Speech, Language and Hearing

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Five years of Avoidant/Restrictive Food Intake

Disorder: no consensus of understanding among
health professionals in New Zealand

Bianca N. Jackson, Léa A. T. Turner, Georgina L. Kevany & Suzanne C. Purdy

To cite this article: Bianca N. Jackson, Léa A. T. Turner, Georgina L. Kevany & Suzanne
C. Purdy (2021): Five years of Avoidant/Restrictive Food Intake Disorder: no consensus of
understanding among health professionals in New Zealand, Speech, Language and Hearing, DOI:
10.1080/2050571X.2021.1926620

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Published online: 16 May 2021.

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SPEECH, LANGUAGE AND HEARING
https://doi.org/10.1080/2050571X.2021.1926620

Five years of Avoidant/Restrictive Food Intake Disorder: no consensus of

understanding among health professionals in New Zealand
Bianca N. Jackson , Léa A. T. Turner, Georgina L. Kevany and Suzanne C. Purdy
Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand

ABSTRACT ARTICLE HISTORY

In 2013, Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced as a new diagnosis. Received 27 August 2020
Prior 2013 there was great variability in professionals’ understanding of children’s food intake. Accepted 26 April 2021
Children with a restricted intake of food had limited recognition amongst health services,
KEYWORDS
which the ARFID diagnosis aimed to change. Over time, it is useful to evaluate whether the Avoidant/restrictive food
formulation of this eating disorder has improved understanding of food refusal or ‘picky intake disorder; picky eating;
eating’ to ultimately enable effective outcomes for children and their families. This study paediatric feeding disorder;
explored changes in perspective from 2013 to 2018 regarding understanding of picky eating child; health personnel
amongst health professionals (medical practitioners, dietitians and speech-language
therapists) working with children and feeding difficulties in New Zealand. An online survey
conducted in 2013 and 2018 targeted understanding of food refusal and consensus within
the medical field for the labelling of picky eating. Responses were analysed with descriptive
statistics, and qualitative content analysis. Health professionals in both years reported there
was no consensus in the labelling of picky eating, with a significant increase in those
reporting ‘no consensus’ in 2018 (n = 141, p = .035). However, health professionals
demonstrated an increased awareness from 2013, by seeking further information regarding
labelling of the condition portrayed. Despite an increase in awareness since 2013, health
professionals are yet to agree on the diagnosis and treatment of ARFID. The impact of picky
eating on parental stress may be underestimated in the literature. Consensus and guidelines
are necessary to support health professionals, individuals and their families to obtain
necessary services and resources.

Introduction
Paediatric feeding disorders (PFD) have been defined
inconsistently across literature, professions and
countries (Goday et al., 2019). PFDs cover four
domains: structure and function of anatomy and physi-
ology needed for eating and drinking, nutritional
factors that may impact growth and development,
feeding skills and psychosocial factors relating to the
child, family and environment. Food refusal or more
commonly ‘picky eating’ also lacks a universally
accepted definition but is incorporated into the PFD
diagnosis under psychosocial factors (Goday et al.,
2019; Kerzner et al., 2015).
Within a continuum of feeding behaviours, picky
eating can be considered both a typical and atypical
feeding behaviour, occurring developmentally in tod-
dlers (Aldridge et al., 2018; Taylor, Wernimont, North-
stone, & Emmett, 2015). The developmental picky
eater may be differentiated from a child with a
feeding disorder by factors such as the length of
time the challenging eating behaviour persists (Mar-
shall, Hill, Ware, Ziviani, & Dodrill, 2015), and the
degree to which it impacts participation in mealtimes
(Aldridge et al., 2018). The lack of a specific definition
prevents clinicians from accurately identifying proble-
matic picky eating in children (Marshall et al., 2015).
The lack of consensus across the board not only
hinders the collaborative approach to caring for indi-
viduals with feeding disorders, but inhibits health pro-
fessionals and researchers to adequately determine
conditions, prevalence, and therefore treatment and
support for individuals and families affected by
feeding disorders. This makes it difficult to differentiate
picky eating behaviours that are developmentally
sound compared to those presenting with more sever-
ity, which consequently influences the rate of preva-
lence in practice (Marshall et al., 2015). With the
introduction of a new diagnostic category, many had
hoped this would clarify understanding, guidelines
and in turn clinical practice (Bryant-Waugh, 2013;
Nakai et al., 2017; Norris & Katzman, 2015; Ornstein
et al., 2013); the more extreme picky eater now being
classified as having new diagnosis of Avoidant/Restric-
tive Food Intake Disorder (ARFID).
In May 2013, the DSM-5 Eating Disorder Work Group
revised and updated the DSM-IV diagnostic criteria and
introduced the new section ‘Feeding and Eating Dis-
orders’, which Zimmerman and Fisher (2017) state

