Camouflaging, not sensory processing or autistic identity, predicts eating disorder symptoms in autistic adults

LAY ABSTRACT

This study aimed to explore the impact of Autistic identity (i.e. feeling like you belong to the Autistic community), sensory profiles (e.g. being over or under responsive to sensations) and camouflaging behaviours (i.e. masking) on eating disorder symptoms in Autistic adults. 180 Autistic people were recruited from the community and NHS. The Autistic people completed online questionnaires measuring Autistic identity, sensory profiles, camouflaging behaviours, autistic traits and eating disorder symptoms. The analysis showed that higher levels of camouflaging behaviour predicted higher levels of eating disorder symptoms. Sensory profiles were related to but did not predict eating disorder symptoms and there was no relationship between level of Autistic identity and eating disorder symptoms. This shows that camouflaging is the most important predictor of eating disorder symptoms in Autistic people, and warrants further exploration.

Patient Experience Research in Children and Young People's Mental Health Services in England: A Route to Genuine Service Transformation or Just Pretty Pictures and Tasteful Color Schemes?

The personalization of service provision and responding to patients’ expressed needs are key components of government plans to improve children and young people’s mental health services in England. This qualitative study explored the use of patient experience research in these services. Despite national level commitments to listening to and acting on the “patient’s voice,” both service users (young people) and parents of this group reported never having been invited to participate in patient experience research. Most professional respondents reported that such research was frequently tokenistic and conducted solely to meet an administrative requirement. Senior policy makers justified the limited investment in, and use made of patient experience research, by pointing to what they felt were more urgent priorities facing children and young people’s mental health services. These included unprecedented levels of demand and critical underfunding of mental health services and related youth- and community-based services. The conceptualization of patient experience research within the National Health Service (NHS) as a service improvement issue was found to have led to its status being diminished to one concerned with relatively cosmetic matters, such as the color scheme or choice of pictures on the walls of clinics. Senior policy makers argued that it was important to rethink the role and value of patient experience research, and to recognize its unique contribution to addressing the existential questions facing services.

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Background

Anorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.

Objectives

This programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.

Methods

WP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.

Results

WP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.

Conclusions

This programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.

Trial registration

Current Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

We don't know how to help: an online survey of school staff

BACKGROUND

Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known about teachers' experiences of ED.

METHOD

A total of 826 school staff completed an online questionnaire exploring their Eating Disorder experiences. Responses were analysed using content analysis principles.

RESULTS

74 per cent of respondents' schools had received no training on ED, 40% did not know how to follow up pupils' Eating Disorder concerns and 89% of respondents felt uncomfortable teaching pupils about ED.

CONCLUSIONS

School staff feel ill-equipped to support ED. Training in the recognition, support and teaching of ED would be welcomed and could improve outcomes for young people.

'My teacher saved my life' versus 'Teachers don't have a clue': an online survey of pupils' experiences of eating disorders

BACKGROUND

Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known about pupils' experiences of ED within a school setting.

METHOD

Five hundred and eleven 11- to 19-year-old school pupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male). Responses were analysed using content analysis principles.

RESULTS

Of the participants, 38% had a current or past ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise ED awareness. Only 7% would confide in a teacher about an ED.

CONCLUSIONS

Efforts are needed to break down barriers to disclosure and support teachers to play an effective role in the detection and early intervention for ED.

Spotting and supporting eating disorders in school: recommendations from school staff

Eating disorders have a high rate of onset in school-aged children. School staff are in an excellent position to spot the early warning signs and offer support during recovery. This article explores the findings from focus groups conducted with 63 members of staff from 29 UK schools with the aims of (i) understanding whether they are in a good position to support students with eating disorders and (ii) to generate recommendations regarding school staff's training needs for spotting and supporting eating disorders. Participants took part in semi-structured focus groups. These were transcribed and analysed using content analysis principles. Five key themes emerged: (i) many staff do not have a basic understanding of eating disorders, (ii) eating disorders are taboo in the staffroom, (iii) staff do not feel comfortable talking to students about eating disorders, (iv) support is needed to ensure the teacher-parent relationship is a positive one and (v) school staff would welcome practical ideas for how they can best support students during the recovery period. The findings show that school staff currently feel ill-equipped to support students with eating disorders and endorse a need for focused training for school staff to better enable them to support students with eating disorders.