Increased emotional eating behaviors in children with autism: Sex differences and links with dietary variety

Abstract

Although food selectivity and so-called “picky” eating are well documented in autism spectrum disorder, emotion-linked eating has rarely been investigated. This study examined emotion-linked over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder ( n = 190) as compared to same-age typically developing children ( n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts. Lay abstract Although “picky” eating is well documented in autism spectrum disorder, emotional eating has rarely been investigated. This study examined emotional over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder ( n = 190) as compared to same-age typically developing children ( n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts.

Problematic eating behaviours of autistic women—A scoping review

“…Recent studies have corroborated this assumption: Wallace et al. (2021) found emotional eating to be increased in autistic girls along with van't Hof et al. (2020), who discovered that autistic traits at age six in girls of the general population were predictive of increased emotional eating at a later age, an association which was found to not be the case for boys from the general population.…”

“…They proposed that the girls' behavioural rigidity and restricted range of interests was more relevant in the development and maintenance of their disordered eating habits than difficulties in sensory processing. And even though restrictive and repetitive behaviours are thought to be more common in autistic men (Wilson et al., 2016), it could be that behaviours such as having preferences for a particular food brand (i.e., behavioural rigidity) or engaging in dieting behaviour (i.e., being busy with food/not eating as a specific and restricted interest) are yet another example of how ASD manifests itself differently in high functioning autistic girls and women than in autistic males (Rynkiewicz et al., 2016; Wallace et al., 2021). It is important to further investigate the roles of sensory sensitivities and restrictive and repetitive behaviours in the development and maintenance of these eating behaviours in autistic women in future research.…”

“…Autistic girls and women might be particularly vulnerable for such behaviours, as difficulties with emotion regulation have repeatedly been found in autistic individuals (Cibralic et al, 2019;Mazefsky et al, 2014). Recent studies have corroborated this assumption: Wallace et al (2021) found emotional eating to be increased in autistic girls along with van't Hof et al (2020), who discovered that autistic traits at age six in girls of the general population were predictive of increased emotional eating at a later age, an association which was found to not be the case for boys from the general population. Wallace et al (2021) theorised emotional overeating to be a strategy of self-stimulation in autistic individuals, a repetitive and stereotyped behaviour in order to produce sensory input to cope with negative emotional or cognitive states, such as overstimulation (Zentall & Zentall, 1983) or stress (LeCompte, 1981).…”

“…These eating or feeding problems range from being very selective with regards to what they eat or refusing food intake altogether (Bandini et al., 2010), refusing to try out new foods (i.e. food neophobia) (Sun et al., 2013), eating either too much or too little (Geier et al., 2012), exhibiting both emotional over‐ and undereating (Wallace et al., 2021) or showing behavioural problems around mealtime (Curtin et al., 2015). In autistic individuals with intellectual disabilities, abnormal eating behaviours such as pica, rumination or regurgitation seem to be more prevalent than in autistic individuals without such disabilities (Brown & Stokes, 2020; Gravestock, 2000).…”

Autism and physical health across the lifespan

“…sensory sensitivities, inflexibility and insistence on sameness, motor weaknesses) can affect activity and diet. In this special issue, Wallace and colleagues (2021) found that decreased consumption of vegetables and increased consumption of sweet foods (perhaps reflecting food selectivity due to ASD-related sensory sensitivities or rigidity) was linked to emotional over-eating in children with ASD, and was higher for autistic females than autistic males. This is one of several examples in this special issue highlighting unique findings for autistic women that cannot be ignored in the study of physical health in ASD.…”