Children with autism or attention-deficit/hyperactivity disorder (ADHD) are more likely than neurotypical children to experience eating difficulties, such as picky/selective eating, slow eating, and over/under-eating. Recent studies show that eating difficulties can persist into adulthood for autistic individuals. Yet little is known about the mechanisms involved and whether adults with ADHD also experience such challenges. We (1) compare eating difficulties among adults with autism, ADHD, autism/ADHD, and neither condition and (2) identify predictors of overall eating pathology and of food selectivity. The sample was 50% female and 78% White, consisting of 961 adults aged 19-57 who self-reported their diagnostic status: 184 with autism, 416 with ADHD, 292 with autism/ADHD, and 69 comparisons. Eating difficulties were assessed via self-report survey using the Swedish Eating Assessment for Autism (SWEAA) and Food Preferences Questionnaire. Autistic adults, with or without ADHD, reported significantly more eating difficulties than all other groups. Total eating difficulties were associated with increased insistence on sameness, other autistic features, food selectivity, and hyperactivity-impulsivity. Food selectivity was predicted by increased insistence on sameness, sensory sensitivity, and other core features of autism, and lower hyperactivity-impulsivity. The high degree of eating difficulties in autistic adults warrants clinical attention on this topic.Lay AbstractSome people do not like many foods, eat very quickly or slowly, or eat too much or too little. These problems are more common in children with autism or ADHD and may continue for a long time, but we do not know much about these problems in adults. Our goal was to understand how eating difficulties are similar and different in adults with autism, ADHD, both autism/ADHD, and neither condition. We also wanted to understand factors that relate to picky eating and overall eating difficulties. We found that autistic adults had the most problems with eating compared to all other groups. Adults with ADHD had more eating problems than adults with neither condition. Adults with autism and/or ADHD were more sensitive to taste and texture of foods, had difficulty with spilling food, and found it hard to tell whether they are hungry or full compared to people without these conditions. We also found that autism and ADHD traits were linked to picky eating and having more eating problems. The results show that many autistic adults and some with ADHD might need support with eating. Doctors should pay attention to eating problems to help people get the care they need. Results also show that wanting things to stay the same may be more related to eating problems than researchers previously thought. We need more research to understand how to support adults with eating difficulties.

Background: Autistic women with eating disorders (EDs) often present with more complex EDs and may not fully benefit from current treatments, yet the reasons for this remain unclear. This study aims to examine the eating behaviors of autistic women with EDs and how these differ from those of (1) non-autistic women with EDs, (2) autistic women without EDs, and (3) non-autistic female controls. It investigates autism-related eating behaviors, traditionally disordered eating behaviors, and avoidant-restrictive food intake disorder (ARFID)-related behaviors to better understand their complex ED presentations. Methods: A cross-sectional study was conducted with 30 autistic women with EDs, 30 non-autistic women with EDs, 29 autistic women without EDs, and 60 non-autistic female controls. Participants completed questionnaires assessing eating behaviors, quality of life, and comorbid psychological symptoms. Results: Autistic women with EDs exhibited higher levels of both autism-related and disordered eating behaviors than all other groups, including food selectivity, mealtime rigidity, and sensory-related eating difficulties. They also reported notable weight and shape concerns. Additionally, they showed higher levels of comorbidity and reported lower mental health-related quality of life compared to all other groups. Conclusions: These findings suggest that the overlap of autism-related and disordered eating behaviors contributes to the complexity and severity of EDs in autistic women, potentially limiting the effectiveness of current treatment approaches. Developing autism-informed interventions that address sensory sensitivities, rigidity, and cognitive differences may improve treatment outcomes. Future research should explore how these factors interact in maintaining ED pathology and identify strategies to distinguish adaptive from maladaptive eating behaviors.

The present meta-analysis aims to assess whether individuals with anorexia nervosa (AN) demonstrate elevated autistic traits, to explore potential associations between autistic traits and eating disorder symptoms; as well as to estimate the prevalence of a positive screen for autism spectrum disorder (ASD) assessed via Autism Diagnostic Observation Schedule (ADOS), in AN.

A systematic literature search was conducted in PsycINFO, MEDLINE, and Web of Science in August 2023 and later updated in April 2024 to identify relevant studies. Twenty-two studies with 1172 AN patients and 2747 healthy controls (HCs) met the inclusion criteria.

There was a significant difference between AN and HC groups in autistic traits (g = 0.88, CI = 0.65-1.12), and a significant but modest correlation was found between autistic traits and severity of eating disorder symptoms (r = 0.28, CI = 0.11-0.44). Proportion meta-analysis indicated that 29% (CI = 0.19-0.38) of children and adults scored above the cut-off for ASD.

The current findings suggest that AN frequently overlaps with both autistic traits and autistic symptomatology. Therefore, it is essential to evaluate autism and autistic traits in individuals with AN to tailor individualized treatment plans.

While diagnostic pathways for identifying Autism in eating disorder (ED) populations have been developed, the field continues to lack validated psychometric tools to measure EDs for use in the Autistic population. Many commonly used measures for EDs potentially lack validity and reliability in the Autistic population limiting theoretical and practical advancements in the field. This paper outlines current conflicts in autism and ED research and how these can be addressed through psychometric methodology. We discuss: (1) the lack of differentiation between ED pathology and Autistic eating behaviours, as well as the limited inclusion of autism-specific mechanisms in existing tools; (2) the subsequent theoretical and practical implications for researchers, clinicians, and Autistic people; and (3) future directions for psychometric research. Scholars are encouraged to employ participatory designs with autistic people before carefully considering which analytical strategies are used in the Autistic population.

