diet is good for your health, but many people don't achieve this. Some autistic people have a restricted diet, eating only a limited range of food. Others may over-eat. Find out which problems to look out for, how to work out the cause,
general pointers, ways you can help, professionals who could help, and how to find further information.
Problems to look out for
In children, rigidity around foods is very common, not just for those on the
autism spectrum. There’s no need to be too concerned if the person is eating
foods from each of the main
food groups, and if a child, is growing well. Get advice if the person is:
accepting fewer than 20 foods
- refusing all foods from one or
more food groups
- constipated – constipation can have a huge impact on appetite and may require medication
- suffering from tooth decay as a result of their diet
- losing weight or not growing well
- gaining weight excessively
- displaying behaviour (eg tiredness or pica (eating non-edible items) that might indicate a vitamin or mineral deficiency (eg iron deficiency anaemia)
- missing school due to eating problems
- coughing and choking while eating, or has recurrent chest infections, especially if they have
developmental delay or physical disabilities
- missing out on social opportunities, eg if they and their family can rarely go out due to the
Finding the cause
Start to take note of what is eaten and when. Sometimes, a food diary can be reassuring – you may in fact see that the person eats a wider range of foods than you originally thought.
Here are some examples of what to include.
- What time of the day did they eat? – 11.05
- What did they eat? – Salt and vinegar crisps
- Where did they eat? – In the living room
- How much did they eat? – Two bags
- Who was there? – Mum, brother
- How did people around respond to the person eating the particular food? – Mum praised, brother had no reaction
- Were there any environmental factors? – Radio was on in the background
This could reveal some causes of the eating difficulties, whether over-eating or restricted eating. Try to work out whether it is the amount, type or range of food being eaten which is the core issue, and then what underlying
problems, or sensory issues, may be involved.
With any approach, it is important that you communicate in a clear, consistent and calm way.
story could help someone to understand why we eat and the function of food,
- food provides us with fuel/power, which enables us to do things we enjoy
- eating food from all the food groups gives us energy
- missing out food groups can make us tired.
Presenting information visually can also help. You could:
- produce clear daily and/or weekly menus of foods – display the time of next meal in a prominent
- provide visual tools to help the person express and recognise their needs, feelings and preferences,
such as stress scales, hunger and fullness scales, or happy/unhappy face pictures
- have a food group chart, with a rule that they must have at least one food from each group each day.
Try not to categorise foods into healthy and unhealthy, or good and bad. This can
sometimes be taken too literally and can cause further problems.
Try to be very specific when talking about food, or using pictures of food. For
example, apples look and taste different, but we call them all apples. It's possible that the person likes golden delicious apples, and dislikes braeburns, but is confused by you showing them a picture of a green apple, then bringing
them a red one.
Find out more about communication,
supports and social
Using reward systems can be effective. However, avoid using a preferred food as a
reward for trying a new or non-preferred food. It could make the preferred food
even more attractive, and the new food appear like a chore. Also, ensure the
emphasis of the reward is not just on eating a certain amount of a
non-preferred food, but on tolerating new food being around, or tasting a new
Encourage activities which involve movement and exercise. This can help with weight loss
(if that's needed) and reducing stress, which may have contributed to
over-eating or under-eating. If the person is reluctant, think about whether
there could be any underlying reasons, eg difficulty with balance, or
Read more about sensory
issues such as balance, social
skills and physical
It can be helpful to model the behaviour you're trying to encourage. This might
mean that the whole family takes part in exercise, avoids snacking between
meals, or follows a rule about eating something each day from each food group.
Ways you can help
Always speak to a GP, dietitian or other medical professional about the problems.
Below are some examples of possible underlying problems – sensory
issues, illness, food presentation, social issues, obsessions
and routines, coping strategy, volume and variety, other conditions – and things you could try to address them.
What works for one person may not work for another.
Many autistic people experience sensory
issues; being over or under-sensitive to sights, sounds, smells, tastes
and textures. This can affect a person's experience of meals and relationship
to food, and cause anxiety around
The person might find it too distracting to eat in a noisy canteen – find out if
they could eat in a quiet room instead. The chair they sit on may be too hard – add a cushion.
Playing some favourite music or a story in the background can be relaxing, distracting
the person from the usual anxiety around eating.
People who are very sensitive to smells and taste may prefer to eat quite bland food,
and may find strong food smells overpowering. Under-sensitivity to taste or
smell may mean the person prefers stronger flavours. Particular smells and
flavours may be a source of intense pleasure. Some people might find the
feeling of hard food, or sloppy food, unbearable.
had a big problem with food. I liked to eat things that were bland and
uncomplicated…I didn't want to try anything new…I was supersensitive to the
texture of food, and I had to touch everything with my fingers to see how it
felt before I could put it in my mouth."
and Baron (1992) in Attwood (1998), p.96
Try modifying food to improve the sensory experience, for example by puréeing or
using food colouring, and introduce a new food or textures in small steps, for a
First let the person just look at it, then touch it, then invite them to put the food
on their plate, then smell it, lick it, put it into their mouth, bite it, chew
it, and swallow it. Try not to react negatively to food being spat out. This is
helping them to become comfortable with different foods being in and around
These steps could take months to complete. Try to see the goal as learning about and
being comfortable around different foods, rather than getting them to eat all
of the different foods presented.
Read more about sensory
Discomfort and illness
Physical pain and discomfort can affect how a person eats. Gut pain could cause a person
to over-eat for comfort. Constipation can dampen appetite. Heartburn
can stop someone wanting to continue to eat. Toothache and mouth ulcers can
make someone reluctant to put things in their mouth. Some medication can affect
appetite (eg Ritalin) or cause stomach upsets (eg antibiotics). A bloated
intestine could cause a person to feel full when in fact they aren't.