CONTACT Bianca N. Jackson bianca.jackson@auckland.ac.nz Speech Science, School of Psychology, The University of Auckland, Private Bag 92019,
Auckland, New Zealand
© 2021 Informa UK Limited, trading as Taylor & Francis Group
2 B. N. JACKSON ET AL.
‘replaces and combines two former sections, “eating
disorders” and “feeding and eating disorders of
infancy or early childhood”’ (p. 95) as these were too
broad and non-specific (Bryant-Waugh, 2013). Prior to
this revision, some eating disorder diagnoses were pre-
dominantly categorized under the ‘Eating Disorder Not
Otherwise Specified’ (EDNOS) category, as other indi-
vidual eating disorder definitions were too narrow
(Fisher, Gonzalez, & Malizo, 2015). In addition, particular
feeding behaviours, such as ‘food avoidance’ and ‘selec-
tive eating’ did not fit in any categories of the DSM-IV
(Bryant-Waugh, 2013). The rearticulation of the
feeding disorders of infancy and childhood diagnoses,
to that of ARFID, successfully decreased the diagnoses
of EDNOS and increased those of Anorexia Nervosa or
Bulimia Nervosa, which improved clinical utility
overall (Fisher et al., 2015; Nakai et al., 2017; Ornstein
et al., 2013). The creation of ARFID as a new diagnostic
category, and its four criteria, was informed by field
studies, analysis, and expert opinion (Norris &
Katzman, 2015) (see Figure 1).
The new diagnosis of ARFID, aimed to ‘identify
patients with clinically significant restrictive eating,
the magnitude of which results in severe nutritional
deficiencies and/or persistent inability to meet
energy needs’ (Zimmerman & Fisher, 2017, p. 97). Con-
sequently, this should enable children and their
families to receive the appropriate care (Ornstein
et al., 2013). Diagnostic consensus influences access
to resources for clinicians and families of children
with the disorder, in terms of funding and interdisci-
plinary support, as well as enabling access to edu-
cational and social supports. Ongoing challenges
with diagnosis include its overlap across the bound-
aries of feeding disorder and eating disorder.
Approaching ARFID from only one of these two per-
spectives can result in other suitable approaches
being invisible as they are not within the scope or
knowledge of the clinician (Sharp & Stubbs, 2019).
The eating disorders approach to ARFID is dominant
in the research literature, with a majority of relevant
articles being published in eating disorders journals,
including a special issue dedicated to ARFID (Eddy &
Thomas, 2019). A subtype taxonomy has been pro-
posed to help clinicians and researchers differentiate
between clinical features and provide suitable
approaches to intervention specific to the presenting
concerns. Three subtypes have been proposed for
the paediatric ARFID population including the fear
presentation, the appetite/interest presentation and
the selective/neophobic eating (Zickgraf, Murray,
Kratz, & Franklin, 2019).
Treatment approaches for ARFID are diverse and as
yet have little evidence-base. Some physicians use
interventions for anorexia nervosa, which may increase
nutritional intake but are not proven effective for
addressing the core deficits of ARFID (Guss, Richmond,
& Forman, 2018). Recent research into treatment for
ARFID encompasses parent training in family based
treatment (Spettigue, Norris, Santos, & Obeid, 2018),
hospital-based re-feeding (Thomas, Wons, & Eddy,
2018), pharmacotherapy (Gray, Chen, Menzel,
Schwartz, & Kaye, 2018), and cognitive–behavioural
therapy (Dumont, Jansen, Kroes, de Haan, & Mulkens,
2019; Thomas et al., 2018). Applied behaviour analysts
can also provide evidence-based effective interven-
tions (Ibañez et al., 2020). Speech-language therapists
have provided feeding skills training, systematic
desensitization and feeding and nutrition education
to increase dietary intake and variety and reduce pro-
blematic mealtime behaviours (Marshall et al., 2015).
Incorporating approaches from both eating disorders
and feeding disorders research will in future
strengthen the interventions available to families
(Sharp & Stubbs, 2019).
There has been an increase in research publications
over the years since the introduction of ARFID in 2013,
with a doubling of articles in the first five years, includ-
ing a small collection from Australia and New Zealand
(Harris, Ria-Searle, Jansen, & Thorpe, 2018; Hay et al.,
2014; Hay et al., 2017; Mairs & Nicholls, 2016). This lit-
erature is predominantly in eating disorders publi-
cations and is written by eating disorders
professionals.
Despite the increasing literature and emerging evi-
dence-base, anecdotal evidence suggested that
feeding disorders clinicians in New Zealand, such as
those working in child development services, were
not considering the ARFID diagnosis, and were still
using a range of terminology to describe children’s
picky eating. This exploratory study aimed to
capture the change in perspectives of picky eating
over five years amongst New Zealand (NZ) primary
and secondary tier health professionals. General Prac-
titioners and Paediatricians were included as they are
often the first point of contact for families who are
concerned about their child’s health, and they are
referring agents for specialist services. Speech-
language therapists and dietitians were included as
it is within their scope of practice to work with chil-
dren with feeding disorders. This study explored
health professionals’ understanding of children with
picky eating and the consensus among professions
for the labelling of a particular condition portrayed
in a vignette.
Method
Data and sample
Ethics approval was obtained from the institutional
Ethics Committee (##). An online survey was created
using www.qualtrics.com. Speech-Language Thera-
pists (SLT), Dietitians (DT) and Medical Practitioners

