SPACE Treatment – ARFID Focus: A promising new evidence-based treatment for ARFID/Picky Eaters

Food for Thought Therapy | SPACE Treatment - ARFID Focus

Avoidant/Restrictive Food Intake Disorder (ARFID) is a complex eating disorder characterized by an individual’s persistent failure to meet appropriate nutritional and energy needs. Unlike other eating disorders, ARFID is not driven by body image concerns but can arise from a lack of interest in eating, avoidance due to sensory characteristics of food, or fear of aversive consequences like choking or vomiting. Treating ARFID is challenging, especially in children and adolescents. One promising approach is the Supportive Parenting for Anxious Childhood Emotions (SPACE) program. Developed by Dr. Eli Lebowitz at the Yale Child Study Center, SPACE treatment is designed to help parents manage and reduce their children’s anxiety and related disorders, including ARFID.

Understanding SPACE

SPACE is a parent-based intervention that focuses on changing parental behaviors rather than directly treating the child. Your child DOES NOT need to be motivated to attend therapy or be interested in changing. It is ideal for families that have tried feeding therapy without success. The underlying principle is that by modifying the way parents respond to their child’s anxiety and avoidant behaviors, the child’s symptoms can be significantly reduced. SPACE helps parents learn to support their child’s capacity to handle anxiety independently and reduce accommodating behaviors that reinforce avoidance.

The Core Components of SPACE

  1. Parental Accommodation:
    1. Definition: Parental accommodation refers to the adjustments parents make to help their child avoid distress. In the context of ARFID, this could mean preparing special meals, avoiding certain foods, or allowing the child to eat only their preferred foods.
    2. Impact: While accommodating behaviors are often well-intentioned, they can perpetuate the child’s avoidance and anxiety around eating. SPACE aims to reduce these accommodations gradually, encouraging children to face their fears and anxieties.
  2. Communication of Support and Confidence:
    1. Supportive Statements: Parents are trained to deliver messages of support and confidence, emphasizing their belief in the child’s ability to cope with anxiety and challenges related to eating.
    2. Positive Reinforcement: By consistently reinforcing the child’s efforts and small successes, parents help build the child’s self-efficacy and reduce anxiety.
  3. Creating a Plan:
    1. Step-by-Step Approach: SPACE involves developing a structured plan for reducing accommodations. This plan is tailored to the individual needs of the family and the specific behaviors that need to be addressed.
    2. Incremental Changes: Changes are introduced gradually to ensure that both the child and parents can adjust to the new expectations without becoming overwhelmed.
    3. Monitoring Progress: Regular check-ins are scheduled to monitor progress, address challenges, and adjust the plan as needed.

Benefits of SPACE for ARFID

  1. Empowerment of Parents: SPACE empowers parents by providing them with the tools and skills needed to effectively support their child’s progress.
  2. Reduction of Anxiety: By addressing the underlying anxiety and avoidance behaviors, SPACE helps reduce the overall level of distress experienced by the child.
  3. Improved Eating Habits: As accommodations are reduced, children gradually expand their diet and improve their nutritional intake.
  4. Long-Term Outcomes: SPACE fosters long-term resilience in children, equipping them with the ability to cope with anxiety and challenges beyond food-related issues.
  5. Children do not need to be invested in therapy or present at session.

Challenges and Considerations

While SPACE is a promising approach, it requires commitment and consistency from parents. Resistance to change, both from the child and parents, can be a significant barrier. Additionally, each child’s situation is unique, and SPACE may need to be adapted to meet individual needs. Collaboration with a trained therapist is crucial for successful implementation.

Conclusion

SPACE offers a novel, evidence based, and effective approach to treating ARFID by leveraging parental influence to reduce anxiety and avoidance behaviors. Through careful planning, skill development, and consistent support, SPACE helps children overcome their eating challenges and fosters long-term resilience. As awareness and understanding of ARFID continue to grow, interventions like SPACE provide hope and practical solutions for families navigating this complex disorder.

Kelly is a Speech Language Pathologist who specializes in providing therapy and coaching from toddlers to teens and young adults with feeding challenges. She is tried in the SPACE Treatment technique and helps those in the Lake Nona area and beyond. She prides herself on individualizing therapy sessions so that you meet your goals, whether that’s expanding your food repertoire, ordering something off a restaurant’s menu, or just appreciating your food preferences so that you can be present at social events.

