Supporting Autistic Clients with Eating Differences

The Importance of a Neuroaffirming Approach

When working with autistic clients, it's essential to recognise that their eating patterns and body image experiences may differ significantly from neurotypical presentations. As Longhurst and colleagues (2024) recently found, body image for autistic individuals encompasses both "what it looks like and what the body feels like" – a crucial distinction that impacts treatment approaches.

Sensory Processing: A Key Consideration

One of the most critical aspects often overlooked in traditional eating disorder treatment is sensory processing. Traditional exposure-based interventions are are often not appropriate for autistic clients as habituation does not occur to sensory aversive foods. Exposure therapy has even been shown to result in hypersensitivity and PTSD symptoms in neurodivergent clients. In a 2024 article, Hinze, Attwood, & Garnet argued that:

‍“Sensory processing differences, especially hypersensitivity, can cause genuine pain and distress that is not merely a product of irrational fear but a physical and neurological response”

Social Eating: Challenging the Neurotypical Ideal

While traditional eating disorder treatment often emphasises social eating, we must recognise that this can present unique challenges for autistic clients. Research by Kinnaird et al. (2019) identified several barriers, including:

• Difficulty managing competing demands of eating and socialising
• Sensory overwhelm from the environment
• Challenges with implementing accommodations due to social pressure

Interoceptive Differences
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Autistic individuals often experience differences in interoceptive awareness—their ability to sense and interpret internal body signals, including hunger and fullness. This can manifest as either heightened or reduced sensitivity to these signals, or difficulty distinguishing between different bodily sensations. These interoceptive differences can significantly impact eating patterns and may present as:

• Irregular meal timing
• Difficulty recognising hunger cues
• Challenges with identifying comfortable levels of fullness

Rather than attempting to "fix" these differences, which could potentially contribute to masking or trauma, support should focus on accommodations. This might include:

• Using external reminders to eat
• Creating structured eating routines
• Offering a variety of textures and portion sizes
• Respecting individual preferences

It's particularly important to note that trauma, which is more prevalent in the autistic community, can further impact interoceptive awareness by either dampening or intensifying body signals, making a gentle, person-centered approach to eating support essential.

A Path Forward

When working with autistic clients with eating differences, consider these key principles:

1. Validate sensory experiences and avoid forced exposures to aversive foods
2. Focus initially on maximising intake of safe and non-aversive foods
3. Recognise that what appears as "resistance" may actually be sensory overwhelm
4. Support clients in developing their own meaning and understanding of their experiences

50-70% of autistic identifying individuals are also ADHDers and both autism & ADHD are a spectrum, so when considering which strategies to use with the client, clinicians should reflect on what each clients reported strengths and difficulties are and what strategies might best fit their presentation (rather than just the identification as autistic or ADHDer).

In the words of dietitian Maud Achard "It's not about trying harder but trying different." This perspective shift is crucial for providing effective, trauma-informed care that honours neurodivergent experiences.

Supporting autistic clients with eating differences requires us to move beyond traditional treatment paradigms and embrace a more individualised, sensory-informed approach. By understanding and respecting their unique experiences, we can create more effective and supportive treatment environments.

Want to know more?

Our free resource provides practical strategies for implementing these principles in your practice: Essential Tips for Supporting Autistic Clients with Eating Differences
For a neuroaffirming adaptation to the RAVES model - SAFETY
For online on demand training - A Neuroaffirming Approach to Working With Eating Disorders
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References‍

- Cobbaert, L., & Rose, A. (2023). Eating disorders and neurodivergence: A stepped care approach
- Hinze, Attwood, & Garnet (2024). Understanding Sensory Processing in Autism and the Limitations of Exposure Therapy
- Hours, C, Recasens, C, Baleyte, JM. (2022). ASD and ADHD Comorbidity: What Are We Talking About? Front Psychiatry Vol 28
- Kinnaird, E, Stewart, C, Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. Eur Psychiatry. 55 p80-89
- Longhurst P, Aspell J, Todd J, Swami V. (2024) "There's No Separating My View of My Body from My Autism": A qualitative study of positive body image in autistic individuals. Body Image. 48