PBS & ARFID

Months ago, we had an enquiry about the use of ‘Positive Behaviour Support’ as it relates to ARFID. We contacted ARFID and Autism expert Dr. Elizabeth Shea for her point-of-view, and this is what she had to say:

“PBS refers to 'Positive Behaviour Support' which is an approach often used with autistic individuals or those with learning disabilities to modify behaviour. It aims to replace a 'negative' or unwanted behaviour with a more 'positive' or desired behaviour. It is often used where a behaviour is considered to be 'challenging' such as physical aggression towards others or self for example. There is currently no evidence base for the use of either PBS or ABA (Applied Behaviour Analysis) in ARFID.

My recommendation and those of other, experienced colleagues would be for children with ARFID to receive a combination of sensory-based strategies and anxiety management combined with psycho-education to the whole family about ARFID, and gradually introducing new foods into the child's range, typically starting with foods that are similar to those already accepted. Other interventions might include seeing other professionals such as a dietician or paediatrician/gastroenterologist, particularly if there are concerns about nutrition or constipation for example.

For children with autism, care must also be paid as to whether they are receiving adequate, autism-informed strategies in school and at home, as unless a child's autism is well supported, it is very hard to change the eating pattern as these children are generally more rigid than other children with ARFID but without autism.

PBS/ABA does have an evidence base in autism (although many clinicians and academics are now questioning this), particularly the lack of emphasis on sensory processes as key in autistic behaviour. There are some papers, often USA based, where ABA approaches have been used to try to increase acceptance of foods in autistic individuals however, once again these generally ignore the influence of sensory issues, and are often single-case designs meaning it is hard to generalise from, to the wider autistic community. Furthermore, none of these papers have directly mentioned ARFID, most likely because they were written before the diagnosis existed.

As to what UK service might be able to provide input at the moment, this is often a child and adolescent mental health service (CAMHS) although as some will be aware, many of these services have yet to learn about ARFID and are not yet equipped to manage these children.

So to summarise, no evidence base as yet for these types of interventions in ARFID or ARFID in autism.”