Kelly is starting a NEW SPACE treatment hybrid group this September. Click here to find out more information about the upcoming SPACE hybrid group.

Sign up for our first cohort! Groups are limited to 6 families, so space is limited!

Contact Kelly at Food 4 Thought Therapy at kelly@food4thoughttherapy.com or visit https://food4thoughttherapy.com/contact/ to book your free consultation, get your questions answered and to take the first step towards your journey.

Find us on Facebook and Instagram to learn more about Kelly’s services and hypnosis.

6 Fun Food-Related Activities to do at Home This Summer

Food 4 Thought Therapy | Color picture of parents and son eating ice cream together | Read for fun food-related activities for the summer

Depending on where you live, you’re probably looking for indoor activities to escape the heat just like me. So, let’s talk about some fun food-related activities that you can do at home either indoors or in your backyard. I want to emphasize that simply exposing your child to foods alone is not going to make them a more flexible eater or increase their food repertoire. However, positive and playful experiences with food can enhance a child’s willingness to try new things, help them develop a healthy relationship with eating, and foster their curiosity and comfort around various foods.

6 Fun Food-Related Activities to do at Home this Summer

1. Use Cookie Cutters to Cut Out Fruits and Make Patterns on Skewers

Turn snack time into a creative adventure by using cookie cutters to cut fruits into fun shapes. You can use watermelon, cantaloupe, apples, or any fruit that’s firm enough to hold its shape. Once you have an assortment of shapes, thread them onto skewers to make colorful and appealing fruit kebabs.

2. Add Jello to a Water Table Outside

Bring a new twist to outdoor play by adding Jello to a water table. The wobbly, slippery texture of Jello provides a unique sensory experience and can help children become more comfortable with different textures, which is important for their feeding development. Plus, as the Jello melts, it turns back into liquid, making clean-up a breeze.

3. Use Cut Fruits for Painting

Combine art and food by using cut up fruits for painting. Slice apples, oranges, or other fruits and dip them in edible paint or food coloring mixed with water (or even use the cookie cutters from idea number 1!). Your kids can use these fruit pieces as stamps to create beautiful patterns and pictures. This activity encourages creativity and provides a playful introduction to new foods.

4. Mix Ice Cream Flavors Together

Experimenting with ice cream flavors can be a delightful and tasty activity. Gather a few different ice cream flavors and let your kids mix small scoops together to create new combinations. They can use spoons to stir and taste their creations. This activity promotes sensory exploration and can help children become more open to trying new flavors and textures.

5. Freeze Some Fruits and Check Out What Happens

Who doesn’t love a good science experiment? Try freezing various fruits and observing the changes. Place grapes, berries, or slices of bananas on a baking sheet and freeze them. Once frozen, let your kids touch, taste, and describe how the fruit has changed. You could even fill out a chart together with your predictions, observations, and final conclusions!

6. Create a “Menu” and Choose Items for a Smoothie

Encourage your kids to design a menu for their own smoothie bar. Provide a selection of fruits, vegetables, and other ingredients like yogurt, milk, or juice. Let them choose their favorite combinations and blend them into a delicious smoothie. This activity gives children a sense of control and ownership over their food choices, making them more likely to try and enjoy different ingredients.

These playful food-related experiences can help build a positive relationship with food that will benefit their feeding development. It’s important to provide low-pressure opportunities when engaged with food, which may mean that they don’t taste the foods during these activities right now and that’s ok! Work with your child’s feeding therapist to help determine what cues may be best for your child when it comes to tasting foods.

Kelly is a Speech Language Pathologist who specializes in providing therapy and coaching from children to teens and young adults with feeding challenges. She prides herself on individualizing therapy sessions so that you meet your goals, whether that’s expanding your food repertoire, ordering something off a restaurant’s menu, or just appreciating your food preferences so that you can be present at social events.

Kelly uses a variety of therapy techniques, including sensory and behavioral therapies, as well as alternative therapy techniques, such as hypnosis, to help each of her clients find the success they’re seeking.

Contact Kelly at Food 4 Thought Therapy at kelly@food4thoughttherapy.com or visit https://food4thoughttherapy.com/contact/ to book your free consultation, get your questions answered and to take the first step towards your journey.

Find us on Facebook and Instagram to learn more about Kelly’s services and hypnosis.

