Dr Elizabeth Shea is a Consultant Clinical Psychologist who has worked with autistic and neurodivergent individuals with eating challenges for 25 years. She specialises in the understanding and management of Avoidant and Restrictive Food Intake Disorder (ARFID), Pica (eating of non-foods) and Rumination Disorder. Her work has featured several times on the BBC and ITV and is the subject of three books. Dr Shea has held several senior NHS positions and regularly works with statutory, voluntary and community sector enterprises including as Advisor to the National Autistic Society (NAS) on eating challenges.   

George is 14; he eats teddy bear crisps, chicken nuggets, fries and a few types of biscuit. James is five; he drinks supplement milk and only eats the filling from a specific brand of chocolate cake. Both George and James are autistic, and both have ‘ARFID’, or avoidant and restrictive food intake disorder (APA, 2013). This article explores eating challenges in autism, including ARFID, and gives ideas for management and sources of support.

If you are living or working with a young autistic person like George or James, or are an autistic adult with eating challenges, then you are not alone. Many autistic or neurodivergent people describe one or more difficulties with foods and eating (Leader et al., 2020). These include:

• repeatedly eating a very small number of ‘safe’ or trusted foods  
• foods must feel, smell, taste and look exactly right, including the packaging
• having very strong disgust and contamination (foods touching) responses
• not noticing the signs of hunger, thirst or fullness
• feeling anxious about eating, including new or unfamiliar foods
• needing routines or rituals around foods or mealtimes.

Many of these difficulties result in a restrictive and avoidant eating pattern, or one that contains a very small range of foods, with many foods or whole food groups avoided completely. For some autistic people, there are other eating issues too; for example, eating non-food items, known as ‘pica’, or developing a serious eating disorder where there is significant weight loss, such as anorexia nervosa. These conditions typically require professional support; for more information, see the sources listed below and this article.
 

Why do eating challenges occur in autism?

Research suggests that eating challenges are linked to the traits and experience of autism and neurodivergence (Cobbaert and Rose, 2023). For example, autistic people may have:

• sensory processing differences, eg high sensitivity to the look, feel, smell and taste of foods and reduced ‘interoceptive’ (how we feel inside our bodies) awareness of hunger, thirst and fullness 
• cognitive or information processing differences, eg eating the same foods or having fixed routines and rituals at mealtimes
• higher levels of anxiety, eg for new/unfamiliar foods or in social occasions involving food.

These traits mean an autistic person may be more likely to develop an issue with food or eating than other people. For example, Sader and colleagues found approximately 16% of people with ARFID are also autistic (Sader et al., 2025), with my clinical experience suggesting it may even be higher.

In addition, many autistic or neurodivergent people experience a high drive for autonomy or sense of control over their environment and may find everyday demands difficult and anxiety-provoking. This is sometimes called ‘demand avoidance’ and can really impact eating; can you think of another demand that happens so often as eating?

Unfortunately, having difficulties with eating can cause significant health, wellbeing, educational or work impacts; although, the label of ARFID may be helpful here in highlighting these and signposting to the right help.

Exploring ARFID

ARFID affects non-autistic people as well as autistic individuals and frequently presents in very similar ways across both groups, although some of the signs and symptoms may be heightened in autism. Here are some signs of ARFID to look out for:

• a lack of interest in eating, eg not being hungry, not enjoying food
• avoiding or choosing foods due to the way they look, feel, smell and taste
• a fear about eating, eg worries about choking, vomiting or other anxiety.

In addition, to get a diagnosis of ARFID, there must be evidence of significant health or psycho-social impacts, for example:

• weight loss or growth problems  
• nutritional deficiencies, eg lack of vitamins and minerals 
• requiring supplemental or tube feeding 
• psycho-social, eg not eating outside of home or avoiding social situations. 

In my experience, understanding and, if appropriate, labelling the eating pattern as ARFID really helps a lot of autistic people. This is because it highlights that it is not the fault of that person or their family and that their eating issue is significant and requires support.