Insights From ARFID Therapy With Neurodivergent Teens
by ARFID Therapist Dr. Marianne Miller, LMFT, offering eating disorder therapy for teens in San Diego, California, both in person and virtually.
Working with neurodivergent teens who have Avoidant/Restrictive Food Intake Disorder (ARFID) has taught me more than any textbook or training ever could. My clients have shown me that ARFID is a deeply misunderstood eating disorder, especially when it shows up in autistic teens, teens with ADHD, or those with significant sensory processing differences.
ARFID is not a phase, and it is not the same as “picky eating.” It is a serious eating disorder that affects nutrition, daily functioning, and emotional well-being. When we understand the patterns that often appear in ARFID therapy, we can provide support that respects autonomy, honors sensory needs, and builds safety.
Here are the key insights I have learned from years of providing ARFID therapy for neurodivergent teens.
ARFID Is Not Just Picky Eating
Parents and educators often misinterpret ARFID symptoms as stubbornness or refusal. Teens have shared with me how overwhelming eating can feel when they are facing intense sensory discomfort, fear of choking, or fear of vomiting. These experiences are real, not exaggerated. ARFID is recognized in the DSM-5 as a legitimate eating disorder, and treating it with compassion rather than criticism is essential.
Why Autonomy and Safety Come Before Variety
In ARFID therapy, one of the most important lessons I have learned is that pressure backfires. When teens feel forced to eat foods that feel unsafe, their anxiety increases and eating becomes harder. Giving teens choices and control over what they eat fosters trust.
It may mean eating the same safe foods every day for a while. Uncrustables, fruit snacks, or buttered noodles might be what they can manage in that moment. Fed is best, even if the food is processed. Over time, as safety builds, some teens become more open to exploring new foods.
How Environment and Distractions Can Support Eating
The context in which a teen eats can make or break the experience. Cafeterias, noisy kitchens, and crowded restaurants can create sensory overload and shut down appetite. Many teens eat more in quiet, familiar spaces where they feel comfortable.
Some teens also benefit from using distraction as a tool. Watching YouTube videos, listening to music, or playing a game on a phone can help take the focus off the act of eating. It can allow them to get down more food with less anxiety. Distraction is not avoidance; it is a valid strategy that supports eating in the short term.
The Role of Family Therapy in ARFID Treatment
For many neurodivergent teens with ARFID, emotional safety with caregivers is just as important as sensory safety with food. Family therapy often plays a vital role in treatment. When parents and teens repair communication, reduce conflict, and work toward understanding, teens often feel more relaxed around food.
Part of this work involves helping parents let go of rigid ideas about “healthy” eating. In ARFID recovery, predictable and safe foods—often processed—can be an important stepping stone toward better nutrition. Letting go of moral judgments about food allows teens to feel less shame and more security.
Following the Teen’s Lead for Long-Term Progress
Teens with ARFID have taught me that progress happens when they can move at their own pace. Following their lead does not mean giving up on change; it means respecting the nervous system’s need for safety before adding new demands. This approach often results in better long-term outcomes than forcing variety too soon.
When parents, therapists, and other supporters recognize that ARFID recovery is not linear, teens feel less pressure and more willingness to engage in therapy.
Practical Takeaways for Parents Supporting Teens With ARFID
ARFID therapy with neurodivergent teens is most effective when it focuses on autonomy, sensory attunement, relational repair, and environmental adjustments. The goal is not to “fix” the teen’s eating overnight but to create conditions where eating feels possible, safe, and predictable.
If you are a parent, educator, or professional supporting a teen with ARFID, remember that fed is best, safety comes first, and progress takes time.
Work with ARFID therapist Dr. Marianne Miller, LMFT, providing eating disorder therapy for neurodivergent teens in San Diego, California, with both in-person and virtual options.
Virtual ARFID treatment is also available to clients anywhere in California, as well as in Texas and Washington, D.C.
Looking for more support?
My self-paced ARFID Course offers trauma-informed, neuroaffirming tools for teens, parents, and professionals. Inside, you will learn strategies that honor autonomy, address sensory needs, and build trust around food.