Eating as an autistic adult: An exploratory qualitative study

Potential mechanisms underlying the association between feeding and eating disorders and autism

There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.

Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience

LAY ABSTRACT

Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.

"There's No Separating My View of My Body from My Autism": A qualitative study of positive body image in autistic individuals

While scholars have investigated positive body image across diverse populations, extant theory largely excludes those with differing socio-cognitive experiences, such as autistic individuals. Using constructivist grounded theory, this study sought to develop a grounded theory of positive body image in autistic individuals. One-to-one interviews with photo-elicitation were conducted with 20 autistic adults (7 women, 8 men, 5 non-binary/agender; aged 18-53 years) from the United Kingdom. Through a process of open, axial, and focused coding, a grounded theory was developed around a core category of positive body image in autistic adults and was found to comprise six themes: body connection, body acceptance, appreciating body functionality and neurodivergent strengths, having a body-positive protective filter, taking care of the body, and body and appearance neutrality. Our findings suggest that some aspects of positive body image in autistic individuals are consistent with those found in neurotypical adults. However, positive body image in autistic individuals further encompasses both the sensory (i.e., how the body is felt) and aesthetic (i.e., how the body is seen) body. These findings may stimulate research aimed at improving positive body image in autistic populations.

Introducing a Smart Toy in Eating Disorder Treatment: A Pilot Study

Individuals with eating disorders (EDs) often encounter challenges related to body image, emotional, and sensory difficulties during nutritional rehabilitation. To address these challenges, a novel technology-enabled smart toy, Purrble, designed for immediate assistance in emotion regulation, is being explored. A mixed-method approach involving workshops, diaries, and focus groups was employed to examine the feasibility of Purrble as a therapeutic tool and its impact on participants' daily routines, sensory experiences, and emotional states. The study results demonstrate the engagement and acceptability of this device. Qualitative analysis revealed that participants independently used and integrated Purrble into their emotional and sensory regulation practices. These pilot results support the potential for a shift in the delivery of adjunct therapeutic tools through technology, particularly for ED patients with complex presentations. Future research is necessary to further explore the psychological benefits of this intervention.

Challenges and opportunities for conceptualizing intuitive eating in autistic people

Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE's prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach. Public Significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.

The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits

Background

Avoidant restrictive food intake disorder (ARFID) is a new eating disorder with a heterogeneous clinical presentation. It is unclear which patient characteristics contribute to its heterogeneity.

Methods

To identify these patient characteristics, we performed symptom-level correlation and driver-level regression analyses in our cross-sectional study in up to 261 ARFID patients (51% female; median age = 12.7 years) who were assessed at the Maudsley Centre for Child and Adolescent Eating Disorders, London between November 2019 and July 2022.

Findings

Symptoms across the three drivers 1) avoidance based on sensory characteristics of food; 2) apparent lack of interest in eating; and 3) concern about aversive consequences positively correlated with each other. Patients' anxiety traits showed the greatest positive correlations with symptoms of concern about aversive consequences of eating. Patient sex was not significantly associated with any of the three ARFID drivers. Patients with comorbid autism spectrum disorder (ASD; 28%) showed more food-related sensory sensitivities (RR = 1.26) and greater lack of interest in eating (RR = 1.18) than those of patients without ASD (49%).

Interpretation

In our clinical sample, the ARFID drivers occurred together and did not show clinically meaningful differences between the sexes. ASD may accentuate food-related sensory sensitivities and lack of interest, but may not drive a completely different symptom presentation. ARFID is multi-faceted and heterogenous, requiring a comprehensive multidisciplinary assessment to sufficiently understand the drivers of the restrictive eating behaviour. Results need replication in larger samples with more statistical power.

Funding

None.

In-person and online sensory wellbeing workshop for eating disorders: updated case series

BACKGROUND

A one-off sensory wellbeing workshop has been developed to help patients with eating disorders (ED) manage sensory sensitivities. The aim of this study was to evaluate and compare the outcomes of the workshop in online versus face-to-face (F2F) formats among a sample of patients with ED.