Figure 1. DSM–5 diagnostic criteria for Avoidant/Restrictive Food Intake Disorder (American Psychiatric Association, 2013).
(including General Practitioners and Paediatricians)
(MP) working with children in New Zealand were
invited to participate via newsletters from the New
Zealand Speech-Language Therapists’ Association
(NZSTA), Dietitians New Zealand (DietitiansNZ), and
the Royal New Zealand College of General Practitioners
(RNZCGP). In both 2013 and 2018 the survey was avail-
able online for eight weeks. Given the small numbers
of potential SLT and DT respondents it is possible
that some respondents completed both surveys, but
no attempt was made to link responses or collect
longitudinal data.
Survey
A novel online survey was created in association with a
highly experienced paediatrician with a special interest
in children’s eating, drinking and swallowing. Ques-
tions were piloted and modified in response, before
publishing.
Respondents were presented with a vignette, a
typical scenario suggestive of ARFID (see Figure 2)
and asked to label the child’s condition given 12
multi-choice options. The vignette was created in col-
laboration with an experienced paediatrician and cri-
teria relevant to the diagnosis of ARFID were
included e.g. concern about weight loss, no other
medical conditions and parents who are committed
and able to offer food. The 2013 survey also asked
five open-ended questions, and the 2018 version
included three additional open-ended questions on
parental stress, treatment options and professional
development (Figure 3).
SPEECH, LANGUAGE AND HEARING 3
Data analysis
Data from the two surveys were compared. Quantitat-
ive data were analysed using descriptive statistics.
Open-ended questions were analysed using qualitative
content analysis described by Duriau, Reger, and
Pfarrer (2016). For each open-ended question, codes
were developed iteratively through examination of
the data at phrase or sentence level. Recurring words
and phrases were grouped together and given code
names from the respondents own words. For
example in response to the question about growth,
‘It might affect growth, but not always’, ‘it’s variable’,
‘sometimes it affects growth’ were all coded as ‘some-
times’. Codes were identified for each question and
subsequently coded for each respondent across both
data sets. Two members of the author team coded
independently and then compared responses until
differences were resolved to arrive at a final coding
scheme for each question. In this way, the research
themes (questions) were decided in advance, but
specific codes under each theme were generated
from the respondents answers. The themes we exam-
ined were: perceptions of clinical consensus for a
label, theoretical understanding, effects on growth,
parental stress, treatment options available and pro-
fessional development pursued, in relation to ARFID.
Quotes from respondents are used to exemplify the
quantitative findings.
Results
Demographic characteristics are shown in Table 1.
Missing demographic data is from the same
4 B. N. JACKSON ET AL.

