Neurodivergent affirming care
/Neurodivergence and Eating Disorders
It is estimated ~ 4% of the Australian population are experiencing an eating disorder at any given time. Neurodivergent people are over-represented, however. For example, avoidant/restrictive food intake disorder (ARFID) is reported in 21% of children with autism and eating disorder risk is three times higher for ADHD children (31.4%) compared to non-ADHD children (12.4%). Importantly, the factors underlying the disorders are often very different to neurotypical people.
Accordingly, adapted and tailored supports and intervention for neurodivergent eating disorder treatment is required.
What is neuro-diversity affirming care?
A neurodiversity affirming approach respects, celebrates, and values all neurocognitive profiles equally, and works to address inequities underlying minority stress.
It is important to incorporate an understanding of the neurodivergent profile into the assessment and all interactions. This requires that the clinician has:
- Foundational understanding of neurodiversity
- A commitment to working to understand the intersectionality of environment, biology and psychosocial factors and how these influence feeding, eating, body image, psychological wellbeing, and health more broadly.
The authors of Eating Disorders and Neurodivergence: A Stepped Care Approach (Cobbaert and Rose, 2023) suggest fourteen treatment considerations.
1. Neurodivergence-informed therapy: focus on the flourishing of a positive neurodivergent sense of self.
2. Quality of life: explore the neurodivergent individual’s conceptualisation of quality of life or ‘life worth living’.
3. Demand avoidance: adapt treatment and utilise alternative approaches if the individual experience demand avoidance, eg. Encourage connection with internal motivators.
4. Psychological trauma: utilise trauma-informed care approaches (higher risk of PTSD in neurodivergent populations).
5. Financial accessibility: consider the need for eating disorder care options that support equitable access.
6. Communication: avoid making assumptions about abilities and preferences. Make an effort to identify individual preferences and understanding.
7. Sensory processing: understand sensory processing differences and adjust service and treatment recommendations to meet individual needs (eg, consider eating environment, meal plan and food offerings in context of sensory profile of neurodivergent individual).
8. Interoceptive confusion and alexithymia: ethical care requires that if a neurodivergent individual indicates that they are in pain or feel unwell but their facial expression and/or body language does not necessarily reflect that, their testimony must be respected and acted upon to avoid medical gaslighting.
9. Pain threshold differences: investigate all health-related suspicions regardless of pain expression, reporting, and body language.
10. Stimming: endeavour not to restrict stim behaviours unless there are medical concerns of they are unsafe, as this can contribute to dysregulation, sensory overwhelm, and increased anxiety.
11. Routines and executive functioning: provide detail as early as possible, allow time to process, do not rush. Practice patience, compassion and a non-shaming, non-judgmental attitude.
12. Dyslexia and dysgraphia: take into consideration during treatment (eg, when giving written resources).
13. LGBTQIA+ affirming care: being neurodivergent is positively correlated with gender and sexual diversity. A gender-affirming care approach involves challenging simultaneously both neuronormativity and heteronormativity.
14. Neurodivergent-led peer support: offers potential as an addition to treatment to help foster a sense of belongingness and positive neurodivergent identity.
Taken from and inspired by: Cobbaert, L. Rose, A. (2023). Eating Disorders and Neurodivergence: A Stepped Care Approach; which aims to “encourage reflection, discussion, and collaboration amongst stakeholders to inspire future co-production and co-design of appropriate, effective, and culturally valid neurodiversity-affirming feeding and eating disorder supports across all levels of care.”
Available from: https://nedc.com.au/assets/NEDC-Publications/Eating-Disorders-and-Neurodivergence-A-Stepped-Care-Approach.pdf