Core Deficits and Eating Behaviors in Children with Autism: The Role of Executive Function

Background: Children with autism spectrum disorder (ASD) frequently experience eating-related behavioral difficulties; however, the relationships among these difficulties, core ASD deficits, and executive function remain poorly understood. The present study examined how core ASD characteristics-restrictive and repetitive behaviors (RRBs) and social impairments-relate to eating behaviors, including food approach and avoidance tendencies. In addition, the study explored whether executive function serves as a mediating mechanism underlying these associations. Methods: A total of 184 children aged 3-12 years participated in this cross-sectional study. All variables were measured using parent-reported questionnaires, and data were analyzed through path modeling. The Social Responsiveness Scale-Second Edition (SRS-2) and the Repetitive Behavior Scale-Revised (RBS-R) were employed to assess social impairments and RRBs, respectively. Eating behaviors-comprising food approach and food avoidance dimensions-were evaluated with the Children's Eating Behavior Questionnaire (CEBQ), while executive function was measured using the Child Executive Functioning Inventory (CHEXI). Results: The analysis revealed significant associations between RRBs and both food approach and food avoidance behaviors in children with ASD. Crucially, follow-up regression analyses specifying RRBs subtypes showed that Stereotyped Behavior independently predicted both food approach (β = 0.305, p < 0.001) and avoidance (β = 0.217, p = 0.002), while Compulsive Behavior specifically predicted food avoidance (β = 0.173, p = 0.021). Furthermore, executive function appeared to serve as a potential mediator in these relationships, suggesting that impairments in executive control may partially explain how repetitive behaviors influence eating patterns. Although social impairments showed weaker direct associations with eating behaviors, they indirectly affected both food approach and avoidance behaviors through deficits in executive function, highlighting the complex interplay among behavioral, cognitive, and social domains in ASD. Conclusions: These findings indicate that RRBs-one of the core characteristics of ASD-can predict children's eating behaviors and are concurrently linked to two seemingly opposite eating patterns. Both social impairments and RRBs appear to influence eating behaviors through executive dysfunction. This study provides new insights into the mechanisms underlying atypical eating behaviors in children with ASD and identifies executive function as a promising target for interventions aimed at improving eating-related outcomes in this population.