New review highlights overlooked eating disorders in autistic children and the need for better detection

A systematic review reveals that children and adolescents with autism are at significant risk of three feeding disorders that are often missed in routine care, underscoring the urgent need for improved diagnosis and treatment pathways.

A new systematic review has found that children and adolescents with autism spectrum disorder face a much higher risk of three eating and feeding disorders that can be missed in routine care: pica, avoidant restrictive food intake disorder, known as ARFID, and rumination disorder. The review, published in the Journal of Eating Disorders by a Norwegian-Swedish team, sifted through nearly 8,700 records before finding just 23 studies that met strict criteria, underlining how limited the evidence still is despite growing concern about the overlap between autism and disordered eating. Researchers said the thin research base itself points to a larger problem: these conditions are not only dangerous, but also too often overlooked.

The best-studied of the three was pica, the repeated eating of non-food items such as soil, paper, plastic or metal. According to the review, children with autism appear to be at increased risk, particularly those with intellectual disability. That matters because pica can cause serious harm, including poisoning from paint chips, bowel obstruction, perforation, dental injury and infection. A separate study in 2020 also found a strong association between autism and pica in children, reinforcing the need for early recognition rather than dismissing the behaviour as an isolated quirk.

ARFID presents differently. Unlike anorexia nervosa or bulimia, it is not driven by weight or body-image concerns. Instead, it may stem from sensory sensitivities, fear of choking or vomiting, or little interest in eating. The review found 10 studies linking autism and ARFID, and a separate scoping review on children and young people with autism described the condition as especially common and difficult to identify early. Other research has reported that feeding problems are widespread in autistic preschoolers, with a notable share meeting criteria for ARFID, while a meta-analysis found substantial overlap between the two conditions.

Rumination disorder received the least attention. It involves effortless regurgitation of recently eaten food, which may then be rechewed, reswallowed or spat out. In the review, only one study met the inclusion criteria for this diagnosis in autistic children and adolescents. The authors argued that this likely reflects under-recognition rather than rarity. Left unaddressed, rumination can lead to weight loss, malnutrition, dental damage and injury to the oesophagus, and it is often mistaken for reflux or vomiting, which can delay the right treatment.

The review also highlighted a broader problem with the existing evidence. Most of the studies were small and used different methods, making it hard to compare findings or estimate how common these disorders really are in autistic children. The authors said there is still no clear evidence-based treatment pathway for any of the three conditions in this population. That leaves families and clinicians navigating a patchwork of assessments that may not be designed for autistic children, even though early identification could improve outcomes.

Other recent research points in the same direction. A study of children and adolescents seen in an outpatient ARFID clinic suggested that a brief autism screening tool may help identify autism in patients with restrictive eating symptoms, while genetic research in a large autism cohort has begun to explore possible shared risk mechanisms. Taken together, the evidence suggests that clinicians across paediatrics, psychiatry, psychology and gastroenterology need to pay closer attention to eating behaviour in autistic children, not only to avoid missed diagnoses but also to catch treatable problems before they cause lasting harm.