A Personal Story: One Individual’s Success with ARFID using Hypnosis with Kelly

Food 4 Thought Therapy | Color picture of boy smiling with arms crossed | Read more about our client success story

About ARFID

Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new and often misunderstood eating disorder that goes beyond picky eating. Unlike other eating disorders, ARFID isn’t driven by concerns about body image or weight. Instead, it involves an aversion to certain foods, leading to significant nutritional deficiencies and challenges in daily functioning. While ARFID can sometimes feel like a constant battle, there is hope and success with support from a trained speech language pathologist.

Here is just one of our client success stories using hypnosis as a treatment option.

Meet Our Client: Matthew*

(*This client’s name has been changed for the purpose of this blog post to maintain confidentiality)

Matthew’s mother reached out to Kelly when Matthew was 12. He was a very motivated young man frustrated with his limited diet. According to Matthew, he had been “scared” of eating since he was 4. Prior to that, he ate a variety of foods and enjoyed them. While neither Matthew nor his mother could think of a “triggering” incident that brought on his fear, his food repertoire became more and more limited over the years. By the time they sought out help, Matthew was only eating 7-10 foods consistently. He usually ate cheerios without milk for breakfast, chicken nuggets and fries for lunch or dinner, and snacked on a few fruits throughout the day (limited to bananas, apples, and pears in limited volumes).

Going out to eat was extremely hard, traveling was miserable, and although he wanted to attend summer camp, he was simply unable due to limited food selection. He also was more hesitant to eat in social situations.

Matthew had attended a sensory based feeding program in the past without success. He would participate, but there was limited slow progress. He stated that there was “just something in my head” stopping him from tasting new foods. He had been evaluated by GI and there were no significant concerns.

These were Matthew’s goals that he discussed with Kelly:

  • Taste and try things without extreme hesitation.
  • Learn to enjoy pizza and pasta (even if it had to be modified).
  • Add some type of meat other than chicken nuggets to his diet.
  • Expand the types of fruits that he ate.
  • Add sweet potatoes to his diet (this was “veggie-like” for him, and he was leaning towards trying to work on this. Other veggies were really of no interest).

Kelly and Matthew agreed that his goals were realistic, as well as ambitious. He made all the final decisions about foods that motivated him while Kelly helped guide him to a few more things that would make life easier, such as obtaining the summer camp menu to identify foods he may want to eat and/or try on the schedule. After an initial evaluation, he and Kelly moved on to the first hypnosis session with prepared foods close by that he was interested in trying. After he underwent hypnosis, Matthew felt calm, relaxed, and was excited to try some new foods! Matthew reported that the voices in his head telling him not to eat were much quieter, and he felt more in control.

Here’s what happened: Matthew tasted each of the foods brought to the session. He described how each food item tasted, discussing flavor, texture, etc. He found some new foods that he enjoyed, and now felt comfortable working on progressively. There were still some foods that were difficult for him, but he even said, “I don’t get why I didn’t try this sooner!” about pancakes with and without syrup.

At the end of the session, Matthew was extremely proud of himself for tasting so many things calmly! His mom was in tears. Matthew and Kelly discussed a personalized and logical follow up to the session, including eliminating foods, adding foods to his meal rotations, and practicing with more foods based on how he was feeling.

After Matthew’s fifth and final session hypnosis session, he felt confident he could try a variety of foods fairly easily. He loved how he could taste and try for himself to determine if he liked something or not, and there was not an irrational fear in his way. He still had likes and dislikes, but he was in control now of his experiences.

Here were a few important factors in Matthew’s success when it comes to hypnosis:

  • HE was highly motivated to change.
  • His mother fully supported him, but it was HIS choice to seek help and “get better” (Matthew’s words).

Six months later, Matthew was able to attend a summer camp and loved it! He had added 10-15 new foods to his consistent food rotations and was still working on increasing this.

Many of our clients have expressed that it’s helpful to hear about and learn from other’s experiences, and it reminds them they are not alone in this journey. Read more about some of our client’s journey’s in Kelly’s book, ARFID Lived Experiences.

ARFID and Hypnosis

Every individual’s experience related to ARFID is different. Therefore, it’s important to find a speech language pathologist who specializes in treating ARFID and who can develop an effective treatment plan to help meet your needs.

Kelly is a Speech Language Pathologist who specializes in providing therapy and coaching from children to teens and young adults with feeding challenges. She prides herself on individualizing therapy sessions so that you meet your goals, whether that’s expanding your food repertoire, ordering something off a restaurant’s menu, or just appreciating your food preferences so that you can be present at social events.

