Clinician Perspectives on Barriers and Enablers to Autism-Affirming Eating Disorder Care.

OBJECTIVE:Autistic people with an eating disorder (ED) report more negative experiences of ED treatment and are at greater risk of requiring higher intensity services. Current ED treatment options do not fully meet underpinning drivers of autistic people's experiences of EDs. There remains little guidance or understanding on how autism-informed adaptations are implemented. This paper aims to explore clinician-perceived barriers and enablers to implementing autism-affirming adaptations in UK ED services. METHOD:Semi-structured interviews were conducted with 12 clinicians in multidisciplinary roles across UK ED services who were beginning to implement autism-affirming care. Data were analysed using critical realist thematic analysis. RESULTS:Clinicians described many barriers associated with implementing autism-affirming care underpinned by longstanding beliefs about the risks of accommodating ED behaviours. This contributed to anxiety about making adaptations to care and the potential to over- or under-accommodate autistic needs. An underlying assumption that evidence-based practice solely equates to manualised treatment for EDs constrained adaptation. A commitment to individualised formulation and care, regardless of diagnosis, and valuing a diverse multidisciplinary team were key enablers. System-level barriers included siloed autism and ED resources and training. CONCLUSIONS:Autism-affirming adaptations challenge some core underpinning messages historically embedded in siloed ED services.