Early-Life Feeding Behavior and Sensory Processing in Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Autism Spectrum Disorder (ASD) affects around 2.8% of the population, yet early diagnosis remains challenging and may delay beneficial interventions. Atypical sensory processing and feeding difficulties are frequently reported in ASD and have been discussed as early behavioral correlates. We conducted a systematic review and meta-analysis to examine associations between these features and to delineate behavioral patterns that may support early developmental assessment.

Studies published until November 15, 2023, were included if they assessed feeding behavior alongside sensory processing or multisensory integration. Articles without original data were excluded. Risk of bias was evaluated using the QUIPS tool, and the protocol was registered in PROSPERO (CRD42023483136). We searched PubMed, Cochrane, Embase, and Scopus. For continuous outcomes, we calculated mean differences (MDs), standardized mean differences (SMDs) and pooled correlation coefficients.

A total of 46 studies met the inclusion criteria, of which 17 contributed to meta-analysis. Children with ASD showed more frequent and severe mealtime behavioral problems than neurotypical peers, with a large difference in BAMBI total scores (SMD = 1.41, 95% CI [0.53, 2.30]). Sensory differences were most pronounced in the tactile domain (SMD = -1.80, 95% CI [-2.52, -1.08]), also evident in taste-smell, visual, and auditory modalities. A moderate correlation was found between sensory processing and feeding difficulties (|r|=0.47, 95% CI [-0.55, -0.44]).

Our findings demonstrate robust cross-sectional associations between sensory processing differences and feeding difficulties in children with ASD, outlining a clinically relevant behavioral pattern that may guide early developmental assessment and complement existing ASD screening recommendations.