Figure 2. Vignette Presented to Respondents in this Study.

respondents rather than spread across respondents Perceptions of clinical consensus for a label
e.g. those who did not provide age, also did not
Responses to the vignette of Cooper revealed differ-
provide years of experience. In both years, a majority
ences between professions as well as differences
of respondents had 10 or more years of experience
over time. Figure 4 shows responses to the multi-
and were based in the two largest cities in NZ. No
choice question in each year. In both years, infantile
respondents worked in a specialist eating disorders
anorexia and problem eater were not chosen by any
service. In 2013, 73 health professionals completed
respondent. In 2018 there was greater variability in
the survey and in 2018, there were 68 respondents.
responses amongst professions. A majority of respon-
In both years there were approximately 75 child
dents in both years labelled the condition as ‘failure
health SLT members of the NZSTA, 30 paediatric DTs
to thrive secondary to undereating’, and this decreased
associated with DietitiansNZ, and 4900 MPs affiliated
in 2018 compared with 2013. More respondents in
with the RNZCGP. This indicates response rates of
2018 labelled the condition as ARFID and the
approximately 60%, 50% and 0.27%, in 2013, and
number of people requesting more information also
38%, 60% and 0.24% in 2018.
substantially increased from 2013 to 2018.
Although a number of respondents reported they
In both years, an overwhelming majority of respon-
had never seen a child like Cooper, more than 50%
dents agreed that there was no consensus regarding a
of respondents from each profession indicated
between 1-25% of their caseloads were similar to label for Cooper’s. In response to a multi-choice ques-
Cooper. In 2018, one DT and one SLT stated more tion ‘Is there a consensus in the medical field for a label
than half their caseload consisted of children like for Cooper’s condition?’ in 2018, 89.7% of respondents
Cooper. said there was ‘no consensus’ on a label for Cooper.

Figure 3. Survey questions.

 SPEECH, LANGUAGE AND HEARING 5

Table 1. Characteristics of Respondents. indicating that there is ‘no consensus’ (75.3% in

