Exploring the spectrum of feeding challenges in children with autism spectrum disorder: A narrative review of aetiology, impact, and intervention strategies

Abstract

Background
Feeding problems are among the most prevalent and troublesome comorbidities in childhood autism
spectrum disorder (ASD), yet, in general, are poorly understood and managed erratically. While
“picky eating” is common in early childhood, feeding problems of ASD are markedly more intense,
persistent, and multifaceted, related to neurodevelopmental differences rather than behavioural
resistance.
Objective
This narrative review summarises current literature to delineate the spectrum, the aetiology, and
consequences of feeding problems in children with ASD and to outline emerging principles of
assessment and management.
Methods
A structured literature search was performed in PubMed and Google Scholar for English language
studies examining prevalence, characteristics, correlates and management of feeding problems in
children (0–18 years) with ASD. Empirical investigations published in peer-reviewed journals were
identified; non-empirical works, studies of adults, or unrelated disorders were excluded.
Results
Feeding problems in ASD include a heterogeneous range of behaviours, which include extreme food
selectivity, sensory aversions, food neophobia, ritualistic behaviours at mealtime, and pica. These
are dysregulated by sensory processing difficulty, cognitive rigidity, interoceptive differences,
gastrointestinal, and oral-motor comorbidities. The effects of such difficulties include
nutritional deficiencies, failure to thrive, family distress, and social isolation. Use of
family-centred feeding interventions, specifically parent training interventions and
neurodiversity-affirming behavioural approaches, has the potential to enhance outcomes.
Conclusion
Feeding difficulties in ASD present a complex neurodevelopmental phenotype that has serious
biopsychosocial implications. To ensure appropriate management with evidence-based, compassionate
approaches, these difficulties must be considered manifestations of sensory and cognitive
differences rather than oppositional behaviour. Future work must focus on consensus on definitions,
adopting a cross-cultural perspective, and the development of scalable
mechanisms to enhance nutrition and family quality of life.