Eating disorders and autism: extension of the PEACE pathway to children and young people

A greater susceptibility to development of eating disorders (EDs) has been recognised among people with autism since the 1980s. Standard treatment approaches for EDs can be less effective for those with autism or autistic features, but there are no separate guidelines for the management of EDs in this population. The clinical need for autism to be understood and accommodated better in ED services has become increasingly apparent in recent years. The PEACE (Pathway for Eating disorders and Autism developed from Clinical Experience) pathway, was launched by the London Maudsley Hospital in 2017 and is the first treatment approach to be developed specifically for autistic adults receiving inpatient treatment for an eating disorder. Following the success of the PEACE pathway in London, three years of innovation funding was granted to child and adolescent ED services in Buckinghamshire, Oxfordshire and Berkshire (BOB) to support the local implementation of this approach in community services. The aim was to apply similar principles while offering reasonable adjustments and ensuring the delivery of neuroinclusive care. Initial evidence suggests that the proactive, neuro-affirming approach to ED treatment in young people with autism emphasised by PEACE can improve treatment experience, reduce risk and shorten or avoid higher-intensity treatments for some patients. It is hoped that the care delivery model, adaptations and resources developed as part of the BOB PEACE implementation will be adopted more widely to benefit many more autistic children, young people, adults and families struggling with EDs.