METHODS

Cumulative link models were applied to the outcome measures (awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing) to test the differences between online and F2F workshops. Participants' ratings of usefulness of the workshop were also compared between online and F2F workshops.

RESULTS

A total of 14 workshops (4 online and 10 F2F) were run from 2020 to 2023. All participants reported significant and substantial improvements in all outcome measures. There was no significant difference in outcomes between online and F2F workshops. The majority of patients rated the workshops as useful.

CONCLUSIONS

Both online and face-to-face formats of the sensory workshop led to improvement in sensory wellbeing management for patients with ED. Future studies are warranted to test the impact of the workshop on ED treatment outcomes.

Understanding the Relationship between Distress Behaviour and Health Status of People with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is associated with complex distress and challenging behaviours that have a negative impact on the everyday life of those with ASD, as well as their parents and carers. These challenging behaviours include negative emotional behaviours, motor behaviours, and changes in routines. Even though challenging behaviours occur in most subjects with ASD, the cause of these largely remains unknown. It has been implicated that these challenging behaviours are associated with a change in the health of those with ASD. More research needs to be conducted that can establish a direct association. Towards this goal, the present study aimed to explore whether health status had an impact on the distressing behaviour in the subjects diagnosed with ASD. We analysed the response from the parents/carers in a Macedonian population of those with ASD, to determine which challenging behaviours were most likely to be observed during a change in health. Based on a scoring system, the manifestation of challenging behaviour was evaluated and compared with the changes in health. Changes in appetite or dietary preferences, irritability and low mood, and loss of previously acquired skills had the greatest association with a change in health. These findings provide early insight into types of challenging behaviours that are directly associated with a change in health. Our results demonstrate a relationship between health status and challenging behaviour in the subject with autism, suggesting that caregivers may need to consider this when choosing strategies for managing challenging behaviour.

Interviews with parents of adolescents with intellectual and developmental disabilities in a weight management study

BACKGROUND

Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study.

METHODS

Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed.

RESULTS

Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed.

CONCLUSIONS

Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches.

Experiences and insights of college students with autism spectrum disorder: an exploratory assessment to inform interventions

Objective: College students with autism spectrum disorder (ASD) experience elevated drop-out rates, peer difficulties, and mental health concerns compared to their neurotypical counterparts. Thus, the firsthand concerns of college students with ASD were examined, so that supports can be appropriately tailored. Methods: Responses of 31 college students with ASD were examined in relation to 39 demographically similar neurotypical students regarding students' college experiences (e.g., social interactions, mental health, daily living habits). Students with ASD also provided recommendations for improving college support programs. Results: Difficulties unique to students with ASD included trouble conversing with peers, feeling isolated despite preferences to be alone, inaccessible extra-curricular activities, and experiencing anxiety and depression resulting from social demands. Notably, these students endorsed desire for a "social group" to learn from the experiences of successful students. Conclusions: Practical targets were identified for university-implemented support groups, such as navigating social interactions and processing experiences with peers.

Systematic Review of the Relation Between Feeding Problems and Sensory Processing in Children With Autism Spectrum Disorder

PURPOSE

Many studies have linked sensory sensitivities to feeding problems in children with autism spectrum disorder (ASD). Despite the importance of sensory processing for a variety of mealtime and eating skills, the specific sensory processes that may impact feeding problems in children with ASD have not been comprehensively reviewed. Thus, the goal of this systematic review was to understand the associations between sensory processing and feeding difficulties in children with ASD.

METHOD

This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, CINAHL Plus with Full Text (EBSCOhost), Scopus (Elsevier), and Embase (Elsevier) databases were searched from their dates of inception through the final search date of April 19, 2022, for English language studies that examined both sensory processing and feeding among children with ASD. Studies were assessed for quality using the Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 27 studies were included. Findings supported the existence of a relationship between sensory processing and feeding problems in children with ASD. Specifically, studies reported that overall scores on sensory processing measures as well as measures of oral sensory processing were frequently associated with feeding problems.

CONCLUSIONS

This review supports the development of future feeding interventions focusing on sensory processing given the relationship between sensory processing and feeding problems among children with ASD. Future research should focus on utilizing consistent feeding assessments specific to children with ASD and collect information on medical diagnoses that can impact feeding in order to report on feeding more holistically in this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21453909.

