Apparently, starving yourself isn’t a serious mental health condition in VSB

There is a kind of harm that unfolds slowly — a hunger that accumulates across weeks and months, tucked beneath the surface of routines and well-meaning systems. It lives in quiet refusal, in eyes cast downward, in a thermos returned untouched. It lives in the place where institutional accommodation is seen as optional — where compliance earns praise, and silence is mistaken for satisfaction.

My daughter is autistic, has ADHD, a history of trauma, a nervous system that works hard to protect her from sensory and social overload. And she has a school board that still treats eating as a behavioural preference instead of a medical need. And like so many autistic girls, she experiences avoidant restrictive food intake.

Prevalence of ARFID in autistic girls

Avoidant/Restrictive Food Intake Disorder (ARFID) is common among autistic youth, and especially among autistic girls, though it is frequently underdiagnosed.

• Autistic children are five times more likely to experience feeding and eating difficulties compared to non-autistic peers, according to a 2022 meta-analysis of over 1,700 participants across 38 studies¹.
• In a large clinical study, up to 33% of youth diagnosed with ARFID also met criteria for autism, highlighting significant diagnostic overlap².
• Among autistic youth referred for ARFID evaluations, girls were more likely than boys to present with low weight, somatic symptoms, and calorie restriction patterns, while boys showed more sensory-driven food avoidance³.
• Autistic girls tend to mask symptoms more effectively, which can lead to delayed or missed ARFID diagnoses and misinterpretation of symptoms as generalised anxiety, fussiness, or low resilience⁴.
• Overall, experts estimate that between one-third and one-half of autistic children experience disordered eating patterns severe enough to impact daily life and development⁵, and clinically significant ARFID may affect roughly 1 in 3 autistic girls at some point during childhood or adolescence⁶.

Because ARFID was only formalised in the DSM-5 in 2013, prevalence data remains in flux — but the pattern is clear: ARFID in autistic girls is both common and critically misunderstood.

Footnotes

1. Chawner, S. J. R. A., et al. (2022). “Feeding and eating problems in children with autism spectrum disorder: A meta-analysis.” Developmental Medicine & Child Neurology, 64(7), 783–793. https://doi.org/10.1111/dmcn.15135 
2. Koomar, T., et al. (2020). “Prevalence and correlates of autism spectrum disorder in children with avoidant/restrictive food intake disorder.” Journal of the Academy of Nutrition and Dietetics, 120(6), 979–989. https://doi.org/10.1016/j.jand.2019.12.003 
3. Norris, M. L., et al. (2021). “Clinical presentations of ARFID in children and adolescents with and without autism spectrum disorder: A comparative study.” Eating Disorders, 29(2), 132–150. https://doi.org/10.1080/10640266.2020.1737345 
4. Mandy, W., & Tchanturia, K. (2015). “Do women with autism who have eating disorders differ from those with anorexia nervosa alone?” International Review of Psychiatry, 27(6), 412–423. https://doi.org/10.3109/09540261.2015.1094033
5. Sharp, W. G., et al. (2013). “Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analytic review.” Journal of Autism and Developmental Disorders, 43(9), 2159–2173. https://doi.org/10.1007/s10803-013-1771-5
6. Estimates inferred by triangulating findings from Koomar (2020), Norris (2021), and Sharp (2013), alongside prevalence studies showing that girls with autism are often underdiagnosed and may experience more internalising symptoms than boys.

The diagnosis exists. The disbelief is louder.

Apparently, almost every person I have met in the Vancouver School Board has a medical degree — or that’s how they behave, anyway. They looked at my daughter, read her file, skimmed her paediatrician’s letter, listened politely as I explained the hours of therapy, the food rituals, the careful calibration it takes to help her body feel safe — and then said she didn’t qualify.

They denied her an H designation. Said she didn’t meet the threshold for a serious mental health condition. That her support needs weren’t severe. Apparently, the physician’s opinion didn’t carry enough weight.

They didn’t see her chewing on the same bite for twenty minutes. They didn’t see the backpack full of uneaten lunches. They didn’t see the tears in the car, the quiet slide into exhaustion.

The body speaks plainly

She arrives home hungry, shakier in the afternoons, more irritable. She often wails in the car, finally letting the feelings out. My son struggles with the cacophony. I do too, to be honest.

Her body feels stretched thin — her growth chart flatlines while her effort rises. At bedtime, she eats quickly at home, almost desperately. She’s finally calm enough to hear her own hunger cues.

When I raise these concerns, the replies circle back to flexibility. The school points to snack blocks, to shared worktables, to a general culture of self-directed breaks. But generalised permission doesn’t meet a specific access need. It places the burden on a child who masks, a child who freezes under pressure, a child who internalises every raised eyebrow and every sigh.

