Feeding, Autism and ADHD
Understanding the overlap between neurodivergence and eating
Prepared by
Dr Melissa Bujtor
HCPC Registered Dietitian · AfN Registered Nutritionist (RNutr)
Paediatric Feeding Specialist
Differences in eating and feeding are common in neurodivergent people.
If you are autistic, have ADHD, or are supporting a neurodivergent child, young person or adult, you may recognise things such as:
- a strong preference for particular foods, brands or presentations;
- sensory differences around food;
- a relatively small range of accessible foods;
- difficulty noticing or responding to hunger and fullness;
- forgetting to eat or finding it difficult to stop another activity to eat;
- finding changes to familiar foods particularly difficult;
- needing particular environments, routines or accommodations in order to eat comfortably.
None of these things, by themselves, mean that someone has a feeding or eating disorder.
“Does this person eat differently?”
“How is eating working for this person — nutritionally, physically, developmentally, emotionally and in everyday life?”
This guide explores why eating and neurodivergence can overlap, when eating differences may simply be part of someone’s individual profile, and when closer assessment or support may be useful. It provides general information and is not a diagnostic tool.
Eating differences and autism
There is good evidence that food selectivity and other feeding differences occur more frequently in autistic children than in non-autistic children.1–4 Research particularly identifies differences involving:
These experiences vary considerably between individuals.
- Some autistic people eat a broad and nutritionally adequate diet.
- Others rely on a smaller number of predictable foods without experiencing significant nutritional or functional difficulty.
- Some experience restriction that affects nutrition, growth, physical health or everyday participation.
- And some meet diagnostic criteria for a feeding or eating disorder such as ARFID.
Difference and disorder are not the same thing.
Autism and ARFID can occur together
Autism and ARFID co-occur more frequently than would be expected from general-population estimates.
~16%
of people in ARFID study populations were autistic — from a 2025 meta-analysis of 21 studies and 7,442 participants.5
~11%
estimated ARFID prevalence in autistic study populations — but based on only three studies, with a very wide confidence interval.5
The figures are therefore best understood as evidence of meaningful co-occurrence, rather than precise estimates that apply to every autistic or ARFID population.
Being autistic does not mean someone has ARFID.
Being autistic does not prevent someone from also having ARFID.
Where restrictive eating meets the diagnostic criteria for ARFID and requires additional clinical attention beyond the person’s co-occurring condition, autism and ARFID can be recognised together.6,7
What about ADHD?
ADHD may also interact with eating, although research specifically examining ADHD, food restriction and ARFID is less established than the autism literature.
A large population-based study of Swedish children with an ARFID phenotype found ADHD to be one of the more frequently co-occurring neurodevelopmental or psychiatric conditions.8 A 2025 case-control study also found higher ARFID-related picky-eating scores and greater sensory-processing differences among children with ADHD than comparison children.9
These findings are important, but the evidence base is still developing and does not mean that ADHD itself causes restricted eating.
For an individual with ADHD, eating may interact with factors such as:
These possibilities should be explored individually rather than assumed because someone has an ADHD diagnosis.
Stimulant medication and appetite
Stimulant medicines can reduce appetite in some people. Where this is affecting nutritional intake, growth or weight, it should be reviewed with the clinician responsible for prescribing the medication.10,11
Why might neurodivergence and eating overlap?
There is unlikely to be one explanation. Eating is a complex developmental activity involving:
Any of these may interact with eating differently for an individual person.
Sensory processing
Eating is highly sensory. It involves taste, smell, texture, temperature, appearance, sound, touch, and sensations inside the mouth and body.
Sensory differences are well recognised in autism, and research consistently identifies associations between sensory processing and food selectivity in autistic children.1–4 Texture and taste appear particularly relevant, although the pattern differs between individuals.2–4
A food that is comfortable or neutral for one person may be uncomfortable, overwhelming or inaccessible to another. Some people may also actively prefer or seek particular sensory characteristics in food.
Neither response should automatically be treated as something that needs correcting.
Predictability and sameness
For some autistic people, predictability can be particularly important around food. This might mean preferring:
A changed recipe, different packaging or unexpectedly different texture may make a previously accessible food more difficult to eat. This can be especially important when someone relies on a relatively small number of foods.
Maintaining predictability can therefore be a useful accommodation, rather than something that automatically needs to be challenged.