Problematic eating behaviours of autistic women-A scoping review

Aim

Eating and feeding behaviours of autistic individuals and related consequences have been mainly investigated in autistic children or in autistic adults with intellectual disabilities. Behaviours such as food selectivity or food neophobia have been shown to persist into adolescence and adulthood and are associated with aversive consequences. However, much less is known about the eating behaviours of autistic adults without intellectual disabilities, especially those of women. By means of a scoping review, we aim to assess the extent of the scientific literature on what is known about the eating behaviours of these women and the possible consequences of such eating behaviour.

Method

Medline, Cochrane, PubMed and PsycInfo databases were searched according to Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines.

Results

Five studies met the eligibility criteria and were included in this review. Autistic women not only reported high levels of eating behaviour frequently seen in autism spectrum disorders (ASD), but also high levels of disordered eating behaviour, similar to that of women with eating disorders.

Conclusions

Autistic women seem to exhibit high levels of eating behaviour frequently seen in ASD as well as disordered eating behaviour. Future research needs to shed light on what underlies these problematic eating behaviours, in order to help to adapt current treatment modalities to meet the unique needs of these women.

This scoping review indicates that autistic women exhibit both eating behaviours frequently seen in autism spectrum disorders (ASD) and disordered eating behaviours, similar to those of women with eating disorders.

The review also indicates that studies investigating these eating behaviours of autistic women are still very scarce, and those that are available often lack a comprehensive assessment of the ASD diagnosis.

Future studies are needed to confirm the findings and to further explore how and why autistic women eat the way they eat, in order to help to adapt current treatment modalities to meet the unique needs of these women.

Relationships between autistic traits, taste preference, taste perception, and eating behaviour

Individuals with autism spectrum disorder exhibit atypical taste perception and eating behaviours. However, little is known about the effect of autistic traits on eating behaviours in the general population. This study explored the relationships between autistic traits, taste preferences, taste perceptions, and eating behaviours among Japanese population using an online questionnaire survey. The results showed significant effect of autistic traits on eating behaviours, that people with higher autistic traits tended to have higher selective eating behaviours, such as increased sensitivity to food texture and mixed flavours. Moreover, selective eating behaviours were correlated with the preference for sour taste and aftertaste sensitivity. Those results suggest that eating behaviours can be influenced by the relationship between autistic traits, taste perceptions, and taste preferences. We discuss these results in the context of previous findings, and future investigations into the possibility of solving selective eating problems in individuals with autism.

Autistic traits were significantly correlated with eating behaviours.

People with higher autistic traits tended to have higher selective eating behaviours, such as increased sensitivity to food texture and mixed flavours.

People who like sour tastes tended to have less selective eating behaviours.

People who are sensitive to aftertaste perception tended to have greater selective eating behaviours.

Autistic traits, taste perceptions, and taste preferences play a role in the development of a number of selective eating behaviours.

The sensory experiences of autistic people: A metasynthesis

LAY ABSTRACT

Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions - physical, emotional, relational and social - experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.

Mild Hypophagia and Associated Changes in Feeding-Related Gene Expression and c-Fos Immunoreactivity in Adult Male Rats with Sodium Valproate-Induced Autism

A core yet understudied symptom of autism is aberrant eating behaviour, including extremely narrow food preferences. Autistic individuals often refuse to eat despite hunger unless preferred food is given. We hypothesised that, apart from aberrant preference, underfeeding stems from abnormal hunger processing. Utilising an adult male VPA rat, a model of autism, we examined intake of ‘bland’ chow in animals maintained on this diet continuously, eating this food after fasting and after both food and water deprivation. We assessed body weight in adulthood to determine whether lower feeding led to slower growth. Since food intake is highly regulated by brain processes, we looked into the activation (c-Fos immunoreactivity) of central sites controlling appetite in animals subjected to food deprivation vs. fed ad libitum. Expression of genes involved in food intake in the hypothalamus and brain stem, regions responsible for energy balance, was measured in deprived vs. sated animals. We performed our analyses on VPAs and age-matched healthy controls. We found that VPAs ate less of the ‘bland’ chow when fed ad libitum and after deprivation than controls did. Their body weight increased more slowly than that of controls when maintained on the ‘bland’ food. While hungry controls had lower c-Fos IR in key feeding-related areas than their ad libitum-fed counterparts, in hungry VPAs c-Fos was unchanged or elevated compared to the fed ones. The lack of changes in expression of feeding-related genes upon deprivation in VPAs was in contrast to several transcripts affected by fasting in healthy controls. We conclude that hunger processing is dysregulated in the VPA rat.

