Disordered Eating in Aspie Girls

I actually had no idea eating disorders were much of a problem for girls (and women) on the autism spectrum until I saw this BBC News story posted on Aspie World.

If anything, I would've thought we'd derive some measure of immunity to eating disorders --- or at least to the diet culture that fosters them --- from our social obliviousness.

According to Sharon's post, and this Greek study published in this past March's Journal of Autism and Developmental Disorders, however, that's not quite true.

The study measured the attitudes of 56 teenage girls diagnosed with Asperger syndrome, and of 56 of their age-, height- and weight-matched female classmates, toward food, eating and body image using the EAT-26 questionnaire, which is a screening tool for eating disorders:

The adolescent girls were asked to complete the Eating Attitudes Test-26 (EAT-26, Garner et al. 1982), which assesses eating attitudes and behaviors. The purpose of this questionnaire is not to provide a diagnosis of eating disorders, but it is used as a screening instrument, and people who score above 20 are advised to consult a counselor or a physician. It has been validated and used in many different countries to explore eating attitudes mainly among adolescents and young people (Lynch et al. 2007). It is divided into three subscales, namely: a) dieting, which consists of 13 items (e.g., "I am terrified about being overweight"); b) bulimia and food preoccupation, which consists of 6 items (e.g., "I have gone on eating binges where I feel I may not be able to stop"); and c) oral control, which consists of 7 items (e.g., "I feel that others pressure me to eat"). The girls rated each item on a scale from 1 = "always" to 6 = "never", which was then transformed to an inverted 4-point scale in order to obtain the final score (ranging from 0 to 78). The Cronbach alpha [link] for the entire scale in this study was .86 and it is deemed satisfactory. The mothers completed the same questionnaire answering the questions for their daughters (e.g., "My daughter is terrified about being overweight").

Both the Aspie girls and their mothers reported more eating problems overall, though the mothers tended to report fewer problems than the daughters in both the AS and control groups, i.e., average total scores and average scores on each subscale were lower when the mothers filled out the questionnaire than when the girls themselves did. Also, a higher proportion of Aspie girls (26.8%, compared with just 7.1% of their peers) scored above 20, indicating serious problems. The Aspie girls also self-reported significantly more problems than their peers did, with significantly higher overall scores (16.34, compared with 12.39) and subscores in two of the three domains. The groups of girls did not differ significantly in dieting behavior.

The study's author, Efrosini Kalyva, attributes the greater incidence of disordered eating attitudes and behaviors in Aspie girls to the "rigid and repetitive behavior patterns" common in autism spectrum conditions. She raises the possibility that these eating problems might be the adolescent incarnation of the very picky eating typical of young autistic children.

Further reading:

Nestor L. Lopez-Duran blogged about this study when it was published online last September.

Kalyva cites this article in the Times of London in her Discussion section.

Kalyva, E. (2008). Comparison of Eating Attitudes between Adolescent Girls with and without Asperger Syndrome: Daughters’ and Mothers’ Reports Journal of Autism and Developmental Disorders, 39 (3), 480-486 DOI: 10.1007/s10803-008-0648-5