Parent’s guide to neurodivergence and eating disorders

There are many different pathways to eating disorders that we’re still learning about, especially when it comes to neurodivergence. In these cases the symptoms may not fit what we consider to be a “typical” eating disorder. They may not begin by dieting to lose weight or include body image issues.

If your child is neurodivergent and has an eating disorder, it’s important to work closely with your child’s providers to make sure eating disorder treatment takes that into account. Working with a therapist and/or dietitian who understands neurodivergence is essential.

Up to 37% of people with eating disorders have autism, and 31% of adults diagnosed with eating disorders also have ADHD. Research indicates that people with neurodivergence benefit less and have poorer outcomes from traditional treatment for eating disorders. Unless we address the neurodivergent symptoms involved in some eating disorders, it’s much harder to achieve recovery. I put together the three symptoms I see most often when working with parents who have neurodivergent kids.

Picky eating/food aversions

The neurotypical approach to food assumes that everyone enjoys eating and will eat most foods. We assume that most people can eat almost anything and that any quirks or preferences can be overcome by circumstance and social pressure. For example, we expect that if you don’t like cantaloupe, but that’s all there is, and your parents are telling you to eat it, you will eat cantaloupe. 

However, while this may be the dominant attitude towards food, it is far from universal. There are many people, particularly those who are neurodivergent and especially those with autism and ADHD, who have highly sensitive palates who are not just mildly averse to certain foods but who develop severe aversions to food based on their five senses (sight, smell, sound, taste, texture) as well as their memories of being pressured to eat the food even when they don’t like it. Combined, these aversions take a tendency to be picky about food to a full-blown food aversion. 

Once a person develops a serious food aversion, eating that food is not as simple as being hungry or receiving well-meaning pressure to try it. These people are strongly opposed to that food and may have physical symptoms like a racing heart, sweating, nausea, and even vomiting when faced with that food. Their list of “safe foods” may dwindle as they become more sensitive over time. This is how picky eating and food aversions can tumble into disordered eating and an eating disorder.

How to help

Parents can support recovery by feeding their child regular meals, having family meals, and gradually exposing them to more food variety in a non-pressured environment. They can support a child in exploring their food-based sensory and emotional issues and soothe them when emotional dysregulation makes eating hard. 

Recovery does not have to mean a person becomes a “typical” eater. Parents and providers can help kids learn to feed their bodies in light of their unique neurobiology and psychology.

Forgetting to eat/procrastinating eating

The neurotypical approach to food assumes that when you are hungry, you will eat. This idea assumes that anyone who skips meals or procrastinates eating is doing so because they want to lose weight. However, while this may be the neurotypical response to hunger, it is far from universal. Sometimes people assume a child who doesn’t eat is being stubborn, defiant, or lazy. However, there are many people, particularly those who are neurodivergent and especially those with ADHD, who don’t notice their hunger cues and/or are not motivated to interrupt what they are doing to eat. This is a neurological difference, not defiance or a choice. 

These people may skip meals because they completely forget to eat or put eating off for a later time. This is a form of unintentional food restriction that can lead to a cascade of other eating disorder behaviors, including negative body image, more restriction, binge eating, and purging. It’s very easy to create the story that the reason they don’t eat is for weight loss. However, if we miss the essential lack of hunger cues and drive to eat, we will not truly address the cause of disordered eating.

How to help

People who don’t notice and respond to their hunger cues can use intentional (vs. intuitive) eating to recover. Parents can support recovery by serving food regularly, having family meals, and prompting eating, especially when distraction is involved. They can also teach kids to prioritize eating and recognize non-typical signs of hunger.

Recovery may not have to mean intuitively feeding their body based on typical hunger cues. Instead, parents and providers can support kids in learning to feed themselves given their unique situation. 

Oppositional assertion of independence

When a child is picky and/or forgets to eat, parents tend to increase their focus on food and eating. This is appropriate, as we are responsible for helping our kids get the nutrition they need. Unfortunately, many times the way we go about this backfires. While parents need to support kids in eating, power struggles about eating are very common. They can compound the original issue that leads to picky eating and/or procrastinating eating. 

Psychiatrist William W. Dodson, MD, says that by age 12, kids with ADHD have heard about 20,000 more negative messages from adults compared to kids who don’t have ADHD. Since they are already highly sensitive to negative feedback, the level of negativity that they receive based on their neurodivergent qualities can be devastating and lead to oppositional defiance. 

Because they feel so criticized and marginalized, neurodivergent kids are often more resistant to even the mildest prompting from parents. Additionally, when food becomes an issue, parents can become hyper-focused on it, making eating even more stressful and, therefore, unlikely.

How to help

Parents can help a child who is oppositional and engaging in extended power struggles over food by learning how to co-regulate with their child before offering instruction. This means slowing the whole process of feeding down to attend to the child’s core need to feel connected to the parent before the parent tells them what to do.

The good news is that when parents learn to feed neurodivergent kids based on their unique symptoms and patterns, they can make a huge difference in eating disorders. A cookie-cutter approach doesn’t really work for anyone with eating disorders, but this is particularly true when neurodivergence is a factor.

See Our Parent’s Guide To Mental Health And Eating Disorders