What is ARFID and why a word shift may be needed with Natasha Lane

Laetitia: Welcome to The Neurodivergent Pulse, where we explore the often misunderstood world of neurodivergence with experts, parents, teachers and therapists. Grounded in lived experience, each bite-sized episode gives you something practical to try. I am your host, Laetitia Andrac, AI expert, neurodivergent mum and founder of Understanding Zoe. This podcast is recorded on Dharawal country. I acknowledge that sovereignty was never ceded. It always was and always will be Aboriginal land. Hello Natasha, welcome to The Neurodivergent Pulse podcast.

Natasha: Hello, thank you for having me.

Laetitia: So today we're going to talk with you about ARFID and the word shift and so many other things that you are an expert in. But before we start, I'd love for our listeners who may never have met you to hear a bit more about you. So who are you and how did you end up creating the beautiful business that you created?

Natasha: Sure. So I, sorry, I am a dietitian. That is what I've trained to be. And I guess the thing that informs me most as a dietitian is the fact that I am neurodivergent. I am autistic. I have ADHD. My children are also neurodivergent, and we are a very neurodivergent family. And I work in an area where, if we look after mostly neurodivergent people, probably 90% of our clients are neurodivergent, and if we drill down even further, many of them have feeding differences and eating disorders.

Natasha: And this is an area that is really, really important to me, in that as a person that has lots of sensory sensitivities, in particular to food, and growing up in a family that really, there was a mismatch in understanding around the sensory challenges that I was facing, and the experience that my family were having, which were not the same as mine. So I guess that kind of really anchors back to the kind of care and support that we offer in our clinic.

Laetitia: I love it. Thank you for sharing, Natasha, your personal story and experience. So for parents who might be new to hearing about feeding differences, feeding disorder, ARFID, all of those elements, would you mind explaining and defining those different words and what they mean, in your own experience and your own approach, in saying that each therapist, clinician, person with lived experience may have a different definition. So this is really coming from your leadership.

Natasha: Sure. I guess, you know, feeding differences are not uncommon in neurodivergent populations, in that often sensory aspects will drive preferences for food. And that is considered to be, you know, outside of normal. So I guess, when, differences to us is a difference rather than an impairment. And to some degree, I guess, developmentally, as children grow up there are periods of time where we would expect some challenges and differences, difficulties around food, and that is part of them becoming independent, learning who they are, being able to articulate their wants and preferences. So I guess, feeding, yeah, feeding is complicated. And there are elements of feeding in a neurotypical kind of trajectory that we would still expect, you know, we come across some barriers.

Natasha: And eating disorders are more serious, much more serious, and typically need strong support and intervention. There is a very, very strong relationship between eating disorders and the neurodivergent community, in that if you are neurodivergent you're much more likely to have an eating disorder. And people with eating disorders that are not diagnosed, you know, I guess, I would certainly encourage an assessment if there are other indicators that you are neurodivergent.

Laetitia: Thank you. And

Natasha: sorry, go ahead. Oh, I wasn't sure if I covered off all three, but I think I have.

Laetitia: I don't think you've covered ARFID, which is where I wanted to drop in. And

Natasha: Sure, sure. Sorry. So ARFID is the newest, I guess, eating disorder. It is avoidant restrictive food intake disorder that has only been added to the DSM in the last DSM, I believe. I have a bit of a strange relationship, I guess, with ARFID, in that I do know that ARFID is true and it is real, but I do also feel as though there is a big overlap between what is typical neurodivergent eating and the criteria for ARFID. And I think also

Laetitia: for a definition.

Natasha: Yeah. Yeah. Thank you.

Laetitia: But you kind of entered, so the definition, perfect. You defined those three concepts for anyone who is new to it, and you defined it in your own words, and you started putting the finger on the topic that I wanted to discuss with you, because I'm very curious around this thought leadership and idea you have around ARFID. So you suggested, in a previous conversation we had together, around a language shift with ARFID. Would you mind diving deeper? You started putting the finger on it, but would you mind diving a bit deeper around this?

