Eating and sleep

Autistic children have more feeding problems than other children. A meta-analysis of 17 studies with comparison groups found the odds about five times higher, and autistic children took in less calcium and protein.¹ A 2026 review of 46 studies, 17 of them pooled, which may share some studies with the first, found mealtime behavior problems more frequent and more severe in autistic children on one widely used mealtime scale, with a wide margin of uncertainty.²

Selective eating often continues past childhood. In one small follow-up of 18 autistic children from about age 7 to 13, food refusal eased, but the number of different foods they ate did not grow.⁴⁰ In one preliminary study, 65 autistic adolescents and young adults without intellectual disability said they preferred familiar foods and disliked particular textures and strong flavors.³ In a survey of 961 adults who reported their own diagnoses, autistic adults, with or without ADHD, reported more eating difficulties than adults with ADHD alone or neither, although only 69 of the adults had neither condition. Adults with ADHD alone also reported more than those with neither, and both autistic adults and adults with ADHD found it harder to tell when they were hungry or full.⁴ A separate study of 106 autistic adults without intellectual disability found higher scores both on a scale of eating-disorder symptoms and on a scale of eating patterns common in autism.⁵

The senses are part of the picture. Across the studies in the 2026 meta-analysis, sensory processing differences and feeding difficulties in children were moderately correlated, and touch showed the largest sensory difference.² Among 53 autistic children aged 3 to 11, those with atypical sensitivity in the mouth refused more foods and ate fewer vegetables.⁶ In the adult survey, food selectivity went with sensory sensitivity and with a strong preference for sameness.⁴ When 12 autistic adults were interviewed, they said overall that sensory and routine preferences still shaped their eating but that they had learned to adapt around them; a minority, particularly those with an eating-disorder diagnosis, felt autism made eating harder.⁷

ARFID is an eating disorder marked by avoiding or restricting food. A 2025 meta-analysis pooled 18 samples of people with ARFID (1,708 people) and estimated that about 16% were autistic; some studies counted a score above a questionnaire cut-off rather than a diagnosis. Going the other way, it estimated ARFID in about 11% of autistic groups, but that figure rests on only three studies and could lie anywhere from about 3% to 36%.⁸ A systematic review of ARFID in children and adolescents, mostly in specialist clinics, found that between 8% and 55% of those in ARFID samples were autistic.⁹ A large Swedish population study of more than 30,000 children found that those with an ARFID-like pattern were about ten times more likely to be autistic than other children (hazard ratio 9.7, 95% confidence interval 7.5 to 12.5), though it did not measure how many autistic children have ARFID.⁴⁸

A scoping review of 56 studies found that all three routes into ARFID named in the diagnostic manual appear in autistic young people: avoiding foods for sensory reasons, fear of what eating might do, and low interest in food. Sensory avoidance was the one most often described. Behavioral treatments looked feasible and possibly effective, but the review called the area under-researched.¹⁰

Autistic children also show higher rates of eating problems that are not about weight or body shape. A 2026 systematic review gathered 23 studies of children and adolescents with autism, 12 of them on pica (eating things that are not food) and one on rumination disorder (bringing food back up without effort). Across the pica studies, the share of autistic children who ate non-food items ran from about 10% to 36%, most around 10% to 14%. In one large United States preschool study the rate was higher in those who also had an intellectual disability: 28%, against 14% of autistic children without one and 3.5% of children generally.⁴⁷ Pica fell with behavioral treatment in two small studies, which cannot show what caused the change, and the review recommends screening autistic children for it. Rumination disorder rested on a single study the review found, in which 3 of 97 autistic children had it; the review says the condition may be underrecognized and mistaken for reflux.⁴⁷

