We know that dieting for weight loss purposes is a major cause of eating disorders. But there are many different pathways to eating disorders that we’re still learning about, especially when it comes to neurodivergent kids.
These kids often don’t fit what we consider to be a “typical” eating disorder. They don’t begin by dieting to lose weight. They may not start with body image issues. (However, disordered eating often causes negative body image and more eating disorder behaviors.)
The “story” of the eating disorder may be food and weight. However, the original cause of many eating disorders is being neurodivergent. Up to 37% of people with eating disorders have autism, and 31% of adults diagnosed with eating disorders also have ADHD.
Research indicates that neurodivergent people benefit less and have poorer outcomes from traditional eating disorder treatment. Unless we address the neurodivergent pathways that lead to eating disorders, it’s much harder to achieve recovery.
There are many causes of eating disorders; they are complex and vary greatly. I put together the three pathways I see most often when working with parents who have neurodivergent kids.
Emotional Regulation Worksheets
Give your child the best tools to grow more confident, calm and resilient so they can feel better, fast!
- Calming strategies
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 neurodivergent 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.
Parents also need to accept that kids like this are unlikely ever to have a neurotypical relationship with food and eating. Their recovery will not mean they become typical eaters. Parents who accept that food and eating are more complicated for neurodivergent kids help them 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 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 must address their underlying neurobiology and 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 at play. They can also teach kids to prioritize eating and recognize non-typical signs of hunger. This is an essential skill that becomes particularly important when kids leave home.
Parents must accept that a child with this neurobiology will probably not turn into a neurotypical eater who intuitively feeds their body based on typical hunger cues. Instead, a person like this will need to learn how to feed themselves on purpose.
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.
It’s so crucial for parents to approach kids’ eating disorders with neurodivergent characteristics in mind. A child who is not eating because they are neurodivergent needs specialized care and treatment. Finding a therapist and/or dietitian who understands neurodivergence is essential.
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. For example, CBT (cognitive behavioral therapy) is a gold standard treatment for eating disorders. However, it is unlikely to help someone who is neurodivergent unless neurodivergent causes are understood and addressed.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate their kid’s eating disorder recovery. Ginny has been researching, writing about, and supporting parents who have kids with eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.