2013 (n = 73) 2018 (n = 68) 2013, 89.7% in 2018).
Health Professionals In 2018, eight health professionals indicated that
SLT 45 29
DT 15 18
they required more information before they could
MP 13 12 give a label. For example, MP18-9 asked, ‘what other
Unspecified 9
Years of Experience
investigations have been done?’ and SLT18-16
Less than 1 5 4 wanted information on ‘what percentiles, what foods
1–2 7 4 does he eat, what behaviours he exhibits at mealtimes
3–10 21 11
10+ 40 35 …’
Unspecified 14 Respondents reported variability in terminology
Region
Auckland 34 25 between professions, ‘ … GPs, Paediatrics, allied
Rest of North Island 31 19 health have different terminology for these conditions’
South Island 7 10
Unspecified 14
(MP13-2) and between practitioners, ‘different terms
Geographical Area are used by different professionals depending on
Urban 41 29 their level of knowledge’ (SLT18-14). A difference in
Rural 1 6
Mixed 31 19 professional interest was noted: ‘Some paediatricians
Unspecified 14 are more focussed on medical pathology than others
who may be interested in behavioural psychology’
(MP18-7) as well as difference in training and experi-
Figure 5 compares professions and years. A chi-square
ence: ‘[Its] complex aetiology and will depend on
analysis indicated an overall significant difference of
who is making the diagnosis and their experience/
opinion regarding the presence of a consensus for
training’ (DT18-6).
the labelling of Cooper’s condition between the 2013
and 2018 survey responses, χ2 (2, N = 141) = 6.706, p
= .035. The 2018 survey showed a marked decrease
Understanding of picky eating
in respondents responding ‘I don’t know’ to their per-
ception of consensus, in comparison with 2013 (15.1% Content analysis highlighted a diversity of factors that
in 2013, 2.9% in 2018), and an increase in those professionals included in their understanding. All

Figure 4. Percentage Responses for Labels Chosen for Cooper’s Condition.

6 B. N. JACKSON ET AL.
Figure 5. Perspective of Consensus for the Three Professional
Groups.
professions agreed across both years that reduced
food quantity and variety were defining features of
picky eating in children. However, individuals com-
mented on different causal factors, different resultant
behaviours and different impacts for the family. For
example, an SLT noted sensory factors as being
causal and noted the impact on family mealtimes,
whilst a DT commented on the enduring and consist-
ent nature of the refusal, and gave examples of
specific behaviours such as spitting out food, crying
and screaming.
Respondents had varying views regarding picky
eating affecting growth. However, DTs’ perceptions
of picky eating affecting growth changed from a
bimodal distribution split between ‘not very often’
and ‘frequently’ in 2013, to a unimodal distribution
with a consensus of ‘often’ in 2018.
Effects on growth
In both surveys, opinion on whether picky eating
affected children’s growth was variable. One MP in
2013 indicated that it often affected growth and four
MPs in 2018 said that is sometimes affected growth,
but otherwise MPs in both years indicated that it
rarely did: ‘I don’t think it commonly affects growth
but fussy eating or food refusal is common in toddlers’
(MP13-4). This was in contrast to dietitians and SLTs.
In 2013, DTs were divided with 7 respondents indi-
cating it rarely affected growth and 8 indicating it very
often or always affected growth. In 2018, 11 (69%) indi-
cated it very often or always affected growth: ‘It is a
very common problem particularly in the outpatient
setting area of my work.’ (DT18-8). DTs commented
on their skewed perception of the impact due to the
nature of their service criteria: ‘Skewed experience
as I only see children who have faltering growth’
(DT18-9).
SLTs in 2013 most frequently said they did not know
(36%) or it very often affected growth (27%). In 2018,
SLTs more frequently said it sometimes (39%) had an
impact, with no SLTs saying it always did. SLTs were
more likely than DTs or MPs to say it was variable:
It’s highly variable. Some children can refuse all but 3–
4 foods, but have absolutely nothing medically or
developmentally wrong, with no weight issues.
Others may have more foods but eat less of them, or
need higher calorie intake to keep growing (SLT18-13).
Respondents mentioned the impacts as being faltering
growth, micro and macronutrient deficiency, higher
need for calories and being underweight.
Parental stress
In 2018, all respondents agreed that the type of
feeding behaviour Cooper presents with significantly
influences parental stress and 52 (76%) described it
as very or extremely stressful. The stress may be
‘extreme and often underappreciated’ (MP18-12). Ten
respondents mentioned that parents felt guilt from
failing to fulfil their parental role; Respondents com-
mented on the impact on actions that would normally
be seen as part of the core identity as a parent. For
example, ‘it can be enormously stressful for the
parents who often feel it is a basic role for them to
feed their children’’ (MP18-4). Fifteen commented on
the worry and fear of nutritional impact to their
child’s health; and 14 noted that the stress and
anxiety added to all mealtime situations. The most fre-
quent comments regarded the cyclical nature of par-
ental stress and the child’s picky eating behaviours,
contributing to stressful mealtimes, ‘ … and can go in
circular fashion – where child refuses food, parent
becomes worried and stressed and then this creates
a stressful mealtime and the cycle continues’
(SLT18-22).
Treatment options
In 2018 only, respondents accessed support though
feeding clinics or feeding groups, input from DTs,
and multidisciplinary assessment through a hospital
or local child development team. Predominantly,
they referred to a single profession rather than a desig-
nated multi-professional team. Less often, they also
mentioned private input, parent programmes and uni-
versity-led programmes. Figure 6 illustrates treatment
options available to respondents.
MPs commented on the need for involvement of
other health professionals, and the difficulty faced by
parents when attempting to access help. All respon-
dents indicated a lack of resources, inadequate referral
criteria and low level of knowledge by professionals,
and hence the lack of support for children and their
parents: ‘Once he is determined not to have a safety
issue there is little professional support – and often
professionals do not know where to send them’
(SLT13-21).

