Disordered Eating and Related Dietary Trends Among Individuals with Neurodevelopmental Disorders: A Comprehensive Review and Considerations for Practice
Lauren Jones, MPH
2025 Capstone Project
About the Author: Lauren Jones earned her Bachelor of Science in Dietetics, Nutrition and Food Sciences from the University of Vermont in 2019, received her Master of Public Health in Community Health Sciences from the University of California, Los Angeles (UCLA) in 2021, and is currently completing a Master of Science in Nutritional Science from the University of Southern California (USC) Leonard Davis School of Gerontology. During her studies, she found a passion for integrating research and patient care to promote the health and well-being of individuals and communities. Following graduation in May 2025, Lauren will be beginning a Dietetic Internship with Children’s Hospital Los Angeles to further her goals of becoming a Registered Dietitian.
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Neurodevelopmental disabilities (NDDs) are defined in the DSM-5 as a diagnostic class of conditions that includes intellectual disability (ID), autism spectrum disorder (autism/ASD), and attention-deficit/hyperactivity disorder (ADHD).1 Most of the current literature on individuals with NDDs focuses on autism and ADHD in childhood, despite these conditions being chronic, lifelong disorders with symptoms commonly persisting into adulthood.2 As such, despite research focusing heavily on younger populations, it is important to consider practical management strategies to assist these populations with lifelong skills development and treatment strategies. For ADHD and autism in particular, individuals with these conditions may experience nutrient deficiencies and feeding difficulties that impact health and longevity and provide a lifelong challenge to obtaining adequate nutrition.2–4
Nutrition considerations for individuals with autism are increasingly important due to co-occurrence rates of feeding issues, GI conditions, and other comorbidities that can contribute to a variety of health issues including, but not limited to nutrient deficiencies and poor bone development.3,5,6 Similarly, research has identified associations with ADHD and “unhealthy” dietary patterns, including increased intake of sugar-sweetened foods and reduced intake of important dietary vitamins and minerals, though the cause of the association is still unclear.7,8 However, one possible mode for this association is disordered eating behaviors, including food avoidance and restriction, that is commonly seen in populations with NDDs.6,8,9 Researchers have noted that feeding difficulties seen in these populations (including food refusal and food selectivity) are associated with reduced consumption of fruits, vegetables, calcium, and protein as well as increased consumption of processed and high-sugar/high-fat foods.4,6,10 Furthermore, research indicates that children with ADHD may have a harder time adhering to “healthy eating patterns” compared to children without ADHD, placing them at risk for potential nutrient deficiencies and other diet-related conditions as well as providing barriers to treatment and change for these populations.7
Disordered eating patterns are not only a risk factor for nutrient deficiencies and other physical health effects, but these eating patterns also pose a risk for eating disorder development later in life. One study found a correlation between ADHD and specific eating disorders, particularly bulimia nervosa and binge eating disorder.11 Another recent study found that people with eating disorders were more likely to have prior diagnoses of ADHD or autism, providing further evidence for increased risk of eating disorder development among these populations.12
Addressing food selectivity and disordered eating behaviors can be a challenge, as these habits are determined by multiple factors that vary between individuals based on texture, appearance, taste, smell, temperature, familiarity, and acceptance.6 The majority of current research on individuals with autism is heavily focused on children with many clinical interventions focusing on early interventions including the whole family unit. One such clinical trial investigated the efficacy of the Managing Eating Aversions and Limited variety (MEAL) plan as a way to expand the dietary habits of children with autism and found that the intervention had high reliability and had the potential to expand the dietary components of children with autism with moderate food selectivity, though they do note that symptom severity is important in the design and administration of dietary interventions.9 Other reviews agree with the recommendation that parent guided intervention and introduction of new foods from a young age can limit or prevent the development of severe food restrictions, but also note that more research is needed to develop recommendations regarding timing, methodology, and family education strategies for these introductions.13
Dietary intervention in these populations may have benefits beyond improving overall health and reversing possible nutrient deficiencies. Research has indicated that adherence to a “healthier” diet, like the dietary approaches to stop hypertension (DASH) diet, may improve not only overall health but has shown results in ADHD symptom management in children.8 The authors of one review further noted that elimination diets may show some assistance in alleviating ADHD symptoms compared to general “healthy eating advice.”2 This is in agreement with the findings of a 2021 trial that tested a few-foods diet on brain activity in children with ADHD via functional MRI and found that there was no relation to task effects but that there was potential influence in inhibition-related activation during stop-signal tasks, indicating a potential impact on neurocognitive pathways in these populations.14 Another review also investigated the impacts of a few-foods diet on food sensitivities in ADHD populations, however the authors note that this diet creates a large burden for individuals and their families as it involves elimination and slow re-introduction of foods that may exacerbate ADHD symptoms.2,8 The contradicting results from these two reviews show the need for additional research in this area to better understand the impact of specific interventions, such as elimination diets, on NDD symptom expression.
