Abstract
Thirty years of scholarship has suggested that anorexia nervosa (AN) may be a “female presentation” of autism, supported by work which has found elevated rates of autism traits and diagnoses among women with clinical levels of AN. These traits are often assessed using the Autism Diagnostic Observation Schedule 2nd Edition (ADOS-2), considered the “gold-standard” tool. Recently, the authors of the ADOS-2 revised the diagnostic algorithm for the adult version of the assessment—the one most often used with AN patients. We therefore examined differences in the scores, rates of diagnosis, and correlations with other mental health issues between the two diagnostic algorithms among women with and without AN. One hundred seventy-five women with current AN, who had recovered from AN, and with no history of AN, between the ages of 12 and 53, took part in an ADOS-2 assessment. Their scores were then calculated according to both the original and the new algorithms. The new ADOS-2 algorithm identifies more women as potentially being on the autism spectrum than the old algorithm. Under both algorithms, more currently ill AN patients were identified as potentially being autistic than those with no history of AN. Recovered individuals represented a midpoint between the scores of those with and without AN on both algorithms. There were no correlations with mental health scores in any group, meaning that the new ADOS-2 algorithm is not falsely identifying anxious behaviors or depressive presentations as signs of autism in this group. Overall, we found that more AN patients and recovered individuals scored above cut-off on the new ADOS-2 algorithm, suggesting that women who experience AN may have more autistic traits, which in part persist following weight restoration and recovery. However, the ADOS-2 should not be used alone but in combination with broader clinical assessments to determine whether an autism diagnosis is appropriate for these women.
Highlights
Autism is a neurodevelopmental condition which is present from early childhood, it may not be identified until much later, especially in girls and women [1]
There was a significant difference in age between the groups such that the recovered from AN (REC) group was significantly older than the healthy control (HC) [t(172) = −3.07, p = 0.007] and the Anorexia nervosa (AN) group [t(172) = −3.51, p = 0.002]
There were no significant differences between currently ill AN and recovered participants on their Autism Diagnostic Observation Schedule 2nd Edition (ADOS-2) scores, inspection of the median scores per group suggested that recovered participants may represent a midpoint between currently ill AN and HC participants
Summary
Autism is a neurodevelopmental condition which is present from early childhood, it may not be identified until much later, especially in girls and women [1] It is associated with a range of difficulties and differences in the realms of social imagination, social communication, restricted and repetitive behaviors and interests (RRBIs), and sensory processing [2]. People with AN have been found to have greater detail focus at the expense of the big picture, poor cognitive flexibility, and strict rule adherence when compared to HCs [17,18,19] Together, these findings have led to increasing interest in the theorized association between AN and autism
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