Kelly uses a variety of therapy techniques, including sensory and behavioral therapies, as well as alternative therapy techniques, such as hypnosis, to help each of her clients find the success they’re seeking.

Contact Kelly at Food 4 Thought Therapy at kelly@food4thoughttherapy.com or visit https://food4thoughttherapy.com/contact/ to book your free consultation, get your questions answered and to take the first step towards your journey.

Find us on Facebook and Instagram to learn more about Kelly’s services and hypnosis.

The Five Subtypes of ARFID

Food 4 Thought Therapy | Color picture of teen sitting on couch next to backpack with arms on knees

Avoidant Restrictive Food Intake Disorder, or ARFID, is a relatively new diagnosis for picky eaters with food phobia. It’s characterized by a persistent disturbance in eating leading to weight loss or growth disturbances, nutrient deficiencies, dependence on supplements, and impaired psychosocial functioning. The fear of food, or anxiety around food, is the hallmark of this diagnosis.

Is ARFID all the same, or are there a variety of types?

ARFID presents differently in every individual. Here are some common signs of ARFID, but it’s important to remember that not everyone suffering from ARFID will have the same experiences:

  • Food refusals
  • Poor or delayed eating or feeding skills
  • Underweight or slowed growth
  • Texture sensitivities
  • A very limited list of preferred foods
  • Avoidance of entire food groups
  • Elimination of foods that never get back into their diets
  • Becoming emotional or demonstrating stress around unfamiliar foods
  • Food limitations impacting social engagements negatively
  • And more

Did you know there are five different types of ARFID?

The 5 subtypes of ARFID:

1. Avoidant

One common subtype of ARFID is Avoidant. In this condition, individuals simply avoid certain types of foods in relation to sensory features, causing a sensitivity or over stimulation reaction. These individuals may feel sensitive to the smell of foods; textures, including soft foods or fruits and vegetables that have prickly or defined textures; or general appearance, including color.

2. Aversive

Another subtype of the ARFID eating disorder is Aversive. Individuals whose food refusal is related to the Aversive type may experience fear-based reactions. Aversive ARFID evokes a fear of choking, nausea, vomiting, pain and/or swallowing, forcing the individual to avoid the food altogether.

3. Restrictive

The third subtype of ARFID is Restrictive. Individuals who experience Restrictive ARFID may show signs of little-to-no interest in food. These individuals can forget to eat altogether, show signs of a low appetite or get extremely distracted during mealtime. Another symptom of Restrictive includes extreme pickiness of foods, resulting in limited intake.

4. Adult ARFID

ARFID can impact an individual across their lifespan. Individuals who carry symptoms into their adulthood are considered to have adult ARFID. This can include any of the above symptoms. Many times, individuals who are 18+ years old feel they are too old for help, but you’re never too old for therapy! No matter your age, there is still a lot of progress to be made with the right therapist!

5. ARFID Plus

When it comes to ARFID, the unwillingness to eat is not the result of the individual wanting to change their body or lose weight. However, there are some individuals with ARFID who also experience anorexia or other body image issues. For example, they may have severe texture aversions leading to an extremely limited food repertoire, but also have body dysmorphia and want to lose weight.

Regardless of your specific symptoms, a Speech-Language Pathologist can evaluate your or your child’s needs through a comprehensive evaluation. It’s important to find a Speech-Language Pathologist who is familiar with and trained to support ARFID and who can develop an effective treatment plan to help you meet your goals.

Kelly is a Speech Language Pathologist who specializes in providing therapy and coaching from children to teens and young adults with feeding challenges. She prides herself on individualizing therapy sessions so that you meet your goals, whether that’s expanding your food repertoire, ordering something off a restaurant’s menu, or just appreciating your food preferences so that you can be present at social events. Contact Kelly at Food 4 Thought Therapy to get your questions answered and to take the first step towards your journey, You can contact Kelly and Food 4 Thought Therapy at kelly@food4thoughttherapy.com or visit https://food4thoughttherapy.com/contact/ to book your free consultation.

Find us on Facebook and Instagram to learn more about Kelly’s services and hypnosis.