Figure 6. Respondents’ reported available treatment options in their area.
Relevant professional development
In 2018, 26 respondents gave examples of the litera-
ture they had read since 2013; the topics covered
parenting practices, tube-weaning, dysphagia,
feeding, picky eating, ARFID, and family mealtimes.
Respondents had reviewed national and organiz-
ational guidelines and policies, and attended pro-
fessional development webinars, local and
international conferences or trainings, on paediatric
dysphagia, feeding, nutrition and dietetics. Other
sources of professional development included pod-
casts, special interest groups, journal clubs, supervision
or general discussion amongst colleagues and the mul-
tidisciplinary team.
Discussion
Following the introduction of ARFID into the DSM-5 in
2013, this study anticipated that 2018 respondents
would exhibit an increase in awareness of ARFID and
a change in consensus among health professionals
regarding terminology-use and their understanding
of picky eating in 2018. Findings demonstrated an
increase in awareness, indicated by seeking more infor-
mation, despite the continued variability of labelling of
Cooper’s presenting condition.
In both 2013 and 2018 surveys, health professionals
agreed that there was no consensus within the medical
field for the labelling of Cooper’s condition. Despite
the inclusion of ARFID in DSM-V, in 2018 there was
still great variability in understanding terminology for
food refusal and picky eating. Encouragingly, health
professionals asked for more information about
weight, nutrition and behaviour specifics, and environ-
mental factors, which are important details relevant to
Connor’s presentation (Goday et al., 2019). This
suggests their increased awareness toward picky
SPEECH, LANGUAGE AND HEARING 7
eating and the scope of its impact. In 2013, one
respondent commented, ‘I have never heard of these
‘disorders’ they sound like … claptrap’ (MP13-5). In
2018, health professionals no longer seemed to view
picky eating as nonsense. In the course of five years,
the new diagnosis of ARFID and its accompanying pro-
fessional development opportunities may have con-
tributed to increased awareness of children with
picky eating, despite the lack of clear guidelines
(Eddy et al., 2015; Nakai et al., 2017).
Some health professionals demonstrated a holistic
understanding of this type of feeding difficulty encom-
passing medical factors, nutritional factors (frequency,
variety and quantity of oral intake), feeding skills (oral
sensory dysfunction and inefficient oral feeding), and
behavioural and psychosocial functioning of the care-
giver and child, and hence environmental factors.
These factors are consistent with those mentioned in
literature specific to feeding disorders (Goday et al.,
2019).
Respondents frequently indicated that parental
stress was significant as a result of picky eating, in
line with a very small body of research (Goh &
Jacob, 2012; Harris et al., 2018). The high level of
respondents’ concern about parental stress is not
reflected in the literature which is sparse in this area
and may underestimate the level of stress that picky
eating and ARFID may cause. A study of 13 school-
aged children with ARFID identified most of their
parents had significant worries about their children’s
future health and social functioning (Zickgraf et al.,
2019). One MP in the current study stated that
although many parents are significantly stressed
about picky eating, there may be many others less
worried who do not come to the attention of health
professionals. These children may appear at the mild
end of the behaviour continuum (Taylor et al., 2015;
Zimmerman & Fisher, 2017).
8 B. N. JACKSON ET AL.

