I recall supporting one person on our inpatient unit, who would become very distressed when her drink was not served at the "right" temperature during mealtimes. This was at the very start of the PEACE pathway; we were just learning to differentiate the symptoms of anorexia from autism driven difficulties and understanding more about sensory sensitivities. As part of the pathway work, we screened for ASD and conducted a research based adult diagnostic observation (ADOS), this suggested she would likely meet criteria and we made a recommendation for a full diagnostic assessment. Meanwhile, I was better able to understand her sensitivity to temperatures and support her to feel less distress by exploring the task of preparing and serving meals in the dining room from multiple perspectives. I vividly recall one lightbulb moment when she realised it was extremely challenging for staff to serve 18 drinks at just the right temperature when they might only be able to fit four into the microwave at a time and had NHS /food hygiene rules to adhere to, meaning nothing could be reheated. Until this point, she had struggled to understand why staff did not get it right for her and experienced it as staff not caring about her preferences, which understandably led to her feeling really hurt and angry. After that one exercise of exploring different perspectives she spoke with pleasure about how she was better able to tolerate her drink not being quite right because it did not feel so personal anymore and she understood how much work there was in serving meals and drinks. That was such an important learning experience for me too, as the sensitivity to temperature could easily have been misinterpreted as anorexia driven "fussiness" rather than an autism related challenge and I think the person benefited so much from our increasing understandings of how autism affects individuals.
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