Even among individuals with NDDs, there may be additional considerations for marginalized populations, particularly female and LGBTQ+ populations. In recent years, new studies have been researching the gender differences between the presentation and diagnoses of NDDs, such as autism.15 For example, individuals identifying as female have reportedly higher camouflaging, behaviors used to disguise ‘atypical’ behaviors to promote social inclusion, which may influence the efficacy of early intervention in these populations.16 Emerging literature further indicates that there may be elevated rates of autism and other neurodevelopmental diagnoses among transgender and gender-diverse populations.17 This is a particularly important crossover to consider, as current literature has established that LGBTQ+ populations experience higher incidence of disordered eating and diagnosed eating disorders when compared to cisgender and heterosexual populations. 18,19 One recent study has begun investigating this intersection, and found that in evaluating pre- and post-pandemic data, individuals with multiple eating disorder diagnoses had reported increased incidence of autism, ADHD, and gender dysphoria across all age groups.20
In summary, current research still maintains individual nutrition recommendations for autism and ADHD despite overlap and diagnostic grouping within the NDD umbrella. However, there may be some overarching recommendations that both populations may benefit from. Disordered eating behaviors, including food avoidance and restriction, were a common thread in both ADHD and autism research.6,8,9 This may indicate potential risk for eating disorders and poses a barrier for nutritional interventions in these populations. Based on the success of parent-mediated interventions, it is possible that these risks and barriers can be mitigated using early intervention, but additional research on adult populations could explore potential solutions to disordered eating in these populations that is not yet outlined in the current literature.
One of the main limitations that was noted during this literature review was the lack of research that evaluated a consistent dietary intervention that could be beneficial for multiple NDDs (i.e. transdiagnostic). As this is a growing field of research, more recent clinical trials and/or observational studies are needed to evaluate targeted strategies, as much of the existing research disagrees or lacks consistency in the methodology being used. Furthermore, very few studies and reviews include research on adults with autism or ADHD, and even fewer continue to evaluate these individuals at later life stages. Even more limited still is research focused on additionally marginalized populations. Although there is a growing interest in the symptomatic and clinical presentation of women with neurodevelopmental disorders, little research has included nonbinary and transgender individuals who may have been assigned female at birth (AFAB), an inclusive term for individuals who may have sex-based risk factors that do not align with their current gender identity.21 Additional research in this area may shed necessary light on the efficacy of dietary interventions for individuals with NDDs beyond childhood and provide additional considerations for clinical practice when treating these populations.
Although current research is limited, there are still resources that dietitians and health providers can utilize to better support these populations. New validated measures, like the nine-item ARFID screen (NIAS), may provide targeted measures that are more specific than the historically used Eating Disorder Examination-Questionnaire (EDE-Q).22,23 Furthermore, programs like Equip Health have begun to adapt to unique patient needs and have built considerations into their clinical practice, including screening tools for conditions like avoidant/restrictive food intake disorder (ARFID).24 Though existing programs may be slower to incorporate considerations for individuals with NDDs, programs like the UCLA Nourish for Life Program have begun to partner with other organizations, such as the UC-LEND Clinic, that can assist with consultations and expansion of interdisciplinary and holistic care.25,26 In general, holistic, individual patient-centered approaches may see the most benefits in populations with NDDs, particularly as the research on supplementation efficacy continues to evolve.
References
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