Mealtime battles are one of the most common and least visible struggles faced by families of children with developmental disabilities. Parents of autistic children have long reported extreme pickiness, refusal of entire food groups, and distress at the dinner table, but clinicians have often lumped all developmental disabilities together when assessing nutrition. A new cross-sectional study published in the Journal of Autism and Developmental Disorders suggests that this one-size-fits-all approach may be a mistake. The research, led by Özge Esgin and colleagues at Bayburt University in Turkey, compared eating behaviours, growth measurements, and malnutrition risk across children with autism spectrum disorder and several diagnostically distinct developmental disability subgroups, and found that each group carries its own nutritional signature.
The study enrolled 220 children aged between 5 and 16 years who were attending special education and rehabilitation centres. Of these, 97 were autistic children, including 26 girls and 71 boys, while 123 had other developmental disabilities, comprising 44 girls and 79 boys. The comparison group was deliberately heterogeneous, reflecting the real-world diversity of developmental clinics: 52 children, or 42.3 percent, had Down syndrome; 58 children, or 47.2 percent, had developmental language disorder; and 13 children, or 10.6 percent, had attention-deficit/hyperactivity disorder. By including these subgroups rather than a single comparison category, the researchers were able to ask a more refined question than most previous feeding studies have attempted: does the diagnostic label itself shape how a child eats and grows?
To capture eating behaviour, the team used the Children’s Eating Behaviour Questionnaire, a well-validated parent-report instrument developed by Wardle and colleagues in 2001 and adapted into Turkish by Yılmaz and colleagues in 2011. The questionnaire measures psychometrically distinct dimensions of eating, including food fussiness, food responsiveness, slowness in eating, satiety responsiveness, and emotional overeating. Growth was assessed through standard anthropometric indicators, with height-for-age and body mass index-for-age expressed as z-scores referenced against World Health Organization growth standards for children aged 5 to 19 years. Malnutrition risk was screened using validated paediatric screening tools, an approach grounded in instruments such as STRONGkids, which has been tested in hospitalised children and in Turkish paediatric populations. This combination of behavioural questionnaires, anthropometry, and structured screening allowed the researchers to triangulate nutritional status from three independent angles.
The results revealed clear separation between the diagnostic groups. Height-for-age z-scores were significantly higher in autistic children than in children with Down syndrome and those with developmental language disorder, a difference that reached statistical significance at p equal to .01. This finding is notable because children with Down syndrome are known to follow different growth trajectories from the general paediatric population, and the study confirms that linear growth cannot be interpreted with the same reference expectations across diagnostic categories. Autistic children also scored significantly higher on food fussiness than children with Down syndrome, with p values below .05, echoing a large body of earlier work showing that food selectivity is a hallmark feeding feature of autism. Classic studies by Schreck and colleagues in 2004 and Bandini and colleagues in 2010 documented elevated food selectivity in autistic children, and meta-analytic work by Sharp and colleagues in 2013 confirmed that feeding problems and restricted nutrient intake are systematically elevated in this population.
Perhaps the most technically interesting result concerned the interaction between diagnosis and the relationship between eating behaviours and body mass index. The statistical analysis showed that the association between eating behaviours and BMI-for-age varied according to diagnostic group, with all interaction terms reaching significance at p values below .05. In plain terms, the same eating behaviour did not predict the same growth outcome in autistic children as it did in children with Down syndrome, developmental language disorder, or ADHD. A behaviour such as food responsiveness, for example, might be associated with higher body mass in one group but not in another. This kind of moderation effect is easy to miss if researchers pool children with different developmental conditions into a single category, and its presence here suggests that pooled analyses in the older literature may have obscured clinically meaningful differences.
Within the other developmental disability groups, eating behaviours also varied according to BMI-for-age categories and malnutrition risk, again with p values below .05. This indicates that the behavioural drivers of nutritional status are not uniform even among children who do not have autism. A child with developmental language disorder and a child with Down syndrome may both show elevated malnutrition risk, but the behavioural profile behind that risk may differ, and those differences matter for intervention. Screening tools that rely on generic questions about appetite and weight loss may therefore fail to detect risk in children whose eating difficulties take atypical forms, such as extreme texture selectivity, ritualised mealtime behaviour, or hypersensitivity to food smells and appearances.
