| Phase 1 Assessment and engagement | Phase 2 Parent facilitated weight restoration | Phase 3 Handing back age appropriate responsibility and exploring issues of individual and family development | Phase 4 Ending well and relapse prevention |
---|---|---|---|---|
Sensory considerations | Assessment of sensory stimuli (e.g. noise, smell, light) that may impact on attention and focus (e.g. affecting eating or ability to participate in the session) as well as specific sensory sensitivities and preferences in relation to food | Ask parents to consider preferred foods prior to onset of AN cognitions as autistic characteristics linked to sensory differences may mean there have always been certain foods they avoid May need an adapted meal plan | May be ongoing struggles with eating in public due to sensory differences and may need ongoing adaptation at school | If sensory assessment tools have been used during assessment include these in relapse prevention/staying well plan |
Cognitive and Behavioural rigidity | Consideration of environment and how family are invited to the assessment. Is there a way to increase aspects of certainty for the young person Using special interests to promote engagement and understanding | Awareness that a strong preference for routine and sameness may lend itself to young person benefitting from a predictable range of foods and eating routine during weight restoration Keeping the therapeutic process predictable and consistent | Introduction of safe certainty vs safe uncertainty and visual aid to help facilitate transition to phase 3 Managing expectations with regards to flexibility of eating Taking smaller, concrete, planned steps towards introducing increased flexibility with eating | Managing expectations from the start of therapy around when ending is appropriate Planning endings in advance and trying to avoid the ending coinciding with other significant life changes (e.g. starting a new school) |
Difficulties with social communication and relationships | Use shorter sentences Avoid too many abstract ideas or idioms Be mindful that a lack of or unusual display of social cues does not always signal non-engagement | Continuing to adopt a more literal style of communication and avoiding figurative language | Consider whether or not difficulties with social relationships and/or identity played a role in the development and maintenance of AN Awareness of proposed female phenotype of autism | Ensuring that relapse prevention plan is clear, concise and visual so that young person has concrete summary to return to as needed |
Challenges with understanding, regulating and expressing emotions | Availability of objects and activities for young person to use to help regulate arousal levels during the appointment Awareness that answering questions about emotions may be difficult | Additional psychoeducation on emotions, with anxiety/fear/guilt being the key emotions to focus on during this phase. Particularly around mealtimes Increased time on emotion regulation strategies with a focus on distress tolerance skills | Consideration of introducing additional emotion literacy and regulation skills | Awareness that endings involve change and how change can be anxiety provoking. Discuss and normalise this with young person and family |