REVIEW OF: Mosheva M et al, Eur Child Adolesc Psychiatry 2025;34(10):3083–3095

STUDY TYPE: Retrospective chart review

Avoidant/restrictive food intake disorder (ARFID) can be stubbornly resistant to non-pharmacologic treatment, especially when anxiety and rigidity block progress. This small study explores whether atypical antipsychotics might help move the needle.

Investigators reviewed charts from 21 children and adolescents (11 male, 10 female) with ARFID treated at a specialty clinic. Most had failed to gain weight after at least 6 months of cognitive behavioral therapy and were started on an atypical antipsychotic, usually low-dose risperidone at 0.2 mg/day, increasing every 4–6 weeks to a final dosage of 0.6–0.8 mg/day. Patients were followed for up to 18 months, with repeated measures of weight, height, BMI, and illness severity.

Over 18 months, patients gained nearly 10 kg in weight and about 10 cm in height, although only boys gained significant height and mean height rose only for those with low baseline height. BMI increased by about 2.5 points overall.

About two-thirds of patients showed clinical improvement on global severity ratings. Side effects were generally mild (most often fatigue or irritability), and no patients discontinued medication due to adverse effects.

CARLAT TAKE

This report is far from definitive. In children with ARFID who are underweight and stuck despite good therapy, low-dose atypical antipsychotics may increase growth. But this study was small, uncontrolled, and retrospective, with a high dropout rate (none from adverse effects), and these medications carry long-term metabolic and neurological risks. Still, if nutritional status is deteriorating and a child is not responding to intervention, you might consider a cautious, time-limited trial with an atypical antipsychotic such as risperidone or olanzapine. Monitor closely, keep expectations grounded, and conduct the trial as part of a broader treatment plan.