How to support adults with anorexia nervosa and autism: Qualitative study of clinical pathway case series

INTRODUCTION

Previous research has explored the overlapping presentation between autism and eating disorders (ED). This study aims to summarize the clinical challenges associated with co-occurring autism and anorexia nervosa (AN) based on clinicians' case notes and minutes from case discussions, to understand how to better support people with the comorbidity.

METHOD

Thematic analysis was conducted on de-identified notes on 20 cases with AN and autistic characteristics and minutes from case discussions. Themes relevant to clinical challenges in supporting those with the comorbidity were identified, and a thematic map was produced to visually represent the results.

RESULTS

The key challenges faced by clinicians when treating patients with AN and autism included: communication difficulties, maintaining boundaries, autism screening, presence of other comorbidities, sensory difficulties, atypical presentation of eating difficulties, cognitive rigidity, and emotional difficulties. Adaptations to resolve some of these difficulties included exposure-based food experiments, keeping a record of patients' self-reported communication preferences, individual-level modification of communication style, and providing tools for patients to identify emotions.

CONCLUSIONS AND IMPLICATIONS

Further exploration to establish the effectiveness of the adaptations is warranted. Furthermore, tools for differentiating between ED, autism and other comorbidities are needed to help clinicians clarify the cause of a presenting symptom, and help them to best support and maintain boundaries with patients.

A comparison of food avoidant behaviours and sensory sensitivity in adults with and without Tourette syndrome

Food selectivity has been shown to be more persistent and severe in children with Tourette syndrome (TS) compared to their typically developing peers. The current study aimed to examine differences in food selectivity, food neophobia and Avoidant Restrictive Food Intake Disorder (ARFID)-associated behaviours, between adults with and without TS. Fifty-three adults diagnosed with TS were compared to 53 neurotypical adults and completed the following measures online: Adult Eating Behaviour Questionnaire (AEBQ), Nine-Item Avoidant/Restrictive Food Intake disorder screen (NIAS), Food Neophobia Scale (FNS) and the Sensory Perception Quotient (SPQ). Higher levels of food avoidant behaviours, in terms of food fussiness, food neophobia and ARFID-associated behaviours, were identified in adults with TS compared to adults without TS. While heightened sensory sensitivity failed to predict food fussiness, greater sensitivity to taste was found to be predictive of food neophobia in TS. These are the first findings to suggest that food avoidant behaviours are more prevalent for adults with TS and signal a need to address health implications.

The Association Between Obesity and Key Health or Psychosocial Outcomes Among Autistic Adults: A Systematic Review

Obesity is linked with health and psychosocial outcomes among many populations. However, it is unclear the extent to which obesity is linked with these outcomes among autistic adults. We searched seven research databases for articles examining the association between obesity and autistic adults' health and psychosocial outcomes. Three studies found that obesity was associated with health outcomes, including: in-hospital mortality, risk of type II diabetes, cardiovascular disease, and number of co-occurring medical conditions. One study found no significant association between autism diagnosis, mental health conditions, and body mass index. Obesity increases the risk of in-hospital mortality and some chronic conditions among autistic adults, highlighting the need for clinicians trained to promote weight management among autistic adults.

Preference to Eat Alone: Autistic Adults' Desire for Freedom of Choice for a Peaceful Space

Backgrounds

Autistic adults tend to prefer eating alone, which may result in further social isolation. This study aims to understand contexts of challenges autistic adults face when eating with other people outside home.