People with anorexia score higher on measures of autistic traits than people without it. A 2025 meta-analysis of 22 studies (1,172 people with anorexia) found a large difference, and in pooled data 29% of children and adults with anorexia scored above the cut-off on a standard autism assessment, a threshold rather than a diagnosis.¹¹ An earlier meta-analysis of seven studies using a self-report questionnaire found the same direction; its studies probably overlap with the later one.¹² A 2013 systematic review of eight studies found higher rates of autism in eating-disorder groups than in comparison groups.¹³ Higher autistic traits went, modestly, with more severe eating-disorder symptoms.¹¹

In one Swedish community study that followed people with teenage-onset anorexia into their early thirties, 16 of them (32%) met autism criteria at least once, and this group had the poorest outcomes. Only six were diagnosed at all four assessments, which included looking back at childhood, and the authors suggest the group may be the extreme of features found more widely in anorexia.¹⁴ A Danish national register study found autism more common in people with anorexia and in their relatives, but the raised risk did not differ from that for depression or for psychiatric diagnoses in general, so the link may not be specific to autism.¹⁵ In a UK birth cohort of 5,381 children, those with disordered eating behaviors at 14 (fasting, purging, dieting or binge eating, not anorexia as such) had about 20% higher scores for autistic social traits, as reported by their mothers, from age 7 onwards.¹⁶

A 2025 commentary on two systematic reviews judged the evidence for raised autistic traits in anorexia to be converging, and the evidence for a raised rate of diagnosed autism less robust.¹⁷ Studies of younger people, and studies using parents' reports, have found lower rates than the earlier adult studies.¹⁸ Most of the evidence comes from clinical samples of girls and women, and many studies used questionnaires or cut-off scores rather than full diagnostic assessments.^11,18

The evidence points both ways. In one study of girls and women aged 12 to 30, those with anorexia and those who had recovered generally scored between autistic women and women with neither condition, though they matched the autistic group on repetitive behaviors and narrow interests. The authors suggest the scores may mix effects of the illness with lifelong traits; the anorexia groups had no full autism assessment, so some may have been undiagnosed autistic women.¹⁹ On the other side, the UK birth cohort found autistic social traits raised from age 7, years before the disordered eating, and its authors suggest the traits could come first.¹⁶ A meta-analysis found that some thinking styles also seen in autism, such as less flexible switching between tasks and focusing on detail over the whole, were more marked in people who had been ill longer. The authors could not say whether these traits prolong the illness or result from it.²⁰

Treatment experiences differ. A 2025 review found that autistic people, and people with high autistic traits, reported poorer experiences of eating-disorder treatment and may be more likely to be treated as inpatients, and for longer. Their eating-disorder symptoms and weight improved about as much as other patients', but few studies measured this, and most were of people with high traits rather than a diagnosis.²¹ A 2022 review found one adapted treatment pathway, PEACE in London, with early evidence of lower costs and favorable outcomes; the review and the pathway come from the same research group.²² PEACE's changes included a sensory box with weighted blankets and ear defenders.²³

Sleep problems are common in autistic children. A 2026 meta-analysis of 22 studies (3,771 children and adolescents), designed mainly to look for factors linked to poor sleep and with no comparison group, put the pooled rate of sleep disorders at 60%.²⁵ In one population-based California study of 2- to 5-year-olds, parents reported at least one frequent sleep problem in 53% of autistic children, 46% of children with other developmental delays and 32% of typically developing children.²⁴ On objective measures, autistic children and adolescents who had never taken medication took longer to fall asleep, slept less efficiently and slept less overall than typically developing peers, and the size of some of these differences varied with age, sex and intellectual disability, and the authors flagged possible publication bias.²⁶

A meta-analysis of studies that counted only confirmed clinical diagnoses pooled sleep-wake disorders in autistic people at about 13%, with very large differences between studies.²⁷