Natasha: Yeah. I guess this kind of thought for me has stemmed from the fact that I'm seeing, and in our clinic we are increasingly seeing diagnosis of ARFID, which is concerning, in that eating disorders are concerning, and as a diagnosis they have quite a negative connotation. And in addition to that, we're seeing quite young people being diagnosed with ARFID, which in my opinion is problematic for quite a few reasons.

Natasha: So I'm not inherently against a diagnosis of ARFID. I am struggling with the fact that we are more likely to see a diagnosis of ARFID than an acceptance that this is the way neurodivergent people eat. And in the spirit of being neurodiversity affirming, it's a gap for me, because if you want to affirm someone's being and who they are and how they operate, and at the same time we're labelling an everyday activity as problematic, there is a mismatch there, particularly with young children who are still developing their identity and forming who they are and learning about themselves. There's a question around, are we setting these kids up to identify with an eating disorder rather than a neurobiological trait. Yeah, I guess that's the crux of it.

Laetitia: Yeah. Thank you. Thank you for explaining this. And this is definitely an interesting view, and a view that I hadn't heard before. So I'm really interested in this. And so how would you see those young people, young folks who are neurodivergent eating differently to those who may be neurotypical, to just set expectations for parents who may be listening to this podcast around, this is actually normal in a neurodivergent lens rather than being a disorder or something to be fixed or something to be corrected. So would you mind sharing some examples that you've seen in your clinic?

Natasha: I might, I will preface by saying I have three children, and two of them food is tricky, and one food is particularly tricky. And unfortunately for that child, genetics are petite, and staying a consistent weight is hard. And I guess I then have the layer of being a dietitian, and expectations around our team about maintaining his weight and growth trajectory, which is tricky.

Natasha: So I can certainly share, perhaps I don't know if it's okay, but maybe I'll share what he would typically eat in a day. And this is what I accept as normal at my house, and there are caveats obviously. So for breakfast, typically like a high protein milk drink, maybe Sustagen, Up and Go, some other kind of protein milk. And then for school, a little bag of chips and maybe some chocolate. And then for lunch, another portable kind of Up and Go, Sustagen, something to that effect that can be thrown in the bin. And then come home from school, free rein, because we are struggling to gain weight, that might be biscuits, it might be chips, might be lollies, it might be yoghurt, anything really.

Natasha: And then for dinner, it's been the same dinner since around four years old, which is a plate of fruit and vegetables. We are very attuned to seasonal taste, so there are some things that don't feature if the season is not right and the taste is off. For example, kiwi, carrots, mangoes, sometimes apples, depending on whether or not the flavour is correct. And then that is followed up by a serve of chicken nuggets and chips, and then ice cream, and then free rein again after dinner, of whatever. And you know, when I say chips, that is only blue chips. That is only plain chips that are a certain brand. We don't mess around.

Laetitia: Okay. Thank you so much for sharing that.

Natasha: Yeah. So I guess what, it's hard to quantify or express exactly what is typical for neurodivergent people, because all neurodivergent people are different. And I will say, you know, I certainly work with people that might eat relatively simple or plain foods, but then they'll have a random thing in there, like, I love olives, or I love, you know, I don't know, something.

Laetitia: Thank you. Thank you for sharing this, and for sharing, you know, the example of Neil that you experience in your own family, and how, you know, you let free rein time. And I've really noticed in our own family that when I let them eat what they feel like eating, they will more likely eat rather than not eating. And this is where you really want them to have some intake of food rather than not eating anything.

Natasha: Absolutely.

Laetitia: And so what do you recommend for parents who may be, you know, embracing a more neuronormative approach, and they may be like, oh my goodness, I'm not going to give an Up and Go, or you know, chips, or I'm not going to give this, or if I give them ice cream then they're not getting this, and they're getting, so what could you say to those parents? Because I'm sure you see some in your clinic who want to just control the food intake of their children a bit, especially if they may not be familiar with eating differences and all of that.