Methods

We explored autistic subjectivities actively situated in eating environments. We conducted follow-up individual email interviews with autistic adults diagnosed with an autism spectrum disorder in adulthood (n = 10) and autistic adults without a formal diagnosis (n = 6), both of whom had participated in our prior online survey with Brazilian autistic adults. We used a thematic analysis to gain an in-depth understanding of challenging characteristics of social situations in the eating space.

Results

To eat out comfortably, many participants did not talk while eating, chose places without sensory overload, chose places with eatable foods, ate at off-peak hours, used sensory tools, and/or left places when stressed. Participants developed these coping strategies to negotiate incongruences between their autistic personal characteristics and their physical environments. However, there were incongruences between the coping strategies and social contexts with codiners. Participants often could not freely use the strategies-both in work and in casual social situations. This lack of freedom of choice often resulted in feeling uncomfortable, sick, or having meltdowns during or after social dining. Because of these experiences, many participants decided to avoid social dining.

Conclusions

The preference to eat alone in autistic adults may reflect their desire for freedom of choice to use coping strategies to eat in a peaceful food space. Creating a peaceful eating environment may be a feasible and humanistic approach to reduce unwanted aloneness and social isolation in autistic adults.

Lay summary

Why was this study done?: Eating together with other people is a common activity to socialize and feel a sense of belonging. But autistic adults often prefer to eat alone, though they have a desire to socialize.What was the purpose of this study?: To study challenging aspects of eating out with other people, to understand why some autistic adults prefer to eat alone.What did the researchers do?: We interviewed adults who considered themselves to be on the autism spectrum. Of the 16 interview participants, 10 were formally diagnosed with an autism condition and 6 were not. They once participated in our online survey with Brazilian autistic adults. The interviews were done by email. We asked about eating places and experiences in eating out. We looked for the common themes over all the interview responses.What were the results of the study?: When eating out alone, participants had strategies to eat comfortably. They could eat without talking, choose places without sensory overload, choose places with eatable foods, eat at off-peak hours, use tools such as earphones, or leave the place when stressed. However, they often could not freely do so in both work and casual social situations. They knew that their coping strategies would be considered inappropriate by others. For example, many participants felt pressured to talk while eating. Also, other people had different preferences for the times and places to eat from participants. It was difficult for participants to deal with the stressful environment without using their coping strategies. So, participants often felt uncomfortable, sick, or had meltdowns during or after eating out with others. For these reasons, many of them avoided eating out with others.What do these findings add to what was already known?: Autistic adults' preference to eat alone and difficulty in social situations involving eating have been understood as eating problems in autism. Our findings suggest that some dining companions reduce autistic persons' freedom to eat in comfortable social and physical environments, and that the preference expresses a desire to have such freedom.What are potential weaknesses in the study?: Because we used email interviews, the study did not include any participant without access to email, and participants were all college educated, unlike most Brazilian adults with an autism diagnosis.How will these findings help autistic adults now or in the future?: The findings will help autistic adults by letting others know ways that dining companions potentially reduce autistic persons' freedom to eat comfortably and by inspiring them not to do so. The findings also suggest that society should focus on creating a peaceful eating environment instead of focusing on finding ways to treat autistic aloneness as if aloneness in autism is caused by problems inside of the autistic individual.

Eating Problems in Autistic Females and Males: A Co-twin Control Study

This study investigated the association between autism and self-reported eating problems and the influence of gender on the association, in a sample of adolescent and adult twins (N = 192). Autistic traits and autism diagnosis were associated with both total and specific eating problems, including selective eating and sensory sensitivity during mealtimes. Interaction effects indicated a stronger association between autistic traits and total eating problems in females, as well as more difficulties with eating in social contexts among autistic females. In within-pair analyses, where unmeasured confounders including genes and shared environment are implicitly controlled for, the association was lost within monozygotic pairs, which might further indicate a genetic influence on the relationship between autism and eating problems.

