In my previous blog, Autism and Restrictive Eating Disorders: A Battle of the Senses, I looked at Loomes et al.’s (2025) review of autistic experiences of restrictive eating disorders. That review, like most research in this area, treated autism on its own. In my work at an eating disorder charity, though, the neurodivergent people I meet rarely fit into one category. Many describe ADHD traits alongside autistic ones. Some suspect they have both, and only a few have ever been asked.
Autism and ADHD are each overrepresented in eating disorder (ED) services. People with EDs are around twice as likely to have ADHD as those without (Nazar et al., 2016), and roughly 29% of people with anorexia nervosa score above the cut-off for autism on gold-standard assessments (İnal-Kaleli et al., 2025), though this does not mean they all had an autism diagnosis. Both conditions are linked to poorer outcomes. Autistic patients with anorexia nervosa (AN) often need longer and more intensive treatment (Nimbley et al., 2024), while ADHD is associated with higher dropout and more symptoms remaining after treatment (Testa et al., 2020; Svedlund et al., 2018).
Around 40% of autistic people also have ADHD (Rong et al., 2021), yet studies have almost always examined the two conditions separately. As a result, we know little about what it means to be both autistic and ADHD (AuDHD).
Makin, Allen and Tchanturia (2026) provide the first quantitative look at AuDHD in an ED population, to the authors’ knowledge. They compared AuDHD, autistic-only, ADHD-only and non-neurodivergent patients using three years of routine data from a specialist adult service.
Methods
The authors analysed existing intake data from the South London and Maudsley specialist adult ED service, collected between December 2022 and August 2025. The study was cross-sectional, capturing each patient at a single point when they entered the service. Patients completed self-report questionnaires online before their assessment. Everyone who completed them was included, whether or not they were accepted for treatment.
The form did not ask about autism or ADHD directly. Patients were classified as autistic or ADHD if they mentioned a known or suspected diagnosis anywhere on the form, usually when describing support needs, or, for ADHD, if they reported taking ADHD medication. This produced four groups: AuDHD, autistic-only, ADHD-only and Neither.
The main outcomes were ED severity (EDE-Q), psychological distress (CORE-10) and work and social functioning (WSAS). The authors also looked at autistic traits (AQ-10), family history of autism, suicide attempts, work absence and support needs. As the study was exploratory, no hypotheses were tested. Instead of significance tests, the authors used effect sizes, which show how large a difference is.
Results
Sample
Of 1,252 patients, 32 (2.6%) were AuDHD, 45 (3.5%) were autistic-only, 81 (6.5%) were ADHD-only and 1,094 (87.4%) were Neither. Most were female (89%) and white (75%), with an average age of 29. Bulimia nervosa (BN) was more common in the ADHD-only group.
The self-reported groups showed some convergent evidence. AQ-10 scores differed substantially across groups (f = 0.34, a large effect). Both the AuDHD (M = 7.84) and autistic-only (M = 6.73) groups scored above the clinical cut-off, while the ADHD-only (M = 5.35) and Neither (M = 4.17) groups did not. Family history of autism was also more common in the two autistic groups (73 to 75%) than in the others (22 to 33%).
ED Severity
Differences in EDE-Q scores were very small (f = 0.07, where around 0.10 is considered small). The ADHD-only group scored highest (M = 4.24), followed by AuDHD (4.19), autistic-only (4.03) and Neither (3.85). AuDHD patients did not score higher than ADHD-only patients. The study, therefore, found little difference in overall measured ED psychopathology between groups; it does not establish that co-occurring autism and ADHD have no additional effect. ED diagnosis was unevenly distributed, which may partly explain the higher ADHD-only score.
Distress and Functioning
The clearest pattern emerged in distress and functioning. CORE-10 distress scores were highest in the AuDHD group (M = 24.16) and lowest in the Neither group (M = 20.10; f = 0.12). WSAS scores followed the same order, from 26.56 to 20.06 (f = 0.16), with every group in the severe range. Over half of AuDHD patients (56%) reported a past suicide attempt, compared with 42% of autistic-only, 36% of ADHD-only and 25% of Neither patients. AuDHD patients were also the most likely to have taken time off work because of their ED (56% vs 22% of the Neither group). It’s important to note that these are descriptive group differences, rather than causal evidence on neurodivergence and distress outcomes.
Support Needs
Autistic patients were more likely to request communication support (31 to 38% compared with 17%). They asked for clear, concise instructions, extra processing time, predictability and help managing sensory overwhelm. ADHD patients preferred email communication to help them retain information, and asked for breaks and support with focus, organisation and time management.
Conclusions
The authors concluded that autistic and ADHD patients may arrive at ED services with greater support needs and more complexity in their presentation. AuDHD patients showed the highest distress and poorest functioning, while ADHD was most closely linked to ED severity, although differences in ED severity were very small.
The authors suggested two possible explanations rather than tested mechanisms. ADHD may fuel ED psychopathology through impulsive cycles of bingeing and purging. Autism’s effect may be more indirect, working mainly through co-occurring anxiety and depression, with autism more closely linked to restrictive eating; this study could not test these pathways directly.
