Short report: An examination of behavioral factors linked to picky eating in autistic children.
Use picky eating as a red flag for elevated aggression and withdrawal in autistic preschoolers, then rush in with feeding and behavior support.
01Research in Context
What this study did
Wallisch et al. (2026) compared autistic preschoolers whose parents said they were picky eaters with autistic peers who were not picky. They looked at aggression and withdrawal scores to see if picky eating flags bigger behavior problems. The team used a case-control design, so every picky eater was matched to a similar non-picky child for a clean comparison.
What they found
Picky eaters scored significantly higher on both aggression and withdrawal. In plain words, the picky group hit, kicked, or bit more often and also played alone or shut down more often. The gap was large enough that the authors call aggression and withdrawal part of a picky-eating behavioral phenotype in autistic preschoolers.
How this fits with other research
Islamoğlu et al. (2025) extends this picture by showing the same preschool group also faces higher ARFID risk and tummy bloating. The two studies together tell us picky eating is rarely just about food—it brings medical and psychiatric red flags.
Ellingsen et al. (2014) and Prosperi et al. (2017) found similar links years earlier. R tied feeding problems to repetitive and sensory issues, while Margherita flagged sleep, self-injury, and anxiety. Anna’s team narrows the focus to aggression and withdrawal, giving BCBAs a shorter, easier screen.
Martins et al. (2008) looks like a contradiction at first glance—they saw only tiny picky-eating differences between autistic and typical kids. The key difference is age range and design: Yolanda surveyed broad-age groups; Anna ran a tight preschool case-control. When you zoom in on very young autistic children, the behavioral split shows up clearly.
Why it matters
If a preschool client barely touches his lunch, don’t wait—score aggression and withdrawal right away. High scores mean fast-track to a feeding specialist and a behavior plan that also targets hitting or social avoidance. Picky eating becomes your early warning system for bigger needs.
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Join Free →Add a two-question parent poll: 'Does your child often hit/kick?' and 'Does your child play alone at recess?' for every autistic preschooler labeled a picky eater—if both are yes, refer to feeding team within one week.
02At a glance
03Original abstract
Eating difficulties are highly prevalent among autistic children and are linked to negative health consequences. While many mechanisms are thought to underly these behaviors, we know less about how internalizing and externalizing behaviors relate to eating difficulties in autism. The purpose of this study was to examine how internalizing and externalizing behaviors differ between autistic children (3-6 years of age) with parent-reported picky eating (n = 80) and without picky eating (n = 30). Data was drawn from intake paperwork and assessments completed as part of an autism diagnostic evaluation at a large medical center. Results suggested that picky eaters, when compared to non-picky eaters, had significantly more difficulties with aggression and withdrawal. Our study findings suggest that understanding the behavioral profiles associated with picky eating may be particularly useful when devising treatment plans. Furthermore, diagnosticians who may be the first to gather both eating and behavioral symptom data can initiate referrals to feeding specialists to help prevent some of the negative health consequences associated with these eating behaviors.Lay AbstractMany autistic children have trouble with eating (e.g. not eating a wide variety of foods) which can lead to later health issues. While there are many factors that are thought to relate to these eating issues, one factor we know less about are internalizing behaviors, or being worried, anxious, or sad, and externalizing behaviors, or issues with attending to a task or aggressive behaviors. In this study, we looked at differences in externalizing and internalizing behaviors in autistic children, who were 3-6 years of age, with picky eating (80 children with picky eating) and without picky eating (30 children without picky eating). Our results suggested that autistic children with picky eating had more issues with an externalizing and an internalizing behavior than autistic children without picky eating. Our findings are important because both externalizing and internalizing behaviors are likely important factors to consider when supporting an autistic child with eating difficulties and their family. Practitioners who diagnose autism may also be the first to gather both eating and behavioral information and may help to refer the child to a feeding specialist to prevent later issues.
Autism : the international journal of research and practice, 2026 · doi:10.1177/13623613261418948