Clinician Perspectives on Barriers and Enablers to Autism-Affirming Eating Disorder Care
Date published: 25/07/26
Authors: Emy Nimbley, Amelia Austin, Kate Tchanturia, Kai Thomas, Catherine R.G. Jones, Karri Gillespie-Smith, Fiona Duffy
Published in: European Eating Disorders Review
Highlights
- Autism-affirming ED care and treatment adaptations appear to challenge some core underpinning messages historically embedded in siloed ED services, including what components of evidence-based practice are emphasised, and beliefs around the risks of accommodating disordered eating.
-Autism-affirming adaptations appear to be facilitated by the skills of a diverse MDT, formulation driven care and reflective supervision.
- This highlights the need for bespoke training relevant to autistic presentations of ED's; the employment of OT's and use of autism champions in ED teams; supervision or clinical “huddles” and the development of pragmatic guidance and resources on treatment adaptations.
Objective
Autistic people with an eating disorder (ED) report more negative experiences of ED treatment and are at greater risk of requiring higher intensity services. Current ED treatment options do not fully meet underpinning drivers of autistic people's experiences of EDs. There remains little guidance or understanding on how autism-informed adaptations are implemented. This paper aims to explore clinician-perceived barriers and enablers to implementing autism-affirming adaptations in UK ED services.
Method
Semi-structured interviews were conducted with 12 clinicians in multidisciplinary roles across UK ED services who were beginning to implement autism-affirming care. Data were analysed using critical realist thematic analysis.
Results
Clinicians described many barriers associated with implementing autism-affirming care underpinned by longstanding beliefs about the risks of accommodating ED behaviours. This contributed to anxiety about making adaptations to care and the potential to over- or under-accommodate autistic needs. An underlying assumption that evidence-based practice solely equates to manualised treatment for EDs constrained adaptation. A commitment to individualised formulation and care, regardless of diagnosis, and valuing a diverse multidisciplinary team were key enablers. System-level barriers included siloed autism and ED resources and training.
Conclusions
Autism-affirming adaptations challenge some core underpinning messages historically embedded in siloed ED services.
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