Feeding Therapy vs. ARFID Therapy: What's the Difference, and How Do You Know What Your Child Needs?
Written by Dr. Colleen Reichmann-director of Wildflower Therapy
"Everyone keeps telling me something different." If you're the parent of a child who struggles intensely with food for any variety of reasons, you have probably heard A LOT of opinions at this point.
"Try feeding therapy."
“How about OT?”
"I wonder if she could have ARFID?"
"He’s autistic, so it’s just part of his sensory aversions.”
"Maybe it's anxiety."
"Oh, all kids are picky. She’ll grow out of it."
For many families, especially those raising neurodivergent children, figuring out where to start when it comes to the food issue can feel overwhelming. At our practice, Wildflower Therapy (an eating disorders and body image-focused group therapy practice), parents often arrive in our office carrying years of worry, guilt, frustration, and confusion. And sometimes (especially if their child is autistic, or had ADHD) they are unsure whether they need a feeding therapist, an eating disorder therapist, occupational therapist, a speech and language pathologist…or all of the above?!
The truth is that feeding therapy and ARFID-focused psychotherapy are different treatments that address different aspects of eating challenges. Sometimes one is clearly the best fit. Sometimes both are needed. And the lines can be burry in terms of when to seek out each, even for professionals in the field! So please, do not judge yourself for being confused or overwhelmed about what your sweet kiddo needs.
Let's break down the differences, what the research says, and how to determine which type of support may best serve your child.
First, What Is ARFID?
So Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by significant restriction of food intake that is not driven by weight or shape concerns. Children, teens, and adults with ARFID may:
Eat an extremely limited variety of foods
Feel limited to only a specific kind of food that feels similar every time (like fast food)
Avoid foods due to sensory sensitivities
Fear choking, vomiting, allergic reactions, or illness
Have very low appetite or little interest in eating
Experience nutritional deficiencies
Struggle with growth, weight maintenance, or medical complications
Experience significant distress or impairment because of eating challenges
ARFID is especially common among neurodivergent individuals, including autistic individuals and those with ADHD, though it can occur in anyone.
Importantly, ARFID is not simply "picky eating." I’ll say that one more time, for anyone in the back- ARFID IS NOT SIMPLY PICKY EATING! The restriction that results from ARFID causes meaningful problems in daily life, nutrition, health, development, and/or social functioning.
What Is Feeding Therapy?
Feeding therapy is typically provided by occupational therapists (OTs) and speech-language pathologists (SLPs) with specialized feeding training.
Feeding therapy often focuses on:
Oral motor skills
Chewing and swallowing abilities
Sensory processing differences
Food exploration
Expanding food variety
Building comfort around new textures, smells, and appearances
Mealtime participation
Feeding therapists frequently use structured exposure activities to help children gradually interact with foods in a way that feels manageable. They also often try to intersperse play with food, in order to help children feel more comfortable and bring down the overall stress level of food interactions.
In feeding therapy, a child may progress from:
Looking at a food → Touching it → Smelling it → Licking it → Taking a bite
And in GOOD feeding there, there will never be pressure during this work to immediately eat large amounts.
Who Benefits Most From Feeding Therapy?
Feeding therapy is often especially helpful for:
Young children (<5)
Children with sensory processing differences
Autistic children
Children with oral motor delays
Children with developmental disabilities
Children with feeding skill deficits
Children who have difficulty chewing, swallowing, or coordinating eating
Overall, feeding therapy mainly addresses the practical mechanics and sensory experiences involved in eating.
What Is ARFID-Focused Psychotherapy?
ARFID-focused psychotherapy addresses the emotional, behavioral, and psychological factors maintaining food restriction. Treatment is commonly provided by psychologists, therapists, or eating disorder specialists who are trained in ARFID (that’s key here.)