The same difference shows up in adulthood. A meta-analysis of studies in autistic adults found worse sleep than in comparison groups on most self-reported and objective measures, including a longer time to fall asleep and more time awake after first falling asleep.²⁸ A 2026 cohort asked 265 autistic and 167 age- and gender-matched non-autistic adults, aged 40 to 93, about their sleep. The autistic group reported worse sleep in every area the questionnaire covers, and 77% scored above the cut-off for poor sleep against 39% of the non-autistic group; within the autistic group, the women reported the most difficulty. The gap held after accounting for age and for symptoms of anxiety, depression and PTSD. The study measured everyone once, so it shows that poorer sleep and being autistic go together in this age group, not which comes first.⁴²

Melatonin is a hormone the body makes in the evening, and it is also sold as a medicine or supplement. A 2011 meta-analysis of five placebo-controlled crossover trials in autistic children found that, compared with placebo, children slept about 44 minutes longer and fell asleep about 39 minutes sooner, with results varying between trials. Night waking did not improve, and side effects were minimal.²⁹ A 2019 meta-analysis of 13 trials in children with a range of neurodevelopmental conditions found about 30 minutes more sleep in parents' diaries, with results that varied widely between trials. All but one trial was at high or unclear risk of bias. In that one, the difference was 13 minutes and not statistically significant before adjusting for how children slept at the start, and 22 minutes after. Benefit may be greatest in autistic children, but the authors said to read this with caution.³⁰

In a 2017 trial, 125 children and adolescents aged 2 to 17 (almost all autistic) whose sleep had not improved with behavioral approaches took a prolonged-release form or a placebo for 13 weeks. By caregivers' diaries, those on melatonin slept about half an hour longer than those on placebo and fell asleep sooner; daytime sleepiness was more common. The trial and its follow-up included authors from the company that makes the product, which also supported the follow-up.^31,32 In a two-year follow-up of 80 of these children, with no comparison group, the gains held, and growth and puberty stayed within normal ranges for age. Sleep worsened during a two-week switch to placebo at the end, though it stayed better than before treatment.³²

Supplements vary. When 31 melatonin supplements sold in Canada were tested, in a study not specific to autism, the amount of melatonin ranged from 83% below to 478% above the label, and more than seven in ten missed the label by more than 10%. Eight of the 31 also contained serotonin.³³ No placebo-controlled trial of melatonin in autistic adults was found as of October 2026.

A 2025 review notes that cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia disorder in adults.⁴⁴ The first randomized trial of a version adapted for autistic adults tested i-Sleep Autism, a five-week guided self-help program delivered online. It assigned 163 autistic adults with at least sub-threshold insomnia symptoms (a score of 10 or more on the Insomnia Severity Index) at random to the program (82 people) or to a waiting list that received written information and sleep-hygiene advice (81 people).⁴³ By the end of treatment, insomnia was less severe in the program group, a large difference (d = 1.02, 95% confidence interval 0.65 to 1.40), and 38% of that group, against 11% of the waiting list, improved enough to count as a meaningful change. The benefit was still there six months later, and the program group also reported less pre-sleep arousal and a better quality of life. The program did not change anxiety, depression or daily functioning, and about half the group did not finish all five modules.⁴³

The research base around it is thin. A 2025 systematic review of CBT-I in neurodevelopmental conditions, autism and ADHD among them, found eight studies with 598 people taking part, only three of them in adults, which together included just 37 people; two of the eight were randomized and six measured people before and after treatment. Together they suggested short-term benefit, but the results were inconsistent, most were not maintained at follow-up, and the studies were rated only moderate in quality because of small samples, a lack of blinding and departures from the treatment as planned.⁴⁴ A 2026 article in the journal Sleep, by Amanda Richdale and Eric Morris, frames the need in its title as high prevalence, low evidence, urgent need.⁴⁶

Autistic adults also describe trouble reaching sleep care. In a survey of 288 autistic adults in the United Kingdom, 90% had poor sleep quality, but 58% had never discussed a sleep problem with a clinician. Of those who were prescribed medication, 60% were dissatisfied with the result, and 41% wanted a non-medication option such as advice, education or a talking therapy.⁴⁵

