How anorexia nervosa patients with high and low autistic traits respond to group Cognitive Remediation Therapy

An examination of the clinical outcomes of adolescents and young adults with broad autism spectrum traits and autism spectrum disorder and anorexia nervosa: A multi centre study

OBJECTIVES

To compare the clinical outcomes of adolescents and young adults with anorexia nervosa (AN) comorbid with broad autism spectrum disorder (ASD) or ASD traits.

METHOD

The developmental and well-being assessment and social aptitude scale were used to categorize adolescents and young adults with AN (N = 149) into those with ASD traits (N = 23), and those who also fulfilled diagnostic criteria for a possible/probable ASD (N = 6). We compared both eating disorders specific measures and broader outcome measures at intake and 12 months follow-up.

RESULTS

Those with ASD traits had significantly more inpatient/day-patient service use (p = .015), as well as medication use (p < .001) at baseline. Both groups had high social difficulties and poorer global functioning (strengths and difficulties questionnaire) at baseline, which improved over time but remained higher at 12 months in the ASD traits group (p = .002). However, the improvement in eating disorder symptoms at 12 months was similar between groups with or without ASD traits. Treatment completion rates between AN only and ASD traits were similar (80.1 vs. 86.5%).

DISCUSSION

Adolescents with AN and ASD traits show similar reductions in their eating disorder symptoms. Nevertheless, their social difficulties remain high suggesting that these are life-long difficulties rather than starvation effects.

The association between symptoms of autism and neuropsychological performance in females with Anorexia Nervosa

The aim of this study was to investigate the relationship between symptoms of autism spectrum disorder (ASD) and performance on measures of set-shifting and central coherence in a sample of females with anorexia nervosa (AN). Ninety-nine females aged 12-47, recruited from inpatient and day patient eating disorder services, were assessed with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2), as well as the Wechsler Abbreviated Scale of Intelligence, 2nd edition (WASI-II); Wisconsin Card Sorting Test (WCST); Rey-Osterrieth Complex Figure Test (ROCFT) and self-report questionnaires assessing eating disorder pathology, depression, cognitive rigidity and attention to detail. Individuals scoring above clinical cut-off on the ADOS-2 (N = 35) reported significantly higher levels of cognitive rigidity than those with lower levels of ASD symptoms but there was no difference between groups on self-reported attention to detail. There group with high levels of ASD symptoms also made significantly more perseverative errors on the WCST but there was no association between ASD symptoms and performance on the ROCFT. The group who scored above cut-off on the ADOS-2 were significantly younger than the sub-clinical groups. The presence of symptoms associated with ASD appears to be related to increased cognitive rigidity in females with AN.

Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme

Previous research has demonstrated links between anorexia nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in anorexia nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with anorexia nervosa. Participants with anorexia nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotient, short version scores remained relatively stable from admission to discharge but there was a small, significant reduction in scores. There was no interaction between time and Autism Spectrum Quotient, short version scores on clinical symptom change. In anorexia nervosa, autism spectrum disorder symptoms appear to be associated with a more severe clinical presentation on admission to inpatient care. Autism spectrum disorder symptoms as assessed by self-report measures may be exacerbated by other mental health psychopathology, which warrants further investigation.

Exploring the Relationship Between Autistic Traits and Body Image, Body Satisfaction, and Body Competence

Autism spectrum disorders (ASD) have been linked to bodily disorders (anorexia nervosa, obesity), and individuals with ASD are known to experience unique bodily states (e.g., exaggerated interoceptive sensitivity). Though there is evidence to suggest body variables may significantly impact quality of life in those with ASD, research has yet to examine the potential relationship between ASD and body image variables, that is, the evaluation of one's body. The present study examined 80 healthy college students (40 male, 40 female) who completed an online set of questionnaires regarding body image and satisfaction, body competency, depression, anxiety, and autistic traits (Autism Spectrum Quotient, or AQ) (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001 ). Of primary interest was whether AQ scores, gender, and the interaction between AQ scores and gender could successfully predict participants' scores on body image, satisfaction, and competency scales. Autistic traits were only a significant predictor of scores on one measure of momentary body image and satisfaction (Body Image States Scale: Cash et al., 2002 ). However, our results did suggest the possibility of an interaction between gender and AQ scores in predicting reports of body image, satisfaction, and competency.

Clinicians' views on working with anorexia nervosa and autism spectrum disorder comorbidity: a qualitative study

BACKGROUND

Anorexia nervosa (AN) and autism spectrum disorder (ASD) form a relatively common comorbidity, with poorer illness outcomes and poorer responses to treatments for AN compared to individuals without ASD. However, the treatment of this comorbidity remains poorly understood: no research to date has examined how clinicians currently approach treating AN/ASD. This study aimed to explore the experiences of clinicians working with comorbid AN/ASD using qualitative methods in order to identify areas for future improvement.

METHODS

Interviews with individual clinicians (n = 9) were carried out and explored using thematic analysis.

RESULTS

The findings suggest that many clinicians lack confidence in treating this comorbidity, which requires specific changes to treatment to accommodate the issues raised by comorbid ASD. At present, any adaptations to treatment are based on the previous experience of individual clinicians, rather than representing a systematic approach.

CONCLUSIONS

Further research is needed to empirically assess potential treatment modifications for this group and to establish guidelines for best clinical practice.

Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review

PURPOSE OF REVIEW

There is growing interest in the relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). This review aimed to synthesise the most recent research on this topic to identify gaps in current knowledge, directions for future research and reflect on implications for treatment.

RECENT FINDINGS

Eight studies assessing the presence of ASD in AN were identified in the literature along with three studies examining the impact of symptoms of ASD on treatment outcome. Research with young people and using parental-report measures suggest lower rates of co-morbidity than previous adult studies.

CONCLUSIONS

The wide range of diagnostic tools, methodologies and populations studied make it difficult to determine the prevalence of ASD in AN. Despite this, studies consistently report over-representation of symptoms of ASD in AN. Co-morbid AN and ASD may require more intensive treatment or specifically tailored interventions. Future longitudinal research and female-specific diagnostic tools would help elucidate the relationship between these two disorders.