An investigation of the diet, exercise, sleep, BMI, and health outcomes of autistic adults

BACKGROUND

Studies of autistic children suggest that restricted eating, reduced physical activity, and sleep disorders are common; however, no studies attempt to broadly describe the diet, exercise, and sleep patterns of autistic adults or consider relationships between lifestyle behaviors and the widely reported increased risks of obesity and chronic conditions. To address this, the authors developed the largest study of lifestyle patterns of autistic adults and assessed their relationships to body mass index, health outcomes, and family history.

METHODS

We administered an anonymized, online survey to n = 2386 adults (n = 1183 autistic) aged 16-90 years of age. We employed Fisher's exact tests and binomial logistic regression to describe diet, exercise, and sleep patterns; mediation of seizure disorders on sleep; body mass index (BMI); relationships of lifestyle factors to BMI, cardiovascular conditions, and diabetic conditions; and sex differences among autistic adults.

RESULTS

Autistic adults, and particularly autistic females, exhibit unhealthy diet, exercise, and sleep patterns; they are also more likely to be underweight or obese. Limited sleep duration and high rates of sleep disturbances cannot be accounted for by epilepsy or seizure disorders. Lifestyle factors are positively related to higher risk of cardiovascular conditions among autistic males, even more than family history.

LIMITATIONS

Our sample may not be representative of all autistic and non-autistic people, as it primarily comprised individuals who are white, female, have a high school education or higher, and reside in the UK. Our sampling methods may also exclude some individuals on the autism spectrum, and particularly those with moderate to severe intellectual disability. This is a cross-sectional sample that can test for relationships between factors (e.g., lifestyle factors and health outcomes) but cannot assess the direction of these relationships.

CONCLUSIONS

Autistic adults are less likely to meet minimal health recommendations for diet, exercise, and sleep-and these unhealthy behaviors may relate to excess risk of cardiovascular conditions. Although the present study can only provide preliminary, correlational evidence, our findings suggest that diet, exercise, and sleep should be considered and further investigated as key targets for reducing the now widely reported and dramatically increased risks of health comorbidity and premature death among autistic individuals compared to others. Physicians should work cooperatively with patients to provide health education and develop individualized strategies for how to better manage challenges with diet, exercise, and sleep.

Autistic Cognition: Charting Routes to Anxiety

Autism Spectrum Conditions are typified by a divergence in cognitive style from that of the non-autistic population. Cognitive differences in autism may underlie significant strengths, but also increase vulnerability to psychopathology such as anxiety, which is a major problem for many autistic people. Many autistic people also do not respond to typical psychotherapeutic interventions, suggesting that autism-specific models and interventions are needed. We advance a theoretical model explaining how three constructs, attenuated predictions, intolerance of uncertainty, and 'black and white thinking', may interact to lead to anxiety in autism. We hope to start a dialogue surrounding how we can best address specific autistic cognitive differences that may lead to distress by developing appropriate models, measurements, and psychotherapeutic interventions.

"For Me, the Anorexia is Just a Symptom, and the Cause is the Autism": Investigating Restrictive Eating Disorders in Autistic Women

Autistic women are overrepresented among people in treatment for Anorexia Nervosa (AN). The current study aimed to: (1) better understand how AN develops and persists in autistic individuals from the perspective of autistic women, parents and healthcare professionals; (2) derive a theoretical model of restrictive eating difficulties in autism. We conducted 44 semi-structured interviews and used Thematic Analysis to identify patterns of meaning across the data. Themes related to sensory sensitivities, social interaction and relationships, sense of self and identity, difficulties with emotions, thinking styles, and a need for control and predictability. We developed a model of potential autism-specific mechanisms underlying restrictive eating difficulties. This study generated novel insights, which have the potential to inform treatment adaptations following empirical testing.

Impact of Selective Eating on Social Domains Among Transition-Age Youth with Autism Spectrum Disorder: A Qualitative Study

Food selectivity is a common feeding problem among autistic children. The objective of this qualitative study was to explore the impact of selective eating on key social domains-with family, peers, and in other social situations-of transition-age autistic youth who self-identified as being food selective. Interviews were conducted with 20 autistic youth ages 18-23 years. Data were analyzed using descriptive and thematic coding. Participants had developed a range of strategies to cope with their food selectivity, and although some expressed concerns, they did not feel that it had a major impact on social situations. A responsive approach to supporting such youth would likely involve recognizing the effort and skills that the youth have already developed around this issue.