Respondents reported they had accessed a broad clinicians understanding and adoption of ARFID and
range of continuing professional development both its subtypes would be strengthened with a longitudi-
in NZ and overseas. This is positive given the substan- nal sample. The wider team of professionals who
tial increase in research publications over the 2013– might be involved with a child, such as occupational
2018 period. In 2018 more health professionals therapists and psychologists and education staff
selected ARFID as a label, suggesting an increase in should also be involved in future studies, to capture
awareness of this diagnosis. A larger-scale survey is a broader view of the services and awareness within
needed to confirm this trend. Respondents generally the professional community.
missed faltering growth as an indicator of ARFID in
this vignette. ARFID is not meant to encompass all
picky or fussy eaters, but rather, the proportion of chil- Conclusion
dren with clinically significant restrictive eating, at the
The study found an increased awareness of picky
more severe end of the continuum (Taylor et al., 2015;
eating as a possible cause for concern, and the chal-
Zimmerman & Fisher, 2017). Studies are beginning to
lenges of diagnosis. The respondents reported a lack
show that there are different ways of operationalizing
of consensus for diagnosing children with picky
the core diagnostic criteria related to weight and nutri-
eating, or ARFID, in 2018. All health professionals
tion, and that overweight is of as much concern as
acknowledged that children who present with a very
underweight (Zickgraf et al., 2019). Detailed assess-
restricted diet may have a medical problem that
ment of nutrition is called for that can identify subtle
required a multidisciplinary approach that they could
nutritional inadequacies and growth problems,
not provide consistently. Parental stress should be con-
before ruling out a diagnosis of ARFID. Additionally,
sidered in the design of effective assessments and
there is a call from researchers to consider a diagnosis
interventions. More health professionals sought
of ARFID in the absence of nutritional challenges, given
additional information before making a diagnostic
sufficient psychosocial impairments (Zickgraf et al.,
decision in 2018, indicating an increase in awareness
2019). This highlights the role of dietitians in the
over the five years since the introduction of the
team, and in this study dietitians particularly sought
ARFID diagnosis. Picky eating is no longer seen as
more information before being willing to give a label.
only benign, and interventions that increase dietary
Respondents reported not only the need for further
variety and flexibility should be accessible to whānau
assessment, but the lack of support for families.
across the country.
Respondents suggested that there is still a lack of suit-
able resources and services, especially in smaller
localities due to limited access to a multidisciplinary
Acknowledgements
team. Research supports the need for the involvement
of a multidisciplinary team in assessment and treat- We are grateful to Dr. Tim Jelleyman for his support and
ment of feeding disorders (Goday et al., 2019; Hay input.
et al., 2014). ARFID-specific research is emerging, for
example cognitive behavioural therapy for adolescents
has some case study support, but there are no well- Disclosure statement
established interventions as yet (Dumont et al., 2019; No potential conflict of interest was reported by the authors.
Eddy et al., 2019). Further research to describe ARFID
subtypes is called for in order to determine effective
interventions for each subtype (Norris et al., 2018; ORCID
Sharp & Stubbs, 2019). Widespread dissemination of Bianca N. Jackson http://orcid.org/0000-0001-5566-8276
this emerging knowledge is essential in developing Suzanne C. Purdy http://orcid.org/0000-0001-9978-8173
equitable services across NZ. Services need to
address not only the child’s picky eating but the
impact of that on the whānau, something that respon- References
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