8 Things You Didn’t Know About ARFID

Food 4 Thought Therapy | 8 Things You Didn't Know About ARFID

Avoidant Restrictive Food Intake Disorder (ARFID) is often a misunderstood feeding disorder, even though many parents are facing signs and symptoms of ARFID with their children. ARFID is a persistent disturbance in eating that leads to weight loss or growth disturbances, nutrient deficiencies, dependence on supplements, and impaired psychosocial functioning. Its hallmark characteristic is a phobia of food, or anxiety around food. Since ARFID is often a misunderstood disorder, I wanted to share 8 things about ARFID that you may not know.

8 Things You Didn’t Know About ARFID

1. ARFID is not just picky eating

ARFID is often mistakenly dismissed as extreme picky eating. While both involve selective eating patterns, ARFID is a clinically diagnosed feeding disorder characterized by a phobia of food, resulting in a very limited food repertoire and that can significantly impact the individual’s physical and psychological well-being.

2. ARFID is rooted in anxiety and fear

Unlike typical picky eaters, individuals with ARFID experience anxiety and fear surrounding specific foods or food groups. This anxiety can stem from various factors, including sensory sensitivities, past traumatic experiences, or an aversion to certain textures, smells, or tastes.

3. ARFID is more common than you might think

ARFID is not as rare you may think. It can affect individuals of all ages, from children to adults. Due to its distinct characteristics, ARFID is often underdiagnosed or misinterpreted. As a Speech Language Pathologist (SLP), part of my role is to collaborate with other healthcare professionals to identify and address ARFID, ensuring appropriate intervention and support.

4. ARFID can have serious consequences

Due to the severely limited variety of foods consumed, ARFID can lead to significant nutritional deficiencies. Individuals with ARFID often struggle to meet their daily nutritional requirements, potentially leading to insufficient intake of essential vitamins, minerals, and other nutrients crucial for proper physical and cognitive development.

ARFID can also have profound social consequences, often leading to social isolation and feelings of exclusion. Individuals with ARFID may encounter challenges in social settings, such as family gatherings or school events, where their restricted food preferences can make participation difficult, fostering a sense of isolation and contributing to emotional distress.

5. ARFID is often misunderstood

There are many misconceptions surrounding ARFID. It’s often dismissed as extreme picky eating, but there is a psychological component that must be addressed beyond preference. Another common misunderstanding is the perception that individuals with ARFID can simply overcome their aversions with willpower. But, in reality, ARFID is rooted in complex psychological factors, making it challenging for individuals to expand their repertoire without appropriate support and intervention.

6. ARFID can go with you into your teens and adulthood

ARFID can persist into teen- and adulthood, presenting with ongoing challenges depending on the individual’s current stage of life. The individual will continue to experience anxiety and sensitivities around food, impacting their dietary choices and overall quality of life.

In teens, ARFID may impact developmental processes, such as physical growth, cognitive development, and social interactions. It can contribute to difficulties in school or social situations, as peer interactions often involve shared meals or gatherings centered around food. Additionally, teenagers with ARFID may face increased challenges in gaining independence and autonomy in their food choices, potentially affecting their overall well-being.

In adults, ARFID can affect the individual’s daily functioning. The impact may extend to relationships, work, and mental health. Adults with ARFID may face unique challenges related to societal expectations around shared meals, dating, and workplace events.

7. ARFID is often associated with other diagnoses like OCD, anxiety disorder, or ASD

ARFID is frequently associated with diagnoses like OCD, anxiety disorder, or ASD. There are many overlapping features, such as sensory sensitivities, rigid thought patterns, and heightened anxiety. Recognizing these associations is crucial to ensure healthcare professionals tailor their intervention to address all the challenges the individual is experiencing.

8. You need to find a provider trained specifically to work with ARFID to get the best results.

Given the unique nature of ARFID, it’s important to find a provider who is trained specifically to work with ARFID to get the best results. The provider must be able to understand the individual’s sensory sensitivities, anxiety, and other associated factors to ensure individualized and effective support.

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Kelly is a Speech Language Pathologist who specializes in providing therapy and coaching from children to teens and young adults with feeding challenges. She prides herself on individualizing therapy sessions so that you meet your goals, whether that’s expanding your food repertoire, ordering something off a restaurant’s menu, or just appreciating your food preferences so that you can be present at social events. Contact Kelly at Food 4 Thought Therapy to get your questions answered and to take the first step towards your journey, You can contact Kelly and Food 4 Thought Therapy at kelly@food4thoughttherapy.com or visit https://food4thoughttherapy.com/contact/ to book your free consultation.
Find us on Facebook and Instagram to learn more about Kelly’s services and hypnosis.