Interoception
Interoception refers to how we sense and interpret signals from inside the body — hunger, fullness, thirst, nausea, pain, temperature, needing the toilet.
Research into interoception and neurodivergence is developing, and findings are more complex than simply saying that neurodivergent people have “poor interoception”. A recent systematic review and meta-analysis found mixed findings in autism, with some studies reporting differences and others finding similar interoceptive abilities to non-autistic participants.12
For an individual person, hunger or fullness may be very noticeable, less noticeable, noticed later, difficult to interpret, or difficult to act on.
It is more useful to explore how this person experiences and responds to their body signals than to assume that autism or ADHD tells us what their interoception is like.
Attention, executive functioning and transitions
Eating does not only require appetite. Someone also has to:
For some people, one or more of these steps can require considerable executive effort. This may be particularly noticeable during periods of intense focus or when transitions are difficult.
Depending on the individual, useful supports might include:
- regular eating opportunities;
- reminders;
- visual or written schedules;
- accessible foods kept nearby;
- predictable routines;
- reducing the number of steps required to access food.
These are supports, not measures of success or failure.
Feeding and eating are also physical
It is important not to attribute every feeding difficulty in a neurodivergent person to neurodivergence.
Eating can also be affected by:
A neurodivergent person experiencing difficulty eating deserves the same careful consideration of possible physical contributors as anyone else.
Neurodivergent eating is not automatically a disorder
A person can eat differently from social expectations without their eating needing to be changed. A limited or highly specific diet may reflect sensory needs, predictability, preference, routine, accessibility, or individual ways of experiencing food.
If the person’s nutritional needs are being met, there are no significant concerns about growth, physical health or safety, and the way they eat is workable for them without causing substantial distress or limiting everyday participation, intervention aimed simply at changing the appearance of their eating may not be necessary.
At the same time, neuroaffirming care does not mean overlooking nutritional, developmental, medical or functional concerns.
Both parts of the picture deserve attention.
When eating may need a closer look
It may be useful to seek assessment where:
- the range of accessible foods is very narrow or continuing to reduce;
- important food groups or nutrient sources are absent;
- there is concern about nutritional adequacy;
- growth in a child is affected;
- there is significant or unexpected weight change;
- eating or obtaining enough nutrition requires considerable effort;
- eating is associated with significant fear or distress;
- eating substantially restricts participation in education, work, relationships or everyday life;
- there is persistent pain, vomiting or gastrointestinal difficulty;
- there is difficulty chewing or swallowing, coughing or choking during food or drink;
- there are concerns about hydration.
The presence of one of these does not automatically mean ARFID. It means the eating deserves to be understood more closely.
What does neuroaffirming feeding support look like?
“How do we make this person eat in a particular way?”
“What makes eating accessible or inaccessible for this person?”
Support will look different for different people.
Protecting accessible foods
Foods a person can reliably eat are important. Where the range is already limited, unnecessarily changing, removing or withholding familiar foods may increase nutritional vulnerability and distress. Reliable access to familiar foods may therefore be an important accommodation.
This does not prevent work on flexibility or food range where that is an appropriate and meaningful goal. It means protecting nutrition and accessibility while that work takes place.
Reducing unnecessary sensory load
Eating may be easier in an environment with:
Not everyone needs these adaptations. The person’s own experience should guide what helps.
Reducing pressure and coercion
Eating should not depend on a person overriding significant sensory discomfort or distress simply to satisfy another person, or to make their eating conform to an external expectation.
Avoid coercive approaches
- forcing food into someone’s mouth;
- withholding accessible food in order to compel someone to eat another food;
- deliberately allowing hunger to escalate as a means of forcing food acceptance;
- shaming or criticising food preferences;
- repeatedly pressuring someone to take “just one bite”.
Some feeding interventions use reinforcement and other behavioural strategies, and studies report improvements in food acceptance from some of these approaches. However, a systematic review of caregiver-implemented feeding interventions for autistic children found that, although food outcomes generally improved, it was difficult to determine how nutritionally meaningful those changes were and to draw firm conclusions about intervention acceptability.13
Success should not be measured only by whether someone swallowed a new food.
Intervention should also consider:
Working with appetite and interoception
Where someone does not reliably notice or act on hunger, external supports may be useful. These might include:
These supports do not mean teaching someone to ignore their body. They provide another source of information and structure alongside whatever internal signals the person experiences.
