A multi-disciplinary assessment with a Clinical Psychologist, Dietitian and Speech and Language Therapist, usually in one longer session. This is for children with more complex medical backgrounds or some physical skill difficulties with their chewing or swallowing in addition to the psychological ARFID needs. You will need to send in a video of your child eating for this to be assessed in advance of the appointment and any previous reports to be reviewed. This very thorough assessment and report costs £850.

 

​ARFID Diagnostic Assessment​s

Some families find it helpful to have the formal diagnosis and from our experience having this formally acknowledged can help other professionals and schools understand the difficulties better and provide more appropriate support. However, the formal label is not required to access our other support services or clinical assessments detailed on this page.

In order to start this assessment you would need confirmation from your GP that the feeding and eating difficulties are primarily not the result of any physical or medical difficulty (although this may be part of the picture for some children) and we can request this in a letter from them. Your GP will usually charge you for this. Where medical difficulties have not yet been ruled out we can refer you to our private paediatrician to help with these investigations.

In accordance with the latest research consensus, a multi-disciplinary team needs to be involved in formally diagnosing ARFID. Here at Wren Psychology our ARFID diagnostic assessments include a dietitian and a clinical psychologist and speech and language therapist where needed. The process includes using an evidenced based assessment tool across two sessions or one leg session with all professionals. This can be done virtually or face to face in our clinic. The professionals then come together to discuss whether the person meets the criteria for ARFID and then produce a report with recommendations for support (this will be given even if a diagnosis is not confirmed). You will then attend a feedback meeting to go through the findings and recommendations and receive the report. There are two options based on clinical needs:

• A full ARFID diagnostic assessment for those without physical chewing or swallow difficulties or complex medical conditions costs £650 (if you have already had an initial consultation, £200 will be deducted from the full assessment cost). This includes a session with a Clinical Psychologist, and a separate session with a dietitian. 

• A full ARFID diagnostic assessment for those with physical chewing or swallow difficulties or complex medical conditions costs £850 (if you have already had an initial consultation, £200 will be deducted from the full assessment cost). This includes a session one longer session with a Clinical Psychologist, a Dietitian and a Speech and Language Therapist in attendance. 

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Ongoing Support​

We provide psychological support for ARFID and severely restricted eating and feeding in a number of ways to both the child or young person and their family. The support offered will be tailored to the difficulties being presented but might include:

​Education and suggested strategies for parents with review appointments to monitor this over time, individual support for the child or young person including a cognitive behavioural approach and/or an exposure programme or liaison, discussion and recommendations to other people working with the child such as schools. Ongoing dietetic appointments and speech and language therapy sessions can also be agreed if required for regular review

• Ongoing psychological support, SLT support or dietetic review for feeding difficulties (with or without an ARFID diagnosis) £110 per session

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Training

We also provide training to school settings and groups of professionals around ARFID. Please enquire for costs for this.

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