Rather than focusing primarily on feeding mechanics, psychotherapy explores:
Anxiety around eating
Fear-based avoidance
Rigid thinking patterns
Perfectionism
Interoceptive awareness
Emotional responses to food
Family accommodation patterns
Motivation and readiness for change
Many evidence-based ARFID treatments incorporate forms of exposure therapy, cognitive behavioral therapy (CBT), family-based approaches, and skills for managing anxiety.
Who Benefits Most From ARFID Therapy?
ARFID-focused psychotherapy is often particularly helpful for:
Older children (5+) and adolescents
College students
Adults with ARFID
Individuals whose eating restriction is maintained by anxiety
Individuals with fear of choking, vomiting, or illness
People whose eating challenges significantly impact social functioning
Neurodivergent individuals who experience intense distress around eating
The goal isn't simply to get someone to try a food, it is to deeply understand the avoidance, and reduce the factors that keep it going.
What Does the Research Say?
Research on ARFID has grown rapidly over the past decade.Current evidence suggests that several approaches can be helpful depending on the child's needs.
Research Supporting Feeding Therapy
Research supports sensory-based feeding interventions and feeding therapy approaches for improving:
Food acceptance
Food variety
Mealtime participation
Oral motor functioning
This is particularly true for younger children and children with developmental or sensory challenges. However, feeding therapy alone may not fully address significant anxiety, fear, or eating-disorder symptoms when those factors are central to the problem. If you have had your younger child in early intervention, or have identified feeding issues in your younger child on your own, feeding therapy will likely be what medical professional end up suggesting first. Then, feeding therapist often try their protocols, and sometimes will refer to an ARFID therapist when it seems like there is an bigger underlying psychological factor, or when children simply don’t make meaningful progress.
Research Supporting ARFID-Focused Psychotherapy
Research on Cognitive Behavioral Therapy for ARFID (CBT-AR) has shown promising outcomes in:
Increasing dietary variety
Reducing food-related fears
Improving nutritional intake
Reducing avoidance behaviors
Family-based approaches have also shown effectiveness, particularly for children and adolescents. The emerging consensus among ARFID specialists is that treatment works best when it directly targets the specific maintaining factors driving restriction, and that a combination of family-based work, exposures, and CBT tends to help people make the best progress.
Sometimes the Best Treatment Is Both!
Many children benefit from collaborative care.
A child might work with:
An occupational therapist for sensory and feeding challenges
An eating disorder therapist for anxiety and ARFID symptoms
A dietitian for nutritional support
A pediatrician for medical monitoring
And 99.9% of the time, when providers communicate with one another, families often experience better outcomes and less confusion.
A Special Note for Parents of Neurodivergent Kids
If you're raising an autistic child, ADHD child, or otherwise neurodivergent child, you may feel exhausted reading all of this. You may have spent years hearing conflicting messages.
Maybe you've been told that you’re catering to your child, and that they will eat if they're hungry enough. You’ve probably also heard every comment under the rainbow about which boundaries you need to enforce better.
Please hear me when I say that I know- I know you have tried all the things people have said to try. I know that you probably know in your gut that the issue here is NOT defiance. It’s distress. Neurodivergent children often truly experience food differently. Sensory experiences, predictability needs, interoceptive differences, anxiety, and nervous system responses can all influence eating. And you can’t discipline away these kinds of struggles.
But please also hear me when I say that this doesn't mean your child is doomed to struggle forever. It does mean they deserve support that actually matches what's driving the problem, and a person or team with a very high level of expertise in feeding struggles (and the willingness to get creative and be kind- every kid is different, and learning to tolerate food can be so hard.)
