Eating Disorder Focused Family Therapy with Autistic Children and Young People: A Narrative Review of Recent Developments

Abstract

This review aims to report the recent advances for eating disorder focused family therapy (FT-ED) for Autistic children and young people, including outcomes, experiences, and suggested adaptations. Quantitative studies suggest that Autistic children and young people (and those with high autistic traits) receiving outpatient FT-ED are more likely to require escalation to more intensive levels of care compared to non-autistic peers. Qualitative research shows that Autistic young people and their parents/carers often report poor experiences of FT-ED. Clinicians report a lack of confidence, particularly when adapting care from a manualised approach. Commonly suggested adaptations include environmental adjustments (e.g., quiet spaces, dimmed lights), sensory-informed understanding of food and eating preferences (e.g., accounting for historical eating behaviour), communication adaptations (e.g., passports and clear, literal language), psychoeducation on autism and eating disorders, careful consideration of externalization, and use of separated sessions. Given that Autistic children and young people and their parents report poorer experiences of FT-ED relative to their non-autistic peers, adaptations that accommodate autistic needs while not interfering with ED recovery should be considered. Further development of guidelines and decision-making tools may support FT-ED clinicians to deliver effective and inclusive care.