BackgroundNew research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).MethodsOnline scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.Results15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.ConclusionsThis review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.

Key words: Qualitative, Autism, anorexia, treatment, comorbidityResearch suggests that up to 1 in 4 individuals with anorexia nervosa (AN) may be on the autistic spectrum, and that these autistic traits may not have been recognised or diagnosed prior to eating disorder (ED) treatment. Significantly, these heightened autistic traits are associated with poorer treatment outcomes, suggesting that treatment may need to be adapted for this population. The purpose of this study was to explore with people with AN on the autistic spectrum their experiences of ED treatment, and their views on what needs to be changed. Women with AN (n= 13) either with an autism diagnosis, or presenting with clinically significant levels of autistic traits, were interviewed on their experiences of treatment and potential improvements. Interviews were analysed using thematic analysis. The findings suggest that this population experience unique needs associated with their autism that are not being met by standard ED treatments, and recommendations are made for potential future adaptations. Future research into a more systematic approach for treatment adaptations for this population, including education programmes for clinicians, could potentially lead to better treatment experiences.

BackgroundAnorexia nervosa (AN) and autism spectrum disorder (ASD) form a relatively common comorbidity, with poorer illness outcomes and poorer responses to treatments for AN compared to individuals without ASD. However, the treatment of this comorbidity remains poorly understood: no research to date has examined how clinicians currently approach treating AN/ASD. This study aimed to explore the experiences of clinicians working with comorbid AN/ASD using qualitative methods in order to identify areas for future improvement.MethodsInterviews with individual clinicians (n = 9) were carried out and explored using thematic analysis.ResultsThe findings suggest that many clinicians lack confidence in treating this comorbidity, which requires specific changes to treatment to accommodate the issues raised by comorbid ASD. At present, any adaptations to treatment are based on the previous experience of individual clinicians, rather than representing a systematic approach.ConclusionsFurther research is needed to empirically assess potential treatment modifications for this group and to establish guidelines for best clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1455-3) contains supplementary material, which is available to authorized users.

Cognitive remediation therapy (CRT) for eating disorders has demonstrated promising findings in adult age groups, with randomised treatment trials and systematic reviews demonstrating medium to large effect sizes in improved cognitive performance. In recent years, several case series have been conducted for young people with anorexia nervosa, but these findings have not been synthesised in the form of a systematic review. This systematic review aimed to evaluate the evidence for the efficacy of CRT in child and adolescent age groups. Nine studies were identified, with a subsequent meta-analysis suggesting improvements in cognitive performance with small effect sizes. Patient feedback was positive, with low dropout rates. These findings suggest that CRT has potential as a supplementary treatment for young people with anorexia nervosa, warranting further investigation using randomised treatment trials. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Background Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals. Aims The aim of this study was to explore carers’ experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved. Method Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis. Results Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers’ problems with clinical services, the impact on carers and suggestions for future improvements. Conclusions Carers agreed that autism played a significant role in the development and maintenance of their daughters’ anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.