Among the autistic children themselves, malnutrition risk was associated with two specific behavioural dimensions: higher food responsiveness and higher slowness in eating, both at p values below .05. Food responsiveness describes eating triggered by external food cues rather than internal hunger, while slowness in eating reflects prolonged, low-tempo consumption of meals. The link between these behaviours and malnutrition risk is mechanistically plausible. Slow eating can reduce total energy intake within the limited window of a meal, particularly when caregivers or school schedules impose time constraints, while heightened responsiveness to palatable food cues can coexist with a narrow accepted diet, producing erratic intake. Previous research by Kral and colleagues in 2015 and by Demir and Özcan in 2022 has linked child eating behaviours with caregiver feeding practices and anthropometric outcomes in autism, and the new findings extend that work by tying behaviours directly to formal malnutrition risk screening rather than to growth measures alone.
The broader context of this research is a field that has accumulated strong evidence for feeding difficulties in autism but far less comparative evidence across other developmental conditions. Systematic reviews, including the 2022 review by Page and colleagues, have catalogued correlates of feeding difficulties in autistic children, ranging from sensory sensitivity to gastrointestinal problems and behavioural rigidity. Studies by Chistol and colleagues in 2018 demonstrated that sensory sensitivity predicts food selectivity, while work by Cappellotto and Olsen in 2021 connected texture acceptance and food neophobia to sensory processing in children and their parents. Meanwhile, meta-analytic evidence from Kahathuduwa and colleagues in 2019 established that autistic children face elevated risk of overweight and obesity, complicating the simplistic assumption that picky eating inevitably leads to undernutrition. The new study adds nuance to this picture by showing that both undernutrition risk and growth patterns must be interpreted within diagnostic context.
The practical implications are significant for paediatricians, dietitians, and special education professionals. Nutritional screening in developmental clinics is often brief and generic, and children with developmental disabilities may already face barriers to routine growth monitoring because of behavioural challenges during measurement or communication difficulties during dietary assessment. The findings argue for diagnosis-informed protocols: an autistic child’s assessment should probe food fussiness, food responsiveness, and eating pace, while a child with Down syndrome may need growth interpretation adjusted for condition-specific reference patterns, and a child with ADHD may require attention to impulsivity around food. Individualised monitoring, the authors conclude, is not merely a preference but a statistical necessity, because the behavioural predictors of malnutrition risk simply do not generalise across diagnostic groups.
The study does have limitations inherent to its design. As a cross-sectional investigation, it captures a single snapshot and cannot establish whether eating behaviours cause differences in growth or malnutrition risk, or whether both emerge from shared underlying mechanisms such as sensory processing differences, medication effects, or family feeding environments. The sample was recruited from special education and rehabilitation centres, which may not represent children with milder presentations, and the data underpinning the findings are not publicly available because of participant privacy protections. Nevertheless, the core message stands out with unusual clarity: children with autism and children with other developmental disabilities are not nutritionally interchangeable. As research continues to dissect the mechanisms linking neurodevelopment, sensory processing, and eating behaviour, including recent work on screen time, sleep, and diet quality in autistic children, the clinical takeaway is already actionable. Every developmental diagnosis deserves its own nutritional lens, and the children who eat differently deserve assessments built around how they actually eat.
Subject of Research: Eating behaviours, anthropometric measures, and malnutrition risk in children with autism spectrum disorder and other developmental disabilities
Article Title: Comparison of Eating Behaviours, Anthropometric Measures, and Malnutrition Risk in Children With Autism Spectrum Disorder and Other Developmental Disabilities
Article References: Esgin, Ö., Ari-Arat, C., Yilmaz, G., & Hamitoglu, A. (2026). Comparison of Eating Behaviours, Anthropometric Measures, and Malnutrition Risk in Children With Autism Spectrum Disorder and Other Developmental Disabilities. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07560-5
Image Credits: AI Generated
DOI: 10.1007/s10803-026-07560-5
Keywords: autism spectrum disorder, eating behaviours, malnutrition risk, Down syndrome, developmental language disorder, ADHD, food fussiness, anthropometry, BMI-for-age, pediatric nutrition, food selectivity, developmental disabilities
News Source: Daisy Hatcher. (October 13, 2026). Autistic Children Show Distinct Eating Behaviours and Growth Patterns Compared With Other Developmental Disabilities. Scienmag.