The authors called for routine screening for autism and ADHD, person-centred adaptations in care informed by the PEACE pathway and larger studies through the UK Eating Disorders Clinical Research Network (EDCRN). Screening should support discussion and referral, not be treated solely as a diagnosis.
Strengths and Limitations
This is the first study to separate AuDHD from autism-only and ADHD-only presentations in an ED sample (Makin et al., 2026). Because it uses routine intake data, it reflects everyone arriving at a service, including people never accepted for treatment, rather than only those who volunteer for research, reducing selection bias (Kaźmierczak et al., 2023).
The main limitation is how patients were classified. Only 12.6% of patients were identified as autistic and/or ADHD, compared with 31% who screened positive for ADHD alone in another adult ED service (Svedlund et al., 2017). Many neurodivergent patients are therefore probably sitting in the Neither group, which would make the differences look smaller.
The analysis also limits what can be concluded. The AuDHD group included only 32 people, and analyses were descriptive rather than adjusted for ED diagnosis. Patients with BN tend to score higher on the EDE-Q than those with restrictive AN (Aardoom et al., 2012; Rienecke et al., 2024), and the ADHD-only group included more BN and less AN than the sample overall. Its higher EDE-Q scores may therefore partly reflect diagnosis rather than ADHD itself. ED diagnosis was missing for about one in five cases, adding uncertainty.
The measures raise further problems. The EDE-Q focuses on weight and shape, so it may miss restriction driven by sensory differences in autistic patients (Longhurst et al., 2025). This could make autistic patients’ ED severity look lower than it is. The CORE-10 combines anxiety, depression and risk into one score, so the authors’ own idea that autism works through anxiety and depression cannot be tested here. Bingeing and purging can also produce ADHD-like traits that ease with recovery (Svedlund et al., 2021), making self-suspected ADHD harder to interpret.
Finally, the cross-sectional intake data cannot show whether neurodivergent patients respond differently to treatment or whether adjustments improve outcomes. The sample also came from one specialist adult service and was predominantly female and white, limiting generalisability; the service does not treat BED or ARFID, so findings may not transfer to those groups.
Implications for Practice
The clearest implication is that services should stop relying on unprompted self-disclosure. The authors attribute the low number of neurodivergent patients identified to reliance on unprompted self-report rather than systematic screening, which suggests the fix is to ask. Intake forms should ask directly about known or suspected autism and ADHD, and services could consider validated screening tools such as the AQ-10 and Adult ADHD Self-Report Scale (ASRS). The EDCRN’s national dataset includes the AQ-10 as a core measure but the ASRS only as an optional one (Jewell et al., 2025). Given how common ADHD is in eating disorder services, and its links with dropout and poorer outcomes, the ASRS should be core too, and a positive screen should lead to a clear route to assessment.
The higher proportion reporting a past suicide attempt in the AuDHD group warrants careful attention, but the cross-sectional design means this should not be interpreted as showing that neurodivergence itself causes suicide risk. Services should assess suicide and self-harm risk individually and routinely, rather than using neurotype as a proxy.
Many of the adjustments patients requested cost very little, such as clear instructions, extra processing time, predictability, email communication and breaks. The PEACE pathway, which I discussed in my previous blog, already offers tools to capture these needs. One is the communication passport, which patients complete on admission to set out how they would like staff to communicate with them (Li et al., 2025). Spreading this practice to other UK services would help teams meet these needs from the start.
PEACE is also expanding beyond autism. Through PEACE+, it is developing ADHD-specific resources, and this study adds weight to that work. However, the evidence that PEACE improves outcomes comes from autistic patients. Its ADHD adaptations, centred on organisation, structured meals and managing binge-purge cycles, now need proper evaluation.
Future research should screen every patient, account for differences in diagnosis, and follow patients through treatment to compare outcomes across groups. Qualitative research with AuDHD people is also needed, as are studies including more people with binge eating disorder and ARFID, which the service is not commissioned to treat.
In my charity work, I have met people who discovered they were neurodivergent only after years in ED services. Looking back, they could identify the moments when nobody thought to ask. The paper is titled Time to notice, and its findings suggest that noticing starts with simply asking.
Statement of Interest
The author was supervised by Lauren Makin and Professor Kate Tchanturia, first and senior authors of the paper reviewed here, for her MSc dissertation at King’s College London. Professor Tchanturia also co-authored other work cited in this blog (Li et al., 2025; Nimbley et al., 2025) and leads the PEACE pathway discussed above. The author is on clinical placement on an inpatient unit within the South London and Maudsley NHS Foundation Trust’s adult eating disorder service, the service from which the study data were drawn.
Editor
The blog was edited by Dr Dafni Katsampa.
Links
Primary Paper
Lauren Makin, Karina Allen, & Kate Tchanturia. (2026). Time to notice neurodiversity in eating disorder services: A three-year real-world analysis of autism, ADHD, and AuDHD. Frontiers in Psychiatry, 17, Article 1787957.
Other References
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İnal-Kaleli, I., Doğan, N., Köse, S., & Bora, E. (2025). Investigating the presence of autistic traits and prevalence of autism spectrum disorder symptoms in anorexia nervosa: A systematic review and meta-analysis. International Journal of Eating Disorders, 58(1), 66–90.
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