Natasha: Yeah, I think it's really difficult to say broadly how someone should approach, but I think that it's really important to remember that the learning curve for parents is huge, and the pressures and external forces that they are experiencing, the magnitude of that can't be underestimated. And some of this is also internal pressure around being a good parent. So there's lots of things for parents. And I think the thing that I find helpful to remember is that food is not simply food. Food is tied back into our values and to our culture and to so many other things. And so in order to shift our belief and behaviour around food, we have to do a lot of work to kind of also shift the other things, and reconcile that all in our own head, which is really hard work.

Natasha: So I guess there is that part, and acknowledging that it's hard, because it is hard. That hasn't really answered your question, but I think for parents, if you are finding yourself in a situation like this, I do advise getting help. That would be the first step, to get support for yourself in reassuring you.

Natasha: The second thing I would say is, look at the facts, like, what are the facts that we're dealing with? I still find it really interesting that often the children I see are underweight. I know that's not always the case, but often the children I see are underweight, and ultimately they need calories. It doesn't really matter how it gets in there. And this is not to say, like, we all know that eating a balanced diet is optimal, but if you can't do that, then reminding someone that they need to eat a balanced diet and they can't do it just promotes guilt and shame for both parents and children or young people.

Natasha: So I guess it's kind of meeting, accepting where you're at, and taking steps from there, and getting support as you need it, because it's actually really, really hard work. Yeah, there's so many directions I could go in, but I guess that's to keep it simple.

Laetitia: I love it. And thank you Natasha for mentioning this shame that we may feel, because I certainly felt that before seeking help and guidance around my own child's feeding differences, and then realising that I have grown up with feeding differences and feeling shameful about my own safe food, before knowing the word safe food. So it was very healing for myself, as I'm neurodivergent and raising neurodivergent children, to just go through that journey. So lots of healing happens through seeing people who are expert in caring for neurodivergent children in their nutrition, in their feeding, in their own experiences. And then, very often, as we know, there is one of the parents who may be neurodivergent as well, identifying as neurodivergent as well. So it's always very healing as well for the parent, and it helped with the pressure.

Laetitia: When we went for Christmas in France just a few weeks ago, I was so proud of myself to be able to advocate with ease, without shame, for my daughters to have a safe food plate, rather than eating the meal that was beautifully prepared by the family for Christmas, but just eating puha and oyster and salmon and all of those kinds of things was really not something that they would like. So rice and ketchup and Laughing Cow was more something that they would feel comfortable eating. So I really see the healing in the journey of seeking help, and for everyone it may look different, sorry.

Laetitia: And can you share with us, as a hopeful note, what do you notice? Because I just shared my personal experience around the signs that I am now on the right track, because I'm understanding and able to advocate for my own children and for myself. What are all the signs that you may notice in families that you support, that actually they're now getting back on the right track, rather than fighting for neuronorms for kids to have a balanced plate, because this is a pressure, this is social pressure in the media and everywhere, even with Crunch and Sip in New South Wales, it's just like this kind of thing that happens, that is pressure. So how do you see families being on the right track, and what are the hopeful messages that we could share with our listeners?

Natasha: Yeah, I think families typically pivot when they have a really clear sense of what their child needs, and they are able to focus on that without other distractions. Other distractions being helpful, well-meaning family and friends, or professionals that don't have a good grasp of what they are encountering. So for me it's usually working with families and parents to educate and explore, and maybe unpack a little bit what's going on for parents to hold this rigidity around food, which is really tricky. And in time we do see confidence and competence return for these children. But it is certainly a whole family kind of effort, and it does take a long time. But I think if you have the ability to support yourself as a parent, with other parents, or your team are all on the same page and truly understand your views, and be able to kind of filter out some of the other noise that's coming through, this is when we see great work happen.

Laetitia: Thank you. Thank you so much. And I just have one more question before we go for our quickfire question, and also the closing question, but it's about some scripts or some elements, questions that you may recommend parents to share. So for instance, with a teacher at school during Crunch and Sip, or during meal time, or for parents who have their children going potentially for a birthday party or a play date, any scripts that may help those parents, and help me for instance to advocate, or anything that you've seen working really well.