Dietary and gastrointestinal (GI) problems have been frequently reported in autism spectrum disorder (ASD). However, the relative contributions of autism-linked traits to dietary and GI problems in children with ASD are poorly understood. This study firstly compared the dietary intake and GI symptoms between children with ASD and typically developing children (TDC), and then quantified the relative contributions of autism-linked traits to dietary intake, and relative contributions of autism-linked traits and dietary intake to GI symptoms within the ASD group.

A sample of 121 children with ASD and 121 age-matched TDC were eligible for this study. The dietary intake indicators included food groups intakes, food variety, and diet quality. The autism-linked traits included ASD symptom severity, restricted repetitive behaviors (RRBs), sensory profiles, mealtime behaviors, and their subtypes. Linear mixed-effects models and mixed-effects logistic regression models were used to estimate the relative contributions.

Children with ASD had poorer diets with fewer vegetables/fruits, less variety of food, a higher degree of inadequate/unbalanced dietary intake, and more severe constipation/total GI symptoms than age-matched TDC. Within the ASD group, compulsive behavior (a subtype of RRBs) and taste/smell sensitivity were the only traits associated with lower vegetables and fruit consumption, respectively. Self-injurious behavior (a subtype of RRBs) was the only contributing trait to less variety of food. Limited variety (a subtype of mealtime behavior problems) and ASD symptom severity were the primary and secondary contributors to inadequate dietary intake, respectively. ASD symptom severity and limited variety were the primary and secondary contributors to unbalanced dietary intake, respectively. Notably, unbalanced dietary intake was a significant independent factor associated with constipation/total GI symptoms, and autism-linked traits manifested no contributions.

ASD symptom severity and unbalanced diets were the most important contributors to unbalanced dietary intake and GI symptoms, respectively. Our findings highlight that ASD symptom severity and unbalanced diets could provide the largest benefits for the dietary and GI problems of ASD if they were targeted for early detection and optimal treatment.

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.

Autistic women struggle with high levels of both autistic eating behaviours and disordered eating behaviours , which might make them particularly vulnerable to develop eating disorders. Research investigating the presence and characteristics of eating disorders in autistic women is however limited, as is research examining the role of autism in the treatment and recovery of an eating disorder in autistic women.

The link between autism and eating disorders has mainly been investigated from the field of eating disorder research, with studies finding an overrepresentation of autism or autistic traits in eating disorders populations. Findings also suggest that autism or autistic traits are associated with a more serious presentation of the eating disorders, including a higher chance of a chronic course of the eating disorders. Most studies however lack comprehensive autism assessments, making it difficult to determine the actual prevalence of autism and its role in women with eating disorders.

Autistic women with an eating disorder seem to suffer from more complex eating disorders and seem to not benefit from current treatment modalities. This could be partly related to specific autism characteristics such as sensory sensitivities, which are not being considered by current treatment protocols. Future research needs to shed light on what underlies the eating behaviours of autistic women with an eating disorder, in order to help to adapt current treatment modalities to meet the unique needs of these women.

There is considerable overlap between the features of avoidant-restrictive food intake disorder (ARFID) and autism. The purpose of this scoping review is to provide an overview of studies published on ARFID and autism in 2022 and the first half of 2023.

ARFID and autism are highly heritable conditions that often co-occur. In a large autism cohort, 21% of participants and 17% of their parents presented with avoidant-restrictive features. Of children diagnosed with ARFID, 8.2-54.8% are autistic. More than half of individuals with ARFID also have other neurodevelopmental, psychiatric, or somatic diagnoses. Anxiety, depression, sleep disorders, and learning difficulties are particularly common co-occurring issues. Various strategies have been developed to support autistic children with feeding difficulties. It appears that their feeding difficulties, particularly sensory sensitivities, food preferences, and mealtime rituals and routines frequently persist into adolescence and adulthood, but research on optimal support for adults and adolescents is still scarce. Untreated ARFID in autistic individuals may lead to serious complications.

Individuals seeking specialist care for autism, eating disorders, or gender dysphoria should be screened for ARFID. More research is needed on how to support autistic adolescents and adults with features of ARFID.

Children with autism spectrum disorders (ASD) or autism are more prone to gastrointestinal (GI) disorders than the general population. These disorders can significantly affect their health, learning, and development due to various factors such as genetics, environment, and behavior. The causes of GI disorders in children with ASD can include gut dysbiosis, immune dysfunction, food sensitivities, digestive enzyme deficiencies, and sensory processing differences. Many studies suggest that numerous children with ASD experience GI problems, and effective management is crucial. Diagnosing autism is typically done through genetic, neurological, functional, and behavioral assessments and observations, while GI tests are not consistently reliable. Some GI tests may increase the risk of developing ASD or exacerbating symptoms. Addressing GI issues in individuals with ASD can improve their overall well-being, leading to better behavior, cognitive function, and educational abilities. Proper management can improve digestion, nutrient absorption, and appetite by relieving physical discomfort and pain. Alleviating GI symptoms can improve sleep patterns, increase energy levels, and contribute to a general sense of well-being, ultimately leading to a better quality of life for the individual and improved family dynamics. The primary goal of GI interventions is to improve nutritional status, reduce symptom severity, promote a balanced mood, and increase patient independence.