Assessments
Not all autistic people will come to you with a diagnosis. Autism diagnoses in those with comorbidities, and especially in females, can be missed and often not picked up until later in life. This is due to two things: firstly, symptoms of the comorbidity, in this case the eating disorder, ‘masking’ those of the autism and secondly, autistic individuals ‘masking’ or ‘camouflaging’ their autism themselves. Camouflaging is where an autistic individual mimics behaviour of those around them in order to ‘fit in’. For more information of camouflaging in autistic females, see this blog post here. Camouflaging can be exhausting and not having a diagnosis can make it confusing and lead to decreased wellbeing. It is important to recognise autism as soon as possible to ensure the individual receives the support they need and to help them contextualise their experiences. As well as this, diagnoses can help their family and their clinicians in understanding how best to support them.
Research suggests that autistic people fare worse in traditional eating disorder treatment than those without autism. Identifying autistic people is essential to ensure that adaptations and consideration can be taken in approach to their treatment and that their autism can be supported.
We have found that in eating disorder settings, once the comorbidity has been acknowledged and sufficient training offered, clinicians are highly attuned to spotting those with high autistic traits and therefore initial instinct should not be ignored. When all of our patients are first admitted, we screen them with the Autism Quotient 10 (short version) or the Social Responsiveness Scale-2. Based on their scores of this, we may then follow up with an ADOS-2 assessment and our PEACE sensory screener (found here). More information on why we chose these screening and assessment measures and how to implement them will be available in our book due out in March 2021.
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