Pica, avoidant restrictive food intake disorder and rumination disorder in children and adolescents with autism spectrum disorder: A systematic review.

Abstract

Background: Children with autism spectrum disorder (ASD) have an increased risk of co-occurring eating disorders such as pica, avoidant restrictive food intake disorder (ARFID) and rumination disorder (RD). The aim of the current systematic review was to synthesize and appraise the existing literature of pica, ARFID and RD in children with ASD regarding occurrence, diagnostic assessment, clinical pathways, intervention and the quantity and design of the included studies.

Methods: We conducted a systematic review in accordance with the PRISMA guidelines. MEDLINE, Embase, Cochrane, CINAHL and PsycINFO were searched up to January 12th, 2026. Inclusion criteria were peer reviewed studies in English, age < 18 years, sample of n ≥3 and diagnoses according to DSM-IV/DSM-5, or ICD-9/ICD-10 or the upcoming ICD-11. Eating disorders describing ARFID symptoms or ARFID phenotypes without a formal diagnosis were excluded.

Results: The search strategy resulted in a total of 8,678 potentially eligible articles, of which 23 fulfilled inclusion criteria. Ten studies examined comorbid ASD and ARFID, twelve ASD and pica and one ASD and rumination disorder. The included studies indicated an increased risk of pica and ARFID in children with ASD, with potentially severe adverse outcomes appearing responsive to early detection and intervention. RD may still be underrecognized and understudied in ASD.

Conclusions: This study confirms a substantial co-occurrence of ASD and eating disorders in which concerns regarding weight and body shape are not the primary drivers. However, there is a scarcity of studies, and the studies have small cohorts and lack standardized diagnostic assessment and treatment. Early detection of these eating disorders may improve clinical outcome.