Selettività alimentare e autismo: una revisione sistematica sul legame tra sensorialità e comportamento alimentare

Methods in brief

The authors analyzed 222 articles from PubMed, Web of Science, and EBSCO, selecting 9 studies that met rigorous methodological quality criteria.
The children involved had a confirmed ASD diagnosis through DSM-5, ICD-10, or standardized assessment tools (e.g., ADOS, ADI-R, CARS).

Food selectivity: nature and prevalence

Five studies examined how much and how food selectivity is present in children on the spectrum.
The results show that:

• the consistency, appearance, color, and smell of food are among the main factors for refusal;

• ASD children prefer simple and predictable foods (rice, pasta, cereals);

• they consume less fruit and vegetables, resulting in a risk of vitamin and mineral deficiencies;

• the severity of selectivity tends to decrease with age, while maintaining persistent characteristics of food rigidity.

An interesting finding: autism scores increase proportionally with the consumption of starchy foods and decrease with a more varied and vegetable-rich diet — a sign of the link between behavioral profile and food choices.

Sensory processing and relationship with food

Two included studies investigated the role of sensory hypersensitivity in eating behaviors.
ASD children show a greater reactivity to tactile, olfactory, and gustatory stimuli, showing difficulty tolerating textures, flavors, and temperatures.
Although overall nutritional status did not differ significantly from neurotypical peers, food preferences were much more limited, with a restricted and monotonous repertoire.

Problematic behaviors during meals

Two other studies (Spain and India) analyzed table behavior.
ASD children showed:

• food refusal and poor variety;

• disruptive or oppositional behaviors (need for attention to eat, rigid rituals);

• low response to satiety and reduced pleasure in eating.

The review also highlights a double risk: underweight and nutritional deficiencies in some children, but also overweight or obesity in others, linked to monotonous and high-calorie diets.

Interpretation and clinical implications

The data reveal a clear common thread: food selectivity is not a "whim," but a complex neuro-sensory and behavioral response, often amplified by negative experiences at the table or attempts to force feeding.

The authors propose an integrated approach that includes:

• assessment of the individual sensory profile;

• strategies for gradual desensitization (exploration, play, food manipulation);

• multidisciplinary support (nutritionist, occupational therapist, psychologist);

• parental education to reduce anxiety, expectations, and stress during meals.

Limits of the review

• Small number of available studies and strong methodological heterogeneity.

• Small samples and lack of longitudinal studies.

• Little investigation into the interaction between gut microbiota, sensory processing, and eating behavior, which represents a promising frontier for future research.

Take-home message

• Food selectivity is common in autistic children and reflects neurobiological and sensory differences.

• Textures, smells, and colors profoundly influence food acceptance.

• It is essential to avoid forcing and promote a predictable and calm environment.

• Collaboration between professionals and families is fundamental to improve the quality of nutrition and reduce stress at the table.

• Interventions that take into account individual sensory characteristics show greater long-term effectiveness.