The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes behaviors such as resistance to change, adherence to routines, and ritualized verbal or nonverbal behaviors as diagnostic criteria for autism. These behaviors may include excessive anxiety over minor changes, insistence on using the same route daily, or a preference for eating the same foods repeatedly.

Individuals with ASD are five times more likely to experience feeding problems due to autism-related behaviors. Some common eating disorders among individuals with autism include Avoidant/Restrictive Food Intake Disorder (ARFID), Food Selectivity, Pica (eating non-food substances), and Rumination Disorder (repeated regurgitation of food).

In interventions, it is essential to determine whether the feeding problem is organic (medical) or behavioral. For example, symptoms such as vomiting, lack of appetite, and food refusal in children may be associated with medical conditions like gastroesophageal reflux, constipation, eosinophilic esophagitis, food allergies, or intolerances. Recent studies suggest that imbalances in gut microbiota may also contribute to food selectivity. Additionally, cravings for non-food substances (pica) may stem from mineral deficiencies, such as calcium and iron. On the other hand, severe food refusal might be a social attention-seeking behavior. Since both medical and behavioral factors can coexist in autism, identifying the root cause is crucial.

Food selectivity is one of the most commonly reported feeding problems in autistic children. It includes behaviors such as limited calorie intake, refusal of certain foods, food-related rituals, fixation on specific foods, and behavioral issues during mealtime. Factors influencing food selectivity include genetics, environmental influences, family eating habits, and meal routines.

Individuals with autism may exhibit selectivity based on food texture (e.g., rejecting lumpy or soft foods), taste, temperature, color, or smell. In cases of complete food refusal, individuals may consume only a limited variety and quantity of foods. They may reject foods by crying, showing aggression, spitting out food, or keeping their mouth shut. Food selectivity may also stem from sensory processing issues.

Long-term eating disorders can reduce food intake, negatively affecting physical health and psychosocial well-being. For example, Avoidant/Restrictive Food Intake Disorder (ARFID) can lead to nutritional deficiencies. Therefore, early intervention is crucial to increase food variety, support growth and development, and promote a balanced diet.