Food Selectivity in Neurodevelopmental Conditions: Sensory Mechanisms, Mental Health, and Clinical Implications

Food selectivity and eating difficulties are common among autistic individuals and those with ADHD, yet they are frequently mischaracterized in clinical settings as behavioral noncompliance, lifestyle choice, or transient developmental concerns. A growing peer-reviewed literature instead demonstrates that these eating patterns are sensory-mediated, persistent across the lifespan, and closely intertwined with mental health, including anxiety, eating disorder vulnerability, and compulsive coping strategies.

This post synthesizes key clinical insights from the literature and highlights an important diagnostic gap related to dyslexia.

Sensory processing as a central clinical mechanism

Multiple studies have established sensory processing differences as a primary contributor to eating difficulties in autism.

Nadon et al. (2011) demonstrated a strong association between atypical sensory processing and eating problems in children with autism spectrum disorders. Tactile and oral sensory sensitivities were particularly predictive of food refusal and restricted dietary variety. These findings indicate that eating difficulties are rooted in how sensory input is processed rather than oppositional behavior, parental practices, or lack of motivation.

Similarly, Cermak, Curtin, and Bandini (2010) found that food selectivity was significantly associated with sensory sensitivity—especially to texture, taste, and smell. Children with greater sensory sensitivity consumed a more limited range of foods, reinforcing the clinical relevance of sensory modulation profiles in feeding assessments.

From a clinical perspective, these findings support routine inclusion of sensory processing evaluation when assessing eating difficulties in neurodevelopmental populations.

Perceptual meaning and clinical misinterpretation

Clinical assessment often prioritizes nutritional adequacy or behavioral presentation, which may obscure underlying perceptual drivers.

Strand (2021) offers a critical interdisciplinary perspective, demonstrating how food characteristics such as colour, visual uniformity, and symbolic meaning influence food acceptance in autism and eating disorder populations. This work cautions clinicians against assuming that food restriction necessarily reflects weight or shape concerns, highlighting instead the role of perceptual coherence and sensory meaning.

Clinically, this distinction is essential. Sensory-based avoidance can closely resemble restrictive eating disorders in presentation while arising from fundamentally different mechanisms.

Persistence into adulthood and the role of ADHD

The assumption that food selectivity resolves with age is not supported by recent evidence.

Bayoumi et al. (2025) examined food selectivity and eating difficulties in adults with autism, ADHD, or both. Published in Autism, the study found that eating difficulties frequently persist into adulthood and remain primarily driven by sensory characteristics. Individuals with co-occurring autism and ADHD reported greater severity of eating-related challenges than those with a single diagnosis.

For clinicians, these findings underscore the importance of adult-focused assessment and caution against dismissing eating concerns as residual childhood patterns.

Mental health, eating disorders, and addictive or compulsive patterns

Although food selectivity itself is not an eating disorder, the literature highlights meaningful intersections with mental health.

Across studies, persistent eating difficulties are associated with:

• Elevated anxiety around meals, novelty, and social eating contexts

• Heightened stress related to predictability and sensory control

• Increased shame and self-blame due to social misunderstanding

Strand (2021) emphasizes that when sensory-based food avoidance is interpreted through traditional eating disorder frameworks without adequate sensory context, individuals may be misdiagnosed or experience exacerbated psychological distress.

Bayoumi et al. (2025) further suggest that in adults with autism and/or ADHD, rigid food routines or reliance on particular “safe” foods may function as self-regulatory strategies. These patterns can externally resemble compulsive or addictive behaviors, yet serve to reduce sensory overload and emotional dysregulation rather than reinforce reward-seeking or weight-control motives.

Clinically, failure to differentiate sensory regulation from pathology may lead to:

• Inappropriate treatment recommendations

• Increased distress or treatment nonadherence

• Erosion of therapeutic alliance

A sensory-informed formulation is therefore critical when evaluating eating behavior alongside anxiety, eating disorders, or substance use concerns.

The dyslexia gap in clinical research and practice

Despite high rates of co-occurrence, dyslexia is absent mainly from peer-reviewed research on food selectivity and eating difficulties.

This omission is clinically relevant given shared features across neurodevelopmental conditions, including:

• Executive functioning and sequencing demands

• Cognitive load during meal planning and preparation

• Sensory integration differences

In practice, dyslexic individuals may present with eating-related stress linked to planning, instruction-following, or cognitive fatigue rather than sensory aversion alone. However, the lack of targeted research limits evidence-based guidance and risks under-recognition in clinical settings.

Clinical takeaways

The current evidence base supports several key clinical considerations:

• Food selectivity in autism and ADHD is sensory-mediated, not behavioral

• These patterns often persist into adulthood

• Eating difficulties intersect with mental health, eating disorder vulnerability, and compulsive coping strategies.

• Dyslexia remains underrepresented in both research and clinical conceptualization.s

A neurodiversity-affirming, sensory-informed approach is essential for accurate assessment and effective intervention.

References

• Nadon G, Feldman DE, Dunn W, Gisel E. (2011). Association of sensory processing and eating problems in children with autism spectrum disorders. Autism Research and Treatment, 2011, 541926. https://doi.org/10.1155/2011/541926

• Cermak SA, Curtin C, Bandini LG. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246. https://doi.org/10.1016/j.jada.2009.10.032

• Strand M. (2021). Eggs, sugar, grated bones: colour-based food preferences in autism, eating disorders, and beyond. Medical Humanities, 47(1), 87–94. https://doi.org/10.1136/medhum-2019-011811

• Bayoumi SC, Halkett A, Miller M, Hinshaw SP. (2025). Food selectivity and eating difficulties in adults with autism and/or ADHD. Autism, 29(6), 1497–1509. https://doi.org/10.1177/13623613251314223