She doesn’t need options. She needs certainty. She needs food at her desk. She needs privacy and ease and familiarity. She needs eating to feel as ordinary as breathing.

Patterns over time

In years of emails, I’ve written about her lunch returning home untouched. About her sensory distress when peers use graphic language or chew loudly. About her tendency to disengage when environments grow too unpredictable. About her fear of seeming rude, calling attention to herself, of being a problem, of getting it wrong.

We arranged counselling. We spoke with her care team. We added quiet strategies, easy foods, structured check-ins. I’d celebrate if she ate a box of fishy crackers. But still, she comes home and describes being discouraged from eating.

We spoke with her care team. We added quiet strategies, easy foods, structured check-ins. I’d celebrate if she ate a package of fishy crackers. But still, she comes home and describes being discouraged from eating.

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ARFID carries risk

This condition shapes more than her lunch. It shapes her endurance, her learning, her physical growth. It speaks through fatigue, distraction, headaches, hollow mood.

She carries all of this with grace. She jokes and masks and smiles through days when her stomach curls in protest. Her weight remains low. Her energy dips early. Her ability to concentrate wanes.

Each day spent accommodating the system drains the resources she needs to manage her body

Many children with ARFID grow into adolescents and adults with more entrenched eating disorders. Research shows clear overlap: children with ARFID often experience early-onset food avoidance, anxiety, sensory overload, and rigid thinking — the same patterns that later fuel anorexia, bulimia, or binge-purge cycles.

In autistic girls, the shift can be subtle — from food fear to food rules to food refusal, masked by competence and praised by adults who mistake thinness for discipline. ARFID becomes a seedbed for more elaborate distress.

When ARFID is misunderstood, dismissed, or framed as something to be overcome through grit or classroom compliance, the outcome isn’t resolution. It’s escalation.

Key findings

• Overlapping risk factors between ARFID and later-onset eating disorders (like anorexia nervosa or bulimia) include high anxiety, sensory sensitivity, perfectionism, and early-onset food avoidance.
• A 2019 longitudinal study found that ARFID in childhood increases the risk of developing restrictive or binge-purge eating disorders in adolescence and early adulthood, particularly when emotional support and therapeutic intervention are absent¹.
• In autistic individuals, ARFID can evolve into anorexia nervosa, not due to body image concerns, but because the same rigidity, fear of discomfort, and need for predictability around food intensify with age and social pressure².
• One clinical review notes that early ARFID symptoms often precede restrictive eating patterns associated with more entrenched disorders, especially when caregivers or schools focus on compliance over collaboration³.

In other words: ARFID is not a phase or a mild disorder — it’s a developmental warning sign. Without appropriate, trauma-informed, neurodivergence-aware support, it often becomes the foundation for deeper food-related distress, medical complications, and long-term eating disorders.

Footnotes

1. Dinkler, L., et al. (2019). “Avoidant/restrictive food intake disorder: A population-based study of incidence, comorbidity, and impact in children.” Journal of Child Psychology and Psychiatry, 60(8), 976–985. https://doi.org/10.1111/jcpp.13048 
2. Brede, J., et al. (2020). “Autistic perspectives on anorexia nervosa: A qualitative study.” Autism, 24(4), 996–1010. https://doi.org/10.1177/1362361320903123 
3. Zucker, N. L., et al. (2019). “The role of emotion regulation and sensory sensitivity in ARFID and other eating disorders.” Child and Adolescent Psychiatric Clinics of North America, 28(4), 649–661. https://doi.org/10.1016/j.chc.2019.05.003 

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She needs safety, not negotiation

A child with this diagnosis requires unconditional access to food — not as a bonus, or a behaviour strategy, but as an essential right. That access must come without penalty, without separation, without public spectacle. It must come in ways that protect dignity.

My daughter knows what helps her thrive. She knows what support looks like. She remembers classrooms where trusted adults understood her rhythms, where fidgets weren’t locked away, where movement and eating and emotion flowed in ways her body could absorb. For a fleeting moment, before her support person was laid off.

She also remembers being told to wait. To ask. To leave the room. To “build stamina.” To try harder. To act with ‘grace’ and ‘understand’ towards stafff.

And she is tired.

She deserves a school environment where access lives in the infrastructure, not in the exception. Where eating is normal, unremarkable, kind. Where the most basic human need isn’t filtered through gatekeeping or shame.

She knows what hunger feels like. She also knows what being believed feels like. And in a world where she is asked every day to prove that her needs are real, that belief is the beginning of everything.