Ethics and Ecology of Nutritional Trials in Pediatric Neurodevelopmental Disorders: A Multidisciplinary Review of Dietary Interventions toward Inclusive Research for Vulnerable Children

Children and adolescents with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are at an elevated risk of nutritional inadequacy owing to feeding difficulties, sensory sensitivities, and selective eating behaviors. This review was conducted by a multidisciplinary team with expertise in nutrition, special education, and clinical research. Although dietary interventions have gained attention as potential adjuncts to behavioral and pharmacological treatments, studies remain limited by methodological, ethical, and ecological shortcomings. This systematic review examined 16 interventional studies published between 2014 and 2024 that focused on nutritional or dietary treatments for pediatric populations with ASD or ADHD. Studies were identified through structured database searches and screened based on the predefined inclusion and exclusion criteria. Each study was evaluated for design quality, ethical considerations, sample representativeness, and ecological validity. The findings reveal the widespread exclusion of children with intellectual disabilities, psychiatric comorbidities, or nonverbal communication, resulting in an underrepresentation of the most vulnerable populations. Despite the frequent use of randomized controlled trial designs, most interventions have been conducted in clinical settings with minimal incorporation of real-world environments, such as homes or schools. Ethical transparency was inconsistent, particularly regarding child-assent procedures, dropout analysis, and monitoring of participant burden. Sociodemographic data are often missing, which limits attention to the structural determinants of health. This review underscores the urgent need for more inclusive, ecologically grounded, and ethically transparent research models of pediatric nutrition.