While most picky eating is perfectly normal, some behaviors may be red flags for autism, says a new study. Here's what you need to know.

By Sally Kuzemchak, MS, RD
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Picky Eater Girl Makes Face When Offered Food
Credit: Lynn Koenig/Getty Images

Diagnosing autism as early as possible is important, so kids and families can start getting the help, treatment, and support they need. Now, new research suggests that unusual eating behaviors may be an early red flag in children—even as young as one or two years old.

Researchers from Penn State University found that unusual eating behaviors were five times more common in kids with autism than in those with other disorders like ADHD and learning disabilities—and 15 times more common than in "typical" kids. In the study of more than 2,000 children (the average age was 7), about 70 percent of kids with autism had atypical eating behaviors, compared with just 13 percent of kids with other disorders and only about 5 percent of typical kids. According to the researchers, atypical eating can been seen as early as the first year of life, and kids with autism can have more limited diets by as young as 15 months.

Some of the unusual eating behaviors researchers saw in kids with autism included:

Severely limited variety: Almost all parents of children with autism reported that their kids resisted trying new foods, and most had a very limited number of foods they would eat. Kids gravitated toward bland and neutral colored-foods, and some of the most commonly liked foods were grain products (like macaroni and cheese, pancakes, cereal, pizza, and PBJ) and chicken, especially nuggets. "Children with autism dislike change and desire to maintain sameness, which is evident in all their behaviors including eating," says researcher Susan Mayes, PhD, a professor of psychiatry at Penn State College of Medicine. "The usual 'autism diet' consists of grain products, such as pasta and bread, and chicken nuggets."

Hypersensitivity to food textures: Kids with autism tended to be more sensitive to foods with smooth and creamy textures (like pudding), foods that need a lot of chewing (like meat and raw veggies), and food that have lumps (like oatmeal).

Rigid brand preferences: Some children would only accept one specific brand of food, such as Kraft Macaroni and Cheese or McDonald's French fries.

Pica: In the study, pica (eating items that are not food, such as crayons, soap, and Play-Doh) was only seen in children with autism.

Other eating behaviors reported by parents: regimented mealtime rituals (such as smelling food before eating it) and demands that the food be presented in a certain way (like served on a specific plate or with foods not touching each other).

But the reality is, most kids go through bouts of picky eating--and plenty of kids make unreasonable mealtime demands. So what's different with autism? Researchers say the presence of multiple unusual behaviors was a key distinction in their research. In the study, a quarter of kids with autism who had atypical eating behaviors had three or more of these eating behaviors (none of the other kids had that number). Another difference: Many children with garden variety picky eating tend to eventually add new foods and textures, whereas children with autism may not--and these behaviors may continue through adolescence and young adulthood.

Researchers say that these eating behaviors, especially in conjunction with language, social, or sensory difficulties, are a clue to parents and health care providers that an autism evaluation should be considered--especially since early diagnosis and treatment can ultimately mean better outcomes for kids.

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. She is the author of The 101 Healthiest Foods For Kids. She also collaborated with Cooking Light on Dinnertime Survival Guide, a cookbook for busy families. You can follow her on Facebook, Twitter, Pinterest, and Instagram. In her spare time, she loads and unloads the dishwasher. And then loads it again.