Table 4 Statements reaching consensus (with a median of six or greater and an interquartile range of one or less) about how eating disorder staff should work with autistic women with anorexia nervosa and how they should be trained

Eating disorder staff might

Have concerns that non-autistic patients will think it is unfair that autistic women with anorexia receive different treatment

1

Find it difficult to work with autistic women with anorexia because of pressure on services and a lack of time

1

Eating disorder staff should

Change how they communicate with autistic women. Staff should try and ask specific questions instead of open ones. Staff should try and be clear about what they mean and check they have been understood

1

Develop 'communication passports' with autistic women so that all staff know the individuals' unique communication needs

1

Be aware that some autistic women benefit from staff communicating with them in a way that puts less pressure on them. This might involve asking them to do things in a less directive or demanding way

1

Provide autistic women with more written information during treatment

1

Be accepting of autistic women's need to stim (make repetitive actions/movement in order to get regulating sensory input)

0

Develop trusting and empathetic therapeutic relationships with autistic women with anorexia nervosa

0

Be aware that it might take more time to develop therapeutic relationships with autistic women with anorexia compared to with non-autistic women with anorexia

0.75

Be aware that autistic women with anorexia may be more likely to feel blamed by staff and should try and communicate information in a sensitive, non-blaming way

1

A training package for eating disorder staff should

Be developed and delivered together with autistic women

0

Be delivered to all eating disorder staff so that they have a better understanding of autism

0

Teach staff about how autism might look different in women compared to men

0.25

Draw attention to autistic people's strengths and theories of neurodiversity instead of just deficit-based information

0

Ensure staff are able to screen patients for autism

1

Ensure staff are able to distinguish between anorexia and ARFID (avoidant/restrictive food intake disorder, where a person finds eating particular foods very aversive due to things like texture and taste)

0.75

Teach staff about the ways that anorexia and autism may interact and affect each other

0

Ensure staff are able to distinguish between eating disorder behaviour and autistic behaviour, and train them to avoid setting treatment goals which aim to change autistic behaviour

0

Teach staff about meltdowns and shutdowns that autistic women may experience when overwhelmed, and how to avoid and respond to these

0

Teach staff how to adapt interventions so they are more suitable for autistic women

0