Exploring food — where this is an appropriate goal
Not every neurodivergent person needs food-expansion work. Where increasing flexibility or food range would meaningfully support nutrition, health or participation — and is an appropriate goal for that individual — exploration can be built around predictability, communication and manageable steps.
For some people this may involve:
- becoming familiar with a food;
- seeing it;
- having it nearby;
- learning about it;
- interacting with it;
- changing one characteristic of an already accessible food;
- tasting it where this is an agreed and appropriate goal.
There is no universal ladder that every person must progress through. Looking at, touching or smelling food should not become another task the person has to perform in order to demonstrate progress.
The approach should fit the individual and the reason the eating is difficult.
Choice, autonomy and communication
A person’s communication about food should be taken seriously. Communication may happen through:
A person does not need fluent spoken language for their preferences, discomfort or refusal to matter.
For children, parents and caregivers retain responsibility for protecting nutrition, health and safety. That responsibility can coexist with respecting a child’s communication, sensory needs and developing autonomy.
For teenagers and adults, support should increasingly centre their own goals, preferences and decisions, with family or carers involved where appropriate and wanted.
Making appointments neurodivergence-friendly
Clinical appointments can themselves create sensory, communication and executive demands. Helpful adjustments may include:
Adjustments should be based on the individual person’s needs, rather than assuming every autistic or ADHD person requires the same environment.
What to hold on to
- Eating differences are common in autistic people, but difference does not automatically mean disorder.
- Autism and ARFID can occur together.
- ADHD can also interact with eating, although the evidence base is less developed than it is for autism.
- Sensory processing can be important, but it is not the only possible explanation for restricted eating.
- Interoceptive experiences vary; they should be explored rather than assumed.
- Medical, gastrointestinal, feeding-skill and swallowing factors should not be overlooked.
- A familiar or restricted diet should not be changed simply because it differs from social expectations.
- Equally, neurodivergence should not be used to dismiss nutritional, developmental or medical concerns.
- Accommodations can be legitimate parts of long-term support.
- Food expansion is one possible goal — not the definition of successful feeding support.
- The aim is to support nutrition, health, safety, development, participation and an eating experience that is workable for the individual.
If you would like the eating understood in context
Neurodivergent people can be poorly served by feeding advice that assumes everyone experiences food, appetite, sensory information and mealtimes in the same way.
Dr Melissa Bujtor works with neurodivergent children, young people and adults to understand eating in the context of the whole person. Assessment can include:
The aim is to understand how the person experiences eating, what helps or makes it more difficult, what their nutritional needs are, and what support or accommodations would genuinely help.
Enquire about specialist feeding and ARFID support
Alternatively, you can speak to your local GP about appropriate assessment and referral.
When to seek medical advice
Seek medical advice where there is:
- significant or unexplained weight loss;
- faltering growth or a concerning change in a child’s growth trajectory;
- inability to maintain adequate food or fluid intake;
- signs or symptoms suggesting nutritional deficiency;
- persistent vomiting or significant pain associated with eating;
- significant gastrointestinal symptoms;
- difficulty chewing or swallowing;
- coughing or choking with food or drink;
- recurrent chest infections where swallowing safety may be a concern;
- acute deterioration in physical health.
Urgent
Coughing, choking or suspected swallowing difficulty requires appropriate assessment regardless of whether the person is neurodivergent.
If someone is acutely unwell, significantly dehydrated or unable to maintain adequate food or fluid intake, seek urgent medical advice through their GP, NHS 111 or emergency services as appropriate.
A final thought
Understanding that eating differences are common in neurodivergence can be enormously helpful. It can explain why conventional feeding advice has not fitted. It can help us recognise sensory needs, make useful accommodations and move away from interpreting difference as defiance.
But neuroaffirming care does not mean assuming every eating difficulty is simply “part of autism” or ADHD.
A better question is: how is eating working for this person?
If their nutritional needs are being met, there are no significant concerns about growth, physical health or safety, and their eating is workable for them without causing substantial distress or restricting everyday life, there may be no reason to change it simply because it looks different from somebody else’s.
If eating is compromising nutrition, growth or development, physical health, safety, wellbeing or meaningful participation, that deserves appropriate support — without asking the person to suppress neurodivergent needs or characteristics simply to make their eating conform to somebody else’s expectations.
