Short report: An examination of behavioral factors linked to picky eating in autistic children

Eating difficulties are highly prevalent among autistic children and are linked to negative health consequences. While many mechanisms are thought to underly these behaviors, we know less about how internalizing and externalizing behaviors relate to eating difficulties in autism. The purpose of this study was to examine how internalizing and externalizing behaviors differ between autistic children (3-6 years of age) with parent-reported picky eating (n = 80) and without picky eating (n = 30). Data was drawn from intake paperwork and assessments completed as part of an autism diagnostic evaluation at a large medical center. Results suggested that picky eaters, when compared to non-picky eaters, had significantly more difficulties with aggression and withdrawal. Our study findings suggest that understanding the behavioral profiles associated with picky eating may be particularly useful when devising treatment plans. Furthermore, diagnosticians who may be the first to gather both eating and behavioral symptom data can initiate referrals to feeding specialists to help prevent some of the negative health consequences associated with these eating behaviors.Lay AbstractMany autistic children have trouble with eating (e.g. not eating a wide variety of foods) which can lead to later health issues. While there are many factors that are thought to relate to these eating issues, one factor we know less about are internalizing behaviors, or being worried, anxious, or sad, and externalizing behaviors, or issues with attending to a task or aggressive behaviors. In this study, we looked at differences in externalizing and internalizing behaviors in autistic children, who were 3-6 years of age, with picky eating (80 children with picky eating) and without picky eating (30 children without picky eating). Our results suggested that autistic children with picky eating had more issues with an externalizing and an internalizing behavior than autistic children without picky eating. Our findings are important because both externalizing and internalizing behaviors are likely important factors to consider when supporting an autistic child with eating difficulties and their family. Practitioners who diagnose autism may also be the first to gather both eating and behavioral information and may help to refer the child to a feeding specialist to prevent later issues.