Background: Binge-like behaviors are well represented among individuals with Autism. Despite this, many of the formal criteria used to clinically establish BED are not applicable. This is not an isolated example of diagnostic discrepancy, but an illustration of the difficulty of eating disorder treatment for those on the autism spectrum.
Objectives: Following this presentation, participants will be able to identify which diagnostic criteria of BED are applicable to individuals with Autism. Following this presentation, participants will be able to identify which diagnostic criteria of BED do not apply or cannot be assessed for individuals with Autism. Following this presentation, participants will be able to explain some of the difficulties with identifying, diagnosing and treating eating disorders amongst individuals with Autism.
A. How Autism is Diagnosed
B. Ancillary Presentation of Behaviors: Sensory based behavior abnormalities
II. Overview of Eating Disorders on the Autism Spectrum
A. Children -- Rates as high as 90%
B. Adults -- ED over the lifespan
III. Binge Eating Disorder (BED)
A. Formal Diagnosis
- Eating more rapidly than is normal;
- Eating until uncomfortably full;
- Eating when not hungry or when full;
- Eating alone due to embarrassment;
- Feelings of disgust, depression or guilt post-consumption
B. Evidence for presentation of formal BED criteria amongst those with autism: a comparison
C. Assessing mental states for those with communicative disorders.
D. BED Treatment
1. Cognitive Behavioral Therapy (CBT)
E. BED Etiology
IV. Diagnosis and treatment of eating disorders on the Autism spectrum
A. Challenges
B. Future Directions
BED is formally defined by the presence of any three out of five features:
This presentation will address each of these criteria and demonstrate the evidence for presentation amongst those with Autism and the difficulty, in most cases, of even assessing mental states for those with communicative disorders. Thus, even though binge eating is widely prevalent amongst children and adults with Autism, assessment based upon formal criteria is almost impossible.
The same discordant note applies to treatment. Cognitive Behavioral Therapy (CBT) has the strongest empirical support for treatment of BED. However, psychotherapy of any type requires that the patient be participative which puts it beyond the reach of most individuals on the spectrum.
Assessing the underlying causes of BED remains complicated in any population, but very different mechanisms appear to be at work on the Autism spectrum and it is most likely that etiology is quite distinct.
This examination demonstrates the difficulties of diagnosing and treating eating disorders for those with Autism. Clinical competency for professionals working with this population is clearly a challenge that will require greater interdisciplinary emphasis in terms of both research and practice.
Janice Goldschmidt has spent the last decade teaching cooking skills to adults with autism as a form of nutrition intervention. Publications include: "Nutritional status and autism spectrum disorders." Adv Nutr 6(6): 865 "What Happened to Paul? Manifestation of Abnormal Pain Response for Individuals With Autism Spectrum Disorder." Qual Health Res. With H. J. Song (2015). "At-Risk and Underserved: A Proposed Role for Nutrition in the Adult Trajectory of Autism." J Acad Nutr Diet 115(7): 1041-1047. With H.J. Song (In Press). "Development of Cooking Skills as Nutrition Intervention for Adults with Autism and Other Developmental Disabilities." J Acad Nutr Diet.
