Association Between Autism-Related Symptoms and Mealtime Behavior Problems in Children With Autism Spectrum Disorders.
One in three baby siblings of kids with autism already shows extra autism signs and mealtime trouble by age three.
01Research in Context
What this study did
Zhang et al. (2026) watched toddlers who have an older brother or sister with autism. These kids do not have an ASD diagnosis themselves.
The team gave each toddler the ADOS and a mealtime checklist. They also asked parents about daily living skills.
What they found
One out of every three high-risk toddlers already showed extra autism signs at age three. These same children also had more trouble at meals.
The kids scored lower on everyday skills like using a spoon or sitting through dinner.
How this fits with other research
Schwichtenberg et al. (2013) saw the same group years earlier. They found more anxiety, aggression, and sleep trouble in preschool. Jiao et al. now show the issues start even younger and show up at the table.
Boudreau et al. (2015) used a parent form called POEMS and spotted early signs from 12 months. The new study adds ADOS scores and real mealtime data, so the picture is clearer.
Ellingsen et al. (2014) worked only with children who already have ASD. They linked feeding problems to repetitive and sensory behaviors, not social ones. Jiao et al. look at high-risk toddlers without ASD and still find mealtime links, hinting the feeding issue may come before full ASD.
Why it matters
If you work with families who have one child with autism, screen the baby siblings early. Watch how they eat, not just how they play. Simple mealtime checklists can flag broader autism traits before preschool. Start brief parent coaching on sitting, tasting new food, and using utensils. Early help may ease later stress for the whole family.
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02At a glance
03Original abstract
We characterized developmental outcomes of a large sample of siblings at familial high-risk of autism spectrum disorder (ASD), who themselves did not have ASD (n = 859), and low-risk controls with no family history of ASD (n = 473). We report outcomes at age 3 years using the Mullen Scales of Early Learning, the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview-Revised (ADI-R) and adaptive functioning on the Vineland Adaptive Behavior Scales. Around 11% of high-risk siblings had mild-to-moderate levels of developmental delay, a rate higher than the low-risk controls. The groups did not differ in the proportion of toddlers with mild-to-moderate language delay. Thirty percent of high-risk siblings had elevated scores on the ADOS, double the rate seen in the low-risk controls. High-risk siblings also had higher parent reported levels of ASD symptoms on the ADI-R and lower adaptive functioning on the Vineland. Males were more likely to show higher levels of ASD symptoms and lower levels of developmental ability and adaptive behavior than females across most measures but not mild-to-moderate language delay. Lower maternal education was associated with lower developmental and adaptive behavior outcomes. These findings are evidence for early emerging characteristics related to the "broader autism phenotype" (BAP) previously described in older family members of individuals with ASD. There is a need for ongoing clinical monitoring of high-risk siblings who do not have an ASD by age 3 years, as well as continued follow-up into school age to determine their developmental and behavioral outcomes. Autism Res 2017, 10: 169-178. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
Journal of autism and developmental disorders, 2026 · doi:10.1542/peds.2014-3667C