Time to Notice Neurodiversity in Eating Disorder Services: A Three-Year Real-World Analysis of Autism, ADHD, and AuDHD

Introduction: Autism and ADHD frequently co-occur and each of them are overrepresented in clinical eating disorder (ED) services, where they are associated with longer treatment, poorer treatment experiences, and worse clinical outcomes. Separately, Autistic and ADHD patients with EDs present with greater ED psychopathology, anxiety, and depression. Autistic patients also present with poorer quality of life, increased suicide attempts, and greater functional difficulties. However, no study has directly compared patients with EDs who are both Autistic and ADHD (AuDHD) with Autistic-only, ADHD-only, or neurotypical patients. <br/>Method: This cross-sectional, observational study compared ED psychopathology (EDE-Q), psychological distress (CORE10), and work and social functioning (WSAS) across adult ED patients reporting suspected or known Autism, ADHD, both, or neither. No formal hypotheses were pre-specified. Data were three-years of routinely collected intake information from a specialist adult ED service. Patients were classified as Autistic or ADHD if they reported a diagnosis/suspicion at intake, or, for ADHD, if they reported ADHD medication.<br/>Results: Of 1,252 patients, 32 (2.6%) were classified as AuDHD, 45 (3.5%) as Autistic-only, and 81 (6.5%) as ADHD-only. Group differences were small but consistent. EDE-Q scores were highest in the ADHD-only group and lowest in the Neither group ((M=4.24 vs M=3.85, f=0.07). CORE10 and WSAS scores were highest in AuDHD and lowest in Neither (M=24.16 vs M=20.1, f=0.12; M=26.56 vs M=20.06, f=0.16).<br/>Discussion: Autistic and/or ADHD patients with EDs showed greater psychological distress, and poorer functioning, particularly when both were present. ADHD was particularly linked to increased ED psychopathology. Screening for neurodivergence in ED services may support person-centred care and improve outcomes.