Support the person to communicate physical pain or discomfort, eg by using a visual
stress scale, PECS (Picture
Exchange Communication System), pictures
of body parts, symbols
for symptoms, or pain
scales, pain charts
Attention to detail, and difficulty with change, is characteristic of autistic
people. The way the food is presented or positioned on the plate, or the
food's packaging, may dictate whether it is eaten or not.
Has the positioning of the food on the plate been altered? Is the food over- or
undercooked? Are there 'bits' on the food? Has the packaging changed? Is the
logo a different colour? Is the box damaged? Have you bought a different brand?
Some people eat better in the company of their family or peers. They may be more
willing to try new foods if they see other people trying the same food and
For others, the social nature of mealtimes can be stressful. They might be more
relaxed, and eat more volume or variety, if they ate alone in another room.
If a meal is not going to be at home, prepare the person in advance by telling
them who will be there, who will they be sitting with or next to, what people
might talk about, and what they could say to start a conversation.
Obsessions, special interests and routines
Many autistic people have obsessions.
If certain foods, or calorie counting, are an obsession, this could lead to
over-eating, under-eating or a rigid diet.
But obsessions, or special interests, can also prove helpful.
You could try to channel an obsession with eating, or with weight loss, into
something positive such as cooking and writing recipes. You could use a special
interest to encourage them to eat more volume or variety, eg by eating
from a Thomas the Tank Engine plate, cutting food into rocket shapes, or
exploring foods from the country or region of their favourite singer or sports
Many autistic people rely on routine and sameness. To eat
well, they may need to have meals at the same time every day, be seated in the same position at the table, or always use the same plate or cutlery.
This need for sameness could also explain a person's preference for processed foods.
Processed foods are predictable, designed to look and taste the same each time.
In contrast, there will always be natural variation in fresh food. Introduce
new foods or textures in small steps.
Read more about obsessions,
repetitive behaviours and routines.
Sometimes, what appears as an obsession is in fact a coping strategy. Some autistic people
say the world feels overwhelming and this can cause them considerable anxiety.
Some people may over-eat, or avoid food, as a result of low self-esteem or anxiety.
Try to minimise any stressful things the food diary has revealed, or encourage a different coping strategy, such as
spending time on their special interest, or using the Brain in
Hand support app.
Volume and variety
If over-eating is still a problem after looking for causes and ways to address
them, you could try:
- reducing food portions, and using a smaller plate
- showing them the empty saucepan, confirming verbally that the food has all gone
- limiting access to food by keeping it out of reach, using locks or visuals such as No Entry signs on
fridges and cupboards, or not buying it at all in the case of snack foods like crisps and chocolate
- setting rules relating to restaurants and food shops eg if you have a starter you cannot have a pudding
- creating a food timetable, eg snacks at 10am, 3pm and 7pm, reducing the amount of food intake gradually
- providing visual hunger and fullness scales to help with expressing and recognising cues.
If under-eating is still a problem, you could try:
increasing food portions, and using a bigger plate
- increasing the person's contact with food – making simple things such as sandwiches, fruit kebabs, little cakes or pizzas – to encourage positive associations
- providing visual hunger and fullness scales to help with expressing and recognising cues
- introducing a food book – place pictures or drawings of foods that the person likes in the front of the book, and those they don't at the back. As they try new food and expand their diet, the pictures can be gradually moved forward in the book.
Eating can be affected by a delay in physical development or low muscle tone. You could encourage activities that help to develop mouth and jaw movement such as using straws, blowing a whistle,
blowing bubbles or using a toothbrush.
Some people over-eat because they aren't able to know when they are full. This is a
symptom of Prada-Willi
syndrome, a rare genetic condition.
Professionals who could help
Your GP might refer you to one or more of the following professionals or
Dentist: eating difficulties may
result in, or be affected by, poor dental hygiene management or toothache.
- Dietitian: they offer assessment and treatment of dietary related health problems such as constipation, allergies and intolerances as well as practical advice on eating problems, weight gain and weight loss. Ask your GP or consultant to refer you to an NHS dietitian or find a private dietitian and visit Paediatric Autism, a specialist sub-group of the British Dietetic Association.
- Eating disorder clinic.
- Clinical psychologist or psychiatrist: if the problem is thought to be psychological, these
professionals can help with cognitive and behaviour strategies.
- Paediatrician: experts in child health issues who can help provide solutions to dietary issues and
investigate underlying problems.
- Occupational therapist (OT): may be able to offer advice on how you manage the situation at home. Find
an occupational therapist with autism experience, and other OTs in private practice.
- Speech and language therapist (SALT): can advise on feeding issues and swallowing
problems (dysphagia). Find a speech and language therapist with autism experience, and other SALTS in private practice.
- Counsellor: trained to talk through a variety of issues. Find a counsellor with autism experience.
Our Specialist Behaviour Advice
autism and sensory experience online training module
Our Online Community
Our Parent 2 Parent services
Can't eat won't eat:
dietary difficulties and autistic spectrum disorders,
Brenda Legge (2002).
The Eatwell Guide (NHS)
chaining - The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems,
and Expand Your Child's Diet
, Cheri Fraker (2007)
Food…fun, healthy and safe, Books Beyond Words
are grateful to Zoe
, member of Paediatric
, for her advice on this page.
reviewed 26 July 2016