The research team, led by Krisztina Szalkay and Kinga Farkas of Semmelweis University in Budapest, set out to answer a question that has long hovered at the edge of autism research: could the way autistic children eat, and the way they sense the world, form a recognizable early behavioral pattern that clinicians could use to spot children who need closer developmental follow-up? With autism now affecting roughly 2.8 percent of children, or about 1 in 36 eight-year-olds in the United States, and with diagnosis often arriving years after symptoms first appear, the search for early, non-social behavioral correlates has taken on real urgency. Widely used screening instruments such as the M-CHAT-R/F focus almost exclusively on social communication and repetitive behaviors, leaving sensory and feeding signs largely invisible to routine surveillance.

That blind spot matters because feeding problems are extraordinarily common in autism. Previous estimates cited in the review suggest they affect between 46 and 89 percent of autistic children, compared with just 1 to 2 percent of typically developing peers. These difficulties frequently emerge between 15 and 36 months of age, a developmental window that precedes or coincides with the onset of core autism symptoms, and they can cascade into malnutrition, growth faltering, poorer academic performance, and impaired social functioning. Atypical sensory processing, formally recognized in the DSM-5 as part of the restricted and repetitive behavior domain, affects more than 70 percent of autistic children and may appear as early as six months of age, potentially before social-communication differences such as impaired joint attention become apparent.

To build their synthesis, the Hungarian team searched PubMed, Embase, Scopus, and the Cochrane Central Register through November 15, 2023, following PRISMA 2020 guidelines and registering the protocol in PROSPERO. From 11,202 articles identified by the search key, plus 1,067 more found through citation chasing, 46 studies survived screening. Most were cross-sectional, spanning participants aged 2 to 19 years, and the majority relied on parent-report questionnaires such as the BAMBI, the Child Eating Behavior Questionnaire, and the Sensory Profile family of instruments. Risk of bias was assessed with the QUIPS tool; ten studies were rated low risk, six moderate, and one high. Statistical pooling used random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment, and correlations were Fisher z-transformed before aggregation.

The meta-analytic numbers are striking. Beyond the large overall difference in mealtime behavior, the Limited Variety subscale, reflecting restricted food repertoires, showed a standardized mean difference of 1.18 across seven studies involving more than 700 children. Disruptive mealtime behaviors differed by 0.86, and food refusal showed a moderate effect of 0.70 with a clear trend toward higher refusal in autistic children, a pattern the authors suggest may reflect communication difficulties around food. On the sensory side, autistic children scored dramatically lower on the Short Sensory Profile total, with a mean difference of minus 26.03 points, indicating far more atypical behavioral and emotional responses to everyday sensory input.

When the team standardized scores across different sensory assessment tools to allow direct comparison, one modality stood out above all others: touch. Tactile sensitivity showed the largest group difference of any domain, with a standardized mean difference of minus 1.80, followed by auditory filtering at minus 1.35, sensation seeking at minus 1.23, and taste-smell sensitivity at minus 1.05. For a child who experiences the texture of a lumpy sauce or the seam of a sock as genuinely aversive, the dinner table becomes a sensory minefield, and the data suggest that this is not fussiness but a measurable neurodevelopmental profile.

Perhaps the most clinically consequential finding is the correlation itself. Across studies, the pooled association between the severity of sensory processing differences and the severity of feeding difficulties was moderate, with an absolute correlation coefficient of 0.47 and, notably, near-zero heterogeneity, suggesting the relationship is remarkably stable across study contexts. The link between taste-smell sensitivity and limited food variety was even stronger, at 0.58. Individual studies reported correlations as high as 0.63 to 0.74 between overall sensory and feeding scores, and strong associations between oral and taste-smell processing and restricted eating even when different instruments and patient selection criteria were used. Tactile processing correlated with feeding problems in the 0.29 to 0.53 range, while visual sensitivity, auditory sensitivity, and auditory filtering were also linked to overall eating difficulties.

From these data, the authors distilled five recurrent dimensions of autism-associated feeding difficulty: limited food variety, food refusal, disruptive mealtime behaviors, sensory-based eating problems such as food touch aversion and temperature sensitivity, and oral-motor challenges. They mapped these dimensions onto existing diagnostic frameworks, including the DC:0-3R and DC:0-5 developmental classification systems and the ARFID-related constructs of DSM-5 and ICD-11, offering clinicians a structured way to think about feeding presentations without inventing new diagnostic categories. The framework is explicitly descriptive and hypothesis-generating, and the authors stress it requires empirical validation in longitudinal and comparative studies before it could inform formal practice.

Caution is warranted on several fronts, and the authors are candid about the limitations. Nearly all the evidence is cross-sectional, meaning the sensory-feeding profiles are best understood as early-emerging correlates of autism rather than established predictive markers. Most samples were assessed after diagnosis, in the preschool and early school-age years, with very little data from infancy and toddlerhood. The instruments were largely developed and normed in Western populations, and most studies came from North America, Europe, or Australia, raising questions about cross-cultural generalizability. Caregiver factors such as feeding-related stress and parent-child mealtime dynamics were rarely reported, comparator groups were transdiagnostically heterogeneous, and publication bias could not be formally assessed because fewer than ten studies contributed to each meta-analysis. Substantial heterogeneity in the between-group analyses further means the pooled effect sizes should be read as distributions of study-specific effects rather than single universal values.

Feeding difficulties, moreover, are not unique to autism. Comparable sensory and feeding features appear in children with ADHD, obsessive-compulsive symptoms, Tourette syndrome, and avoidant/restrictive food intake disorder, and a recent prevalence-based meta-analysis documented substantial co-occurrence between autism and ARFID, recommending bidirectional screening in clinical settings. The authors therefore argue that feeding inventories and sensory questionnaires should function as structured prompts within routine pediatric and developmental assessments, flagging children who warrant closer neurodevelopmental evaluation, rather than as stand-alone autism screening tools. They complement, rather than replace, existing evidence-based screening recommendations. What the review delivers is a quantified, multi-modal portrait of a behavioral pattern that emerges early, persists over time, and is measurable with brief parent-report instruments already in clinical use. Confirming whether that pattern can genuinely predict autism, and whether intervening on sensory-driven feeding problems during periods of heightened neuroplasticity improves nutritional status, daily functioning, and family quality of life, will require the prospective longitudinal cohorts the authors call for, following children from infancy through childhood with both high-risk samples and community controls. Until then, the dinner table, long a site of quiet struggle, has gained new scientific significance as a window onto the developing autistic brain.

Subject of Research: The association between early-life feeding behavior and sensory processing differences in children with autism spectrum disorder

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

Article References: Szalkay, K., Gergő, D., Kói, T., Kenesei, D., Ocskay, K., Garami, M., Hegyi, P., Nagy, R., & Farkas, K. (2026). Early-Life Feeding Behavior and Sensory Processing in Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07543-6

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07543-6

Keywords: autism spectrum disorder, feeding difficulties, sensory processing, food selectivity, meta-analysis, systematic review, tactile sensitivity, taste-smell sensitivity, early detection, BAMBI, Sensory Profile, child development