Gender differences in mental health prevalence in autism

Purpose

Mental health conditions are known to be more common amongst autistic than non-autistic people. To date, there is little work exploring gender differences in mental health amongst autistic people and no work including non-binary/trans people. This paper aims to address this gap.

Design/methodology/approach

This was a large-scale online study, with 948 participants between 18 and 81 years old. Participants self-reported autism, anxiety, depression and eating disorder status. Analyses were run examining gender differences in the rates of these conditions in each group.

Findings

Autistic people are more likely to have anxiety and depression than non-autistic people of all genders. Autistic women and non-binary people experienced mental health issues at higher rates than men and at similar rates to each other. Autistic people were twice as likely as non-autistic people to have all eating disorders. Further, gendered patterns of eating disorders seen in the non-autistic population are also present in the autistic population.

Research limitations/implications

There are inherent issues with self-report of diagnoses online, but this study showed that using screening questionnaires is effective.

Originality/value

This is the first paper to look at gender differences in common mental health issues amongst autistic and non-autistic adults. It highlights that there are significant gendered patterns in the prevalence of mental health issues in both the autistic and non-autistic population and that these have an impact for how treatment should be approached to be effective.

Pragmatic Sensory Screening in Anorexia Nervosa and Associations with Autistic Traits

BACKGROUND

Research suggests that people with anorexia nervosa (AN) experience subjective hypersensitivity to external sensations that may require consideration in treatment. These difficulties may be particularly pronounced in people with AN and high autistic traits. The purpose of this pilot study was to explore the use of a brief screening tool to assess sensory sensitivity in individuals receiving treatment for AN, and to assess if self-rated sensitivity in AN is related to autistic traits.

METHODS

47 individuals receiving treatment for AN completed a brief sensory screening tool and self-rated their autistic traits. Individuals were also asked to give qualitative feedback on the screening tool.

RESULTS

People with AN and high autistic traits rated themselves as more hypersensitive compared to people with AN and low autistic traits. Feedback surrounding the use of the screener was positive.

CONCLUSIONS

The results of this study suggest that the use of this screener may be beneficial in eating disorder settings to help adjust and calibrate treatment to personal needs, although further research and psychometric evaluation around the clinical use of the screener is required. The finding that people with AN and high autistic traits may experience elevated hypersensitivity also warrants further exploration in future research.

Interoception in Anorexia Nervosa: Exploring Associations With Alexithymia and Autistic Traits

BACKGROUND

Previous research on whether interoception is altered in anorexia nervosa (AN) using the heartbeat tracking task has yielded inconsistent results. However, no previous research has examined whether interoception is associated with alexithymia and autistic traits in AN, conditions which are more prevalent in this population and thought to be related to performance in this task. The aim of this study was to explore whether altered interoception in AN is associated with alexithymia and autistic traits.

METHODS

We assessed interoceptive accuracy using the heartbeat tracking task in n = 37 people with AN, and n = 37 age and gender matched healthy controls (HC), and explored within the AN group if interoceptive accuracy was related to self-rated alexithymia or autistic traits. We also assessed self-reported interoceptive ability, and the relationship between subjective and actual performance.

RESULTS

Heartbeat tracking task performance was not found to be altered in the AN group compared to the HC group. However, confidence ratings in task performance in the AN group were lower compared to the HC group. Unlike the HC group, confidence ratings in the AN group did not correlate with task performance. Within the AN group there was no relationship between interoceptive accuracy, alexithymia, and autistic traits, after controlling for the potential confounders of anxiety and depression. There was a relationship between confidence ratings and illness severity in the AN group.

CONCLUSION

The results found no differences between heartbeat tracking task performance in people with AN compared to HC. There was no association between task performance, alexithymia and autistic traits in AN. Results do suggest that people with AN exhibit lowered confidence in their task performance, and that they may lack insight into this performance compared to HC. The findings are discussed in the context of potential significant limitations of the heartbeat tracking task, with recommendations for future research into interoception in AN.