One French research group measured a breakdown product of melatonin in urine. At night it was lower in 49 children and adolescents with autistic disorder, the narrower diagnosis used before 2013, than in 88 matched non-autistic children,³⁴ and in 43 autistic adolescents and young adults it was lower across the whole day, with a smaller difference between night and day.³⁵ A 2011 systematic review found that all nine studies that had measured melatonin or its breakdown products in autistic people reported at least one difference, seven of them lower levels.²⁹ A genetic study of 250 autistic people found two variants of the gene for a melatonin-making enzyme (ASMT) more often than in controls, and lower enzyme activity and melatonin in the autistic group's blood cells. Its authors concluded that low melatonin is a risk factor for autism, a causal claim the design cannot establish.³⁶ The 2011 review notes that such gene changes were found in only a small percentage of autistic children.²⁹ And in a small study of nine autistic children with insomnia, the peak level and timing of their own night-time melatonin were similar to published values for typically developing children.⁴¹

In 36 autistic adults without intellectual disability, more met criteria for a body-clock sleep disorder than comparison adults, especially a delayed sleep phase; work status, anxiety and depression were also associated with their sleep patterns.³⁷ A systematic review of 103 studies found later sleep timing and evening preference common in autistic children and adults, and its authors hypothesized that disrupted body clocks and autistic traits may reinforce each other.³⁸ A 2025 narrative review describes delayed sleep-wake phase as highly prevalent in autistic children.³⁹

Many autistic writers talk about "safe foods". Megan Anna Neff, a psychologist who is autistic, defines them as "those go-to foods you can eat even when sensory overload hits" and advises keeping them stocked.^c1 She treats leaning on them during stress or change as "a form of self-care", and suggests finding one nutrient-dense format a person can tolerate, smoothies in her case, while keeping safe foods on standby.^c1

Writers also describe eating the same things, or choosing in advance, as a way to save effort. Sarah and Larry Nannery describe "premade decisions", including "a few go-to choices when it comes to food and drinks", after a breakfast at which Sarah spent fifteen minutes weighing each item on the menu.^c2 The setting matters too: Sol Smith describes a client who avoids restaurants because of the sound of silverware on plates.^c3

Some writers connect their own eating disorders to autism. Devon Price describes years of restrictive eating and overexercise, from about fifteen to twenty-five, as bound up with being undiagnosed and masking.^c4 These are personal accounts; the research on anorexia is in the sections above.

Several writers describe restriction driven by control rather than body image. Carly Jones, an autistic advocate who had an eating disorder in her twenties, tells of Sasha, 19, for whom "This was not about being thin; this was about control and empowerment."^c5 Jones argues that standard treatment, with more demands and less control, "may make Autistic girls with an eating disorder worse rather than better".^c5 Daniel Burford separates two diagnoses, writing that anorexia "is about the body" while "ARFID is about the food", and says autistic women describe eating-disorder clinicians who did not believe them when they said it was not about their bodies.^c6 Luke Beardon, an autism educator, knows adults whose diagnosed eating disorder came from "autistic anxiety and the need for control" rather than body image.^c7

Others tie eating to the senses and the body. In a clinicians' guide, Donna Henderson, Sarah Wayland and Jamell White relay the account of Kim Clairy, an autistic occupational therapist who nearly died of an eating disorder: difficulty with proprioception made it hard for her to judge her body size, and her frequent movement, read as exercise to burn calories, was a way to regulate her nervous system.^c8 Mallory Cruz writes that it took time for their parents to see "that I wasn't just being a picky eater", and that the smell of eggs is "quite figuratively my kryptonite".^c9 Beardon suggests buffet or "tapas-style eating", which lets a person control what they eat and in what order.^c7

On sleep, Celeste, writing in Our Autistic Lives among contributors in their sixties, describes a fixed nightly ritual that ends in complete darkness on a tiny pillow cut from memory foam "to the perfect size"; "Sleep comes quickly."^c10 Burford treats bedding as a sensory choice too, warning noise-sensitive readers that percale "rustles more".^c11