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Do women with eating disorders who have social and flexibility difficulties really have autism? A case series.

Mandy W, Tchanturia K - Mol Autism (2015)

Bottom Line: They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy.Only one had a childhood diagnosis of ASD.The ADOS is a useful component of an ASD assessment for adult women with ED.

View Article: PubMed Central - PubMed

Affiliation: UCL, Research Department of Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT UK.

ABSTRACT

Background: Many women with eating disorders (EDs) have social impairments and difficulties with flexibility. It is unclear to what extent these are manifestations of an underlying autism spectrum disorder (ASD); or whether they are instead the consequence of starvation, anxiety, low mood or obsessive compulsive disorder, all of which are highly prevalent in EDs. The resolution of this clinically and theoretically important uncertainty will require the use of gold-standard ASD assessment measures. To date these have not been employed in ED research. This case series is the first report of a well-validated, direct-observational measure of ASD, the Autism Diagnostic Observation Schedule (ADOS), being administered to women with EDs. We aimed to learn about the feasibility of the ADOS in this population, and to contribute to debates about whether a sub-group with EDs really have ASD.

Methods: Ten women (mean age = 26.4 years, range = 19 to 38 years) who had a suspected ASD due to social and flexibility difficulties and were receiving treatment for ED (seven anorexia, two ED not otherwise specified, one bulimia) at a specialist service (four inpatient, six outpatient) received an ADOS Module 4 assessment.

Results: All 10 participants completed all activities of the ADOS Module 4. Five scored in the ASD range on the ADOS diagnostic algorithm. An additional two were judged likely to have ASD, even though they scored below the ADOS's diagnostic threshold. This was on the basis of clinical observation, participant self-report and parent report. The seven women who we estimated to have ASD all reported autistic difficulties prior to the onset of their ED. They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy. Only one had a childhood diagnosis of ASD.

Conclusions: A substantial proportion of women with EDs who present with social and flexibility difficulties may have an unrecognised ASD, indicated by a constellation of autistic difficulties that appears to predate the onset of their eating problems. The ADOS is a useful component of an ASD assessment for adult women with ED.

No MeSH data available.


Related in: MedlinePlus

Scores on the Autism Diagnostic Observation Schedule (ADOS) Module 4 Social and Communication Domains.
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Fig1: Scores on the Autism Diagnostic Observation Schedule (ADOS) Module 4 Social and Communication Domains.

Mentions: While all 10 women in the current sample were perceived by their clinical care teams to have social and flexibility difficulties, they showed variability in their ADOS scores, as is illustrated in Figure 1. Three were classified on the ADOS algorithm as having autism, and a further two scored in the autism spectrum range. The remaining five scored below the ADOS’s ASD threshold.Figure 1


Do women with eating disorders who have social and flexibility difficulties really have autism? A case series.

Mandy W, Tchanturia K - Mol Autism (2015)

Scores on the Autism Diagnostic Observation Schedule (ADOS) Module 4 Social and Communication Domains.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4459459&req=5

Fig1: Scores on the Autism Diagnostic Observation Schedule (ADOS) Module 4 Social and Communication Domains.
Mentions: While all 10 women in the current sample were perceived by their clinical care teams to have social and flexibility difficulties, they showed variability in their ADOS scores, as is illustrated in Figure 1. Three were classified on the ADOS algorithm as having autism, and a further two scored in the autism spectrum range. The remaining five scored below the ADOS’s ASD threshold.Figure 1

Bottom Line: They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy.Only one had a childhood diagnosis of ASD.The ADOS is a useful component of an ASD assessment for adult women with ED.

View Article: PubMed Central - PubMed

Affiliation: UCL, Research Department of Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT UK.

ABSTRACT

Background: Many women with eating disorders (EDs) have social impairments and difficulties with flexibility. It is unclear to what extent these are manifestations of an underlying autism spectrum disorder (ASD); or whether they are instead the consequence of starvation, anxiety, low mood or obsessive compulsive disorder, all of which are highly prevalent in EDs. The resolution of this clinically and theoretically important uncertainty will require the use of gold-standard ASD assessment measures. To date these have not been employed in ED research. This case series is the first report of a well-validated, direct-observational measure of ASD, the Autism Diagnostic Observation Schedule (ADOS), being administered to women with EDs. We aimed to learn about the feasibility of the ADOS in this population, and to contribute to debates about whether a sub-group with EDs really have ASD.

Methods: Ten women (mean age = 26.4 years, range = 19 to 38 years) who had a suspected ASD due to social and flexibility difficulties and were receiving treatment for ED (seven anorexia, two ED not otherwise specified, one bulimia) at a specialist service (four inpatient, six outpatient) received an ADOS Module 4 assessment.

Results: All 10 participants completed all activities of the ADOS Module 4. Five scored in the ASD range on the ADOS diagnostic algorithm. An additional two were judged likely to have ASD, even though they scored below the ADOS's diagnostic threshold. This was on the basis of clinical observation, participant self-report and parent report. The seven women who we estimated to have ASD all reported autistic difficulties prior to the onset of their ED. They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy. Only one had a childhood diagnosis of ASD.

Conclusions: A substantial proportion of women with EDs who present with social and flexibility difficulties may have an unrecognised ASD, indicated by a constellation of autistic difficulties that appears to predate the onset of their eating problems. The ADOS is a useful component of an ASD assessment for adult women with ED.

No MeSH data available.


Related in: MedlinePlus