Skip to main content

Table 2 Summary of proposed autism-related adaptations for Family Therapy for Anorexia Nervosa (FT-AN)

From: Widening the reach of family-based interventions for Anorexia Nervosa: autism-adaptations for children and adolescents

 

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