From ARFID to Binge Eating: A Review of the Sensory, Behavioral, and Gut-Brain Axis Mechanisms Driving Co-Occurring Eating Disorders in Children and Adolescents with Autism Spectrum Disorder.

This review looked at eating problems in autistic children and teens. It found that sensory issues, rigid thinking patterns, and gut-brain communication problems all contribute to feeding difficulties. Autistic children often have very limited food preferences and may develop serious eating disorders. Some become underweight while others become overweight. The research shows that treatment needs to address nutrition, behavior, and emotions together for each individual child.

This 2025 narrative review examined the complex relationship between autism spectrum disorder (ASD) and eating difficulties in children and adolescents. The analysis identified three key mechanisms driving feeding problems: sensory processing abnormalities, behavioral inflexibility, and gut-brain axis disturbances. Children with ASD frequently exhibit food selectivity, neophobia, and symptoms consistent with ARFID. The review documented increased prevalence of anorexia nervosa and orthorexia nervosa, alongside tendencies toward emotional eating and preference for high-caloric foods.

This results in a bimodal distribution of body mass, with both undernutrition and obesity observed. The authors emphasize the need for individualized, evidence-based interventions that integrate nutritional management with behavioral and psychotherapeutic approaches.

Clinicians should screen for eating disorders in autistic children and assess sensory, behavioral, and gut-brain factors. Treatment requires individualized approaches integrating nutritional management, behavioral interventions, and psychotherapy. Both undernutrition and obesity risks need monitoring, with particular attention to medication effects and activity levels.

As a narrative review, this study lacks systematic methodology for study selection and quality assessment. No sample size is reported, and the review nature means findings represent synthesis of existing research rather than new empirical data. The heterogeneity of reviewed studies may limit generalizability of conclusions.

Autism spectrum disorder (ASD) constitutes a heterogeneous neurodevelopmental condition frequently accompanied by considerable disturbances in feeding behavior and nutritional balance. These difficulties arise from complex and multifactorial mechanisms, exerting a significant impact on physical health, metabolic homeostasis, and psychosocial functioning. The present review aims to provide a critical synthesis of current evidence regarding the underlying biological and behavioral mechanisms of feeding difficulties in ASD and to delineate the spectrum of comorbid eating disorders within this population.A narrative review of the peer-reviewed scientific literature was undertaken, emphasizing studies investigating the interrelationship between ASD and nutritional functioning in pediatric and adolescent populations. Particular focus was placed on research exploring sensory processing abnormalities, gut microbiota alterations, and the clinical manifestation of eating disorders in individuals with ASD.The analysis revealed that sensory hypersensitivity, behavioral inflexibility, and disturbances within the gut-brain axis constitute principal determinants of atypical eating patterns in ASD.

Individuals on the autism spectrum frequently exhibit pronounced food selectivity, neophobia, and symptoms consistent with Avoidant/Restrictive Food Intake Disorder (ARFID). Furthermore, an increased prevalence of anorexia nervosa and orthorexia nervosa has been documented, likely reflecting shared cognitive and behavioral features with ASD. "Emotional eating" tendencies and a marked preference for high-caloric, energy-dense foods-often potentiated by psychopharmacological treatment and reduced physical activity-further contribute to an elevated risk of overweight and obesity.Children and adolescents with ASD display a bimodal distribution of body mass, encompassing both undernutrition and obesity, indicative of a multifaceted interplay among sensory, behavioral, cognitive, and metabolic determinants. A comprehensive understanding of this heterogeneity is crucial for the development of individualized, evidence-based interventions integrating nutritional management with behavioral and psychotherapeutic approaches.