Time to Notice Neurodiversity in Eating Disorder Services: A Three-Year Real-World Analysis of Autism, ADHD and AuDHD

Background

Autism and ADHD frequently co-occur and each of them are overrepresented
in clinical eating disorder (ED) services, where they are associated
with longer treatment, poorer treatment experiences, and worse clinical
outcomes. Separately, Autistic and ADHD patients with EDs present with
greater ED psychopathology, anxiety, and depression. Autistic patients
also present with poorer quality of life, increased suicide attempts,
and greater functional difficulties. However, no study has directly
compared patients with EDs who are both Autistic and ADHD (AuDHD) with
Autistic-only, ADHD-only, or neurotypical patients.

Method

This cross-sectional, observational study compared ED psychopathology
(EDE-Q), psychological distress (CORE10), and work and social
functioning (WSAS) across adult ED patients reporting suspected or known
Autism, ADHD, both, or neither. No formal hypotheses were
pre-specified. Data were three-years of routinely collected intake
information from a specialist adult ED service. Patients were classified
as Autistic or ADHD if they reported a diagnosis/suspicion at intake,
or, for ADHD, if they reported ADHD medication.

Results

Of 1,252 patients, 32 (2.6%) were classified as AuDHD, 45 (3.5%) as
Autistic-only, and 81 (6.5%) as ADHD-only. Group differences were small
but consistent. EDE-Q scores were highest in the ADHD-only group and
lowest in the Neither group ((M = 4.24 vs M = 3.85, f=0.07). CORE10 and WSAS scores were highest in AuDHD and lowest in Neither (M = 24.16 vs M = 20.1, f=0.12; M = 26.56 vs M = 20.06, f=0.16).

Conclusions

Autistic and/or ADHD
patients with EDs showed greater psychological distress, and poorer
functioning, particularly when both were present. ADHD was particularly
linked to increased ED psychopathology. Screening for neurodivergence in
ED services may support person-centred care and improve outcomes.