Psy-Q: How can clinicians recognize – and respond – to the earliest signs of disordered eating in young people with autism spectrum disorder (ASD)?

Stephanie Waitt, PhD

Answer:  Stephanie Waitt, PhD, LPC, CEDS, who runs Texoma Specialty Counseling in Sherman, Texas, shares some strategies to help practitioners be proactive, especially when caring for young people with autism spectrum disorder (ASD), who can be at increased risk for developing serious eating disorders.

“There is a new diagnosis in the DSM-5: Avoidant Restrictive Food Intake Disorder (AFRID). This looks very similar to anorexia, except there are no weight or body concerns. But there are a lot of food concerns,” explains Dr. Waitt. “Individuals with autism are at a higher risk to develop AFRID.” Yet, body weight, appearance, and lab tests may not reveal an obvious problem. This makes it important to screen for more subtle signs of eating issues.

Screening for Eating Disorders: Ask the Right Questions

As a clinician, some questions you can ask patients (or their parents/caregivers) to understand a person’s eating habits include:

  • How much is the person eating?
  • What rules and diets are they following?
  • How many diets have they tried?
  • How much does weight and food concern impact their day?

“I also love to use an evidence-based screening tool called the SCOFF that asks five simple questions with ‘yes’ or ‘no’ answers. Any ‘yes’ response would warrant further investigation into a possible eating disorder. This screening tool could be added to any intake questionnaire,” says Dr. Waitt.

Eating Disorder Treatment Strategies: Take a Multifaceted Approach

The good news is that eating disorders are very treatable – both in people with ASD and the general population. “The sooner someone can get help and treatment, the more positive treatment outcomes they will experience,” stresses Dr. Waitt.

Her treatment strategies, which are multifaceted, include:

  • Encouraging patients to forego diets, which can lead to eating disorders, and helping them embrace intuitive eating practices.
  • Involving parents or caregivers in the treatment process – including through family-based therapy – to ensure patients have support to adopt healthier behaviors.
  • Working with the person’s strengths. “Someone living with autism operates with rules and structure; this can be used to help set up a structure for mealtimes. Eating at certain times and giving the individual autonomy to choose foods will help with anxiety around eating,” she points out.
  • Reducing anxiety. “We also use a lot of anxiety management tips when helping children manage autism and an eating disorder. Grounding skills and distraction tools can also be helpful at mealtime,” Dr. Waitt says.

Clinical Resources

For clinicians who want to access more resources to support people with eating disorders, Dr. Waitt recommends contacting the National Eating Disorder Association at or the Recovery Academy.

More perspectives.

Last Updated: Oct 12, 2021