Important information
This guide provides general educational information only. It is not a diagnostic tool and does not replace individual medical, dietetic, psychological, feeding or swallowing assessment.
If you are concerned about your own or your child’s eating, nutritional intake, growth or physical health, you can contact Dr Melissa Bujtor Specialist Dietetic Practice, another suitably qualified dietitian, or your local GP.
Where there are concerns about chewing or swallowing, recurrent choking, significant medical symptoms, rapid deterioration in intake or acute physical illness, seek appropriate medical or specialist assessment.
Prepared by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Paediatric Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general educational information and is not a diagnostic tool or a substitute for individual assessment.
References
- Page SD, Souders MC, Kral TVE, Chao AM, Pinto-Martin J. Correlates of feeding difficulties among children with autism spectrum disorder: a systematic review. J Autism Dev Disord. 2022;52(1):255–274. doi:10.1007/s10803-021-04947-4.
- Rodrigues JVS, Poli MCF, Petrilli PH, Dornelles RCM, Turcio KH, Theodoro LH. Food selectivity and neophobia in children with autism spectrum disorder and neurotypical development: a systematic review. Nutr Rev. 2023;81(8):1034–1050. doi:10.1093/nutrit/nuac112.
- Zulkifli MN, Kadar M, Fenech M, Hamzaid NH. Interrelation of food selectivity, oral sensory sensitivity, and nutrient intake in children with autism spectrum disorder: a scoping review. Res Autism Spectr Disord. 2022;93:101928. doi:10.1016/j.rasd.2022.101928.
- Mørdre M, Ørbeck B, Hoel RE, Øvergård KR. Food selectivity in children and adolescents with autism spectrum disorders — a systematic literature review. Tidsskr Nor Laegeforen. 2024;144(14). doi:10.4045/tidsskr.24.0193.
- Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): a prevalence-based meta-analysis. Int J Eat Disord. 2025;58(3):473–488. doi:10.1002/eat.24369.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed, text rev. Washington, DC: American Psychiatric Association Publishing; 2022.
- World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: World Health Organization; 2024.
- Nyholmer M, Wronski ML, Hög L, et al. Neurodevelopmental and psychiatric conditions in children with an avoidant/restrictive food intake disorder phenotype. J Child Psychol Psychiatry. 2025;66(9):1333–1344. doi:10.1111/jcpp.14134.
- Kašak M, Günal Okumuş H, Çelik YS, Kırşan FZ, Coşkun M, Öztürk Y, et al. Selective eating and sensory sensitivity in children with ADHD: a comparative study of ARFID symptom profiles. Int J Eat Disord. 2025;58(10):1991–2002. doi:10.1002/eat.24512.
- Pennell A, Couturier J, Grant C, Johnson N. Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder. Int J Eat Disord. 2016;49(11):1036–1039. doi:10.1002/eat.22602.
- Finn DM, Menzel JE, Gray E, Schwartz T. Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders. J Eat Disord. 2023;11(1):226. doi:10.1186/s40337-023-00954-1.
- Klein M, Witthöft M, Jungmann SM. Interoception in individuals with autism spectrum disorder: a systematic literature review and meta-analysis. Front Psychiatry. 2025;16:1573263. doi:10.3389/fpsyt.2025.1573263.
- Blennerhassett C, Richards M, Clayton S. Caregiver-implemented feeding interventions for autistic children with food selectivity: a systematic review. Rev J Autism Dev Disord. 2025;12:224–242. doi:10.1007/s40489-023-00378-2.
Prepared by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Paediatric Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general educational information and is not a diagnostic tool or a substitute for individual assessment.
About the author
Dr Melissa Bujtor
A HCPC Registered Dietitian and AfN Registered Nutritionist with specialist expertise in paediatric dietetics, feeding development and eating disorders.
Dr Bujtor also holds a British Psychological Society-accredited Master’s degree in Psychology, bringing an understanding of behaviour, cognition and emotional development to her clinical work with children and young people.
She is a published scientist whose work spans research, policy and advocacy, and serves on the Board of Trustees of The Feeding Trust, helping to connect research, policy and clinical practice to improve outcomes for children, young people and families.
Her clinical practice combines evidence-based dietetics with a developmental understanding of feeding — looking beyond what a child eats to understand the factors that may be contributing to their difficulties.
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