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

BackgroundFeeding 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.ObjectiveThis 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.MethodsA 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.ResultsFeeding 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.ConclusionFeeding 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 scalablemechanisms to enhance nutrition and family quality of life.