Natasha: This is actually a really hard one, in that I think institutionally, one parent's voice, if you've got a great teacher that might make a difference. I typically will encourage parents to let me write a letter, and that way it's kept on file, and it can be distributed throughout the school, and you have written, I guess, evidence that you have addressed this. You can certainly put it into notes about your children that are held at school, whether or not someone reads them, I'm not sure. Typically we will write a letter saying, don't talk about food, don't force the child to interact if they don't want to, and they need to know what they can do as an alternative to discussing food, and they need to know in advance. There are quite good guidelines also by NEDC around schools and how they should talk about food, which I often include as well, just because this good and bad food rhetoric is not helpful, for guilt and shame, but also for eating disorder awareness.

Natasha: So I guess that is school. In terms of other advocating, I'm pretty blunt and don't ask questions. I know that that's not easy for everyone, but I will just say, encourage parents to say things like, I know you're really worried, but don't worry, we have professionals that we're working with that are giving us great advice. And kind of don't enter into a conversation. Ultimately what you eat and what your children eat is no one else's business. Unfortunately we live in a world that is full of diet culture, and people are obsessed with what other people are eating and doing, but ultimately it's not really anyone else's business.

Laetitia: My gosh, this is so gold. Like it's no one else's business. Yet everyone comments, everyone reacts. You know, when it's a birthday party and your child is not eating the cake, it's like, what's happening? Why aren't they eating the cake? Or when they're not touching the pizza or whatever, it's so interesting what you said about it's no one else's business. And definitely it isn't, yet everyone comments on it. It's really interesting.

Natasha: So I will certainly feed our children before we go somewhere. So if we're going somewhere where there's food, and then, you know, whether they've eaten or not, I will say, oh, they've already eaten, they've already eaten. You know, if a child had an allergy, no one would ask a question, but you shouldn't have to give up the information in order for someone to be compassionate and understanding to your plot, like that doesn't make sense.

Laetitia: I love it. Thank you Natasha. Your confidence when you speak, your experience, your expertise is just a gift. Thank you so much. So I just want to ask you a quick fire question. We always ask that at the end of the podcast. But what is your favourite food? What is your safe food, to stay on the topic, because I'm curious, maybe it's no one else's business. You can tell me it's not your business, but I had this question for you.

Natasha: Do I have to narrow it down to one?

Laetitia: No, no, no, no, no. It's of course.

Natasha: It depends on the occasion. So chocolate milk is certainly one that I will turn to. Chicken chips, they have to be Smith's, don't accept any other brand. Two minute noodles or pasta, yeah, that's probably something that I would go to. It is very common for me to revert back to that if things are all getting a little bit tricky for a while.

Laetitia: Thank you. Thank you for sharing, Natasha. And for anyone who is listening to this podcast and they're really curious about Eating and Feeding Clinic, about your work, about everything you put out there, how can they connect with you?

Natasha: Well, I guess you could go to our website, which is www.eatingandfeeding.com.au. Instagram. Yeah, it's probably the best place.

Laetitia: Thank you so much. Thank you for taking the time for this podcast interview this morning.

Natasha: Thanks for having me.

Laetitia: Welcome to another pulse check with Zoe on The Neurodivergent Pulse. And today we are talking about food. So Zoe, what

Zoe: Spaghetti, bolognese, and omelettes.

Laetitia: Yes it is. I have some other ideas, but you definitely love that kind of food. And what do you dislike about some food?

Zoe: When they taste spicy or sour, salty and a little bit oily.

Laetitia: Thank you for sharing. And when we were in France, you tried some new food sometimes, and there is one specific food that you love. What did you love?

Zoe: Raclette.

Laetitia: Raclette. Do you want to explain what it is?

Zoe: Yeah. So it's a potato with ham, or no ham, on top, with melted cheese.

Laetitia: Yes. You make the cheese melt with the raclette machine, and then you put it on top of your plate, and you love that. Thank you so much, Zoe, for today.

Zoe: Bye.

Laetitia: Bye. That's a wrap for The Neurodivergent Pulse. If this helped, follow the show and leave us a quick review on your favourite platform. You can even share this episode with someone who needs it. You can learn more about our platform at understandingzoe.com. Thanks for listening.