Feeding Therapy or ARFID Therapy? Questions to Help You Decide
Feeding Therapy May Be the Better First Step If:
Your child is very young
They have difficulty chewing or swallowing
Oral motor delays are present
Sensory sensitivities are the primary concern
They have developmental feeding skill deficits
They can discuss food calmly but struggle with the physical experience of eating
ARFID Therapy May Be the Better First Step If:
Anxiety is driving avoidance
They fear choking, vomiting, allergic reactions, or getting sick
They become highly distressed around eating situations
Food restriction interferes with school, friendships, travel, or family life
They understand how to eat but feel unable to do so
Their avoidance resembles an anxiety disorder or eating disorder
You have already done feeding therapy, will minimal progress
Consider Both If:
Sensory issues and anxiety are equally significant
Previous feeding therapy has stalled
Food variety remains extremely limited
Restriction is affecting nutrition or growth
Family stress around eating is becoming overwhelming
You Don't Have to Figure This Out Alone
One of the biggest misconceptions about ARFID is that parents need to determine the perfect treatment before seeking help. You don't. A thorough assessment by professionals experienced with both feeding challenges and eating disorders can help identify what's actually maintaining the problem. The goal is not simply to get your child to eat more foods. The goal is to help them build a safer, more flexible, less stressful relationship with eating.
And that process looks different for every child.
Looking for Eating Disorder Therapy in Philadelphia or the Main Line?
At Wildflower Therapy, we provide ARFID-focused therapy for children, teens, college students, and adults throughout Philadelphia and the Main Line. We frequently collaborate with feeding therapists, occupational therapists, dietitians, pediatricians, and schools to create individualized care plans that reflect each person's unique needs. We also specialize in working with children, teens, adults struggling with body image and various other eating disorders (as well as parents and caregivers navigating children or teens who are struggling with eating disorders, body image concerns, and the emotional toll of caring for a struggling child).
Our therapists also support children, teens, adults, and families who are navigating things like ADHD, anxiety, depression, OCD, and maternal mental health/infertility.
We provide therapy in-person in Philadelphia or Devon (and virtually for anyone in Pennsylvania, New Jersey, Delaware, Florida, South Carolina, Vermont, Virginia, Ohio, and Massechusetts.) We work with children, adolescents, and adults. We are neurodivergent-affirming, queer-celebratory, and feminist-relational in our work.
You do NOT have to do this alone. Many of us have been in your shoes. We know how hopeless it can feel. And we want to shine the flashlight in-and show you the way out.
Reach Out Today!
If you’re looking for therapy for your child or yourself in one of the states mentioned above, or are seeking virtual parent coaching or consultation anywhere in the world, we invite you to reach out for your free consultation call!
Frequently Asked Questions
Is ARFID the same thing as picky eating?
No. Picky eating is common during childhood and often improves over time. ARFID causes significant impairment, nutritional concerns, distress, or interference with daily functioning.
Can autistic children have ARFID?
Yes. ARFID occurs at higher rates among autistic individuals, though not every autistic person with selective eating meets criteria for ARFID.
Does my child need feeding therapy or an eating disorder therapist?
The answer depends on what is driving the restriction. If sensory and skill-based challenges are primary, feeding therapy may be indicated. If anxiety, fear, or avoidance are central, ARFID-focused psychotherapy may be more helpful. Many children benefit from both.
Can ARFID be treated successfully?
Yes. Research suggests that many individuals improve with evidence-based treatment, particularly when treatment is tailored to the factors maintaining the restriction.
Is ARFID-focused therapy appropriate for my mimimally speaking autistic child?
It depends! If your child has already engaged in feeding therapy, but have not experienced much change, feeding therapist will then sometimes suggest ARFID therapy. If your child is mimimally speaking, you might be engaging in more of the family-based work with an ARFID therapist. You might also be asked to help the therapist to discover what may be some of the underlying causes of your child’s feeding difficulties. A qualified therapist will be able to engage a mimimally speaking child in creative ways that do not involve back and forth mouth words- and then strongly lean on parental involvement to help your child move through the behavioral aspects of therapy.
Do you offer ARFID therapy in Philadelphia and the Main Line?
Wildflower Therapy provides ARFID-focused psychotherapy for children, teens, college students, and adults throughout Philadelphia, the Main Line, and Pennsylvania through in-person and telehealth services.
What if I'm not sure where to start?
That's completely normal. A comprehensive evaluation can help determine whether feeding therapy, ARFID-focused psychotherapy, or a collaborative treatment approach is likely to be the best fit.