Kelly Barnhill, MBA, CN, CCN, discusses nutrition in autism based on recent publications. She outlines research updates on amino acid patterns, probiotics, and dietary interventions, underscoring both what we know and what we don’t know. The speaker discusses the clinical interpretation and application of this research, touching on common nutrient deficiencies before the Q&A.

In this webinar:

0:00 – Introductions
2:00 – Prospective study on amino acid patterns
5:50 – Prospective Study on Probiotic Intervention
7:40 – Systematic Review of Dietary Intervention and Gut Health
10:54 – Bibliometric Analysis of Influential Articles
13:47 – Systematic Review of Probiotics in Autism
16:06 – Nutrition Reviews Study on Mediterranean Diet
19:28 – Study on Gluten- and Casein- Free Diet
21:48 – Review on Ketogenic Diet
26:16 – Food, Nutrition, and Autism
27:57 – Systematic Review – Food as Medicine
34:40 – Clinical interpretation and application
40:30 – Micronutrients
44:10 – Q&A

Prospective Study on Amino Acid Patterns 

Dr. Barnhill outlines a 2025 study on amino acid patterns in over 1,200 children (2-8 years) with autism. Researchers found lower levels of glutamine in children with autism and significant differences in several amino acids across groups (2:00). Specifically, the study noted that those with neurological impairment were deficient in amino acids that presented with susceptibility to neurocytotoxicity and oxidative stress, while those with nutritional concerns presented with a different set of issues, pointing more toward metabolic concerns. Barnhill explains that these findings substantiate clinical observations and suggest that specific amino acid imbalances may be related to different manifestations of autism, supporting the use of nutritional therapeutic intervention to balance amino acid levels. The speaker emphasizes that this is the only amino acid study presented in a prospective way that has been published in a reputable journal in the past few years. 

Amino Acid Patterns in Children with Autistic Spectrum Disorder: A Preliminary Biochemical Evaluation (Ferraro et al., 2025)

Prospective Study on Probiotic Intervention 

The presenter outlines another recent study that speaks to the concerns of effects of probiotic support for children with autism, AD/HD, and children with both diagnoses (AuDHD) (5:50). Children were given a probiotic or a placebo for three months. Researchers saw a significant improvement in hyperactivity and impulsivity in both the autism and ADHD groups. Most notably, the “comfort score” on a quality-of-life instrument showed significant improvement for autistic children. Barnhill notes that, although this is a small study, its findings support clinical observations that probiotics can improve gastrointestinal symptoms and other related issues in children with autism, potentially impacting their quality of life.

Effect of Probiotics on the Symptomatology of Autism Spectrum Disorder and/or Attention Deficit/Hyperactivity Disorder in Children and Adolescents: Pilot Study (Rojo-Marticella et al., 2025)

Systematic Review of Dietary Intervention and Gut Health 

Barnhill examines a systematic narrative review of all articles published between 2000 and 2024 related to autism, dietary interventions, probiotics, and the microbiome. (25-year review) (7:40). The review validated that dietary intervention can improve GI symptoms and gut health for children with autism, which in turn improves their quality of life. Researchers also identified a cycle where sensory processing issues lead to food avoidance (ARFID), which decreases microbiome diversity and increases harmful microbial species, leading to a neuroinflammatory process that affects behavior (9:12). The speaker asserts that this review provides a strong rationale for addressing GI and microbiome concerns as part of a comprehensive care plan for individuals with autism.

Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder (Tomaszek et al., 2025)

Bibliometric Analysis of Influential Articles 

The speaker highlights another 25-year study that reviewed all publications on microbiome treatment in autism since 2000 to identify the most impactful and cited articles (10:54). This is one of the first in a series of bibliometric analyses. The study identified two landmark publications: a 2013 mouse model study that established the link between the gut microbiome and ASD, and a very early, relatively small study from 25 years ago that showed improvements in both GI symptoms and behavior in a small group of autistic children treated with an oral antibiotic. These two studies, along with many more, laid the groundwork for the growing field of gut-brain research in autism and further validated the clinical utility of targeting gut health.

Influential articles in autism and gut microbiota: bibliometric profile and research trends (Ying et al., 2025)

Systematic Review of Probiotics in Autism 

Barnhill discusses a systematic review that analyzed 10 completed and published clinical studies, as well as 18 ongoing clinical trials, on the use of probiotics in autism. (13:47). Reviewers found that probiotics can improve social behaviors, drastically improve GI symptoms, and positively alter the gut microbiome when used appropriately. The presenter emphasizes this paper as a valuable and easily accessible resource for clinicians and parents, as it provides research backing for the use of probiotics in addressing a range of symptoms beyond just GI issues – essentially describing what we’ve learned and why it’s important.

Probiotics in autism spectrum disorders: a systematic review of clinical studies and future directions  (Barba-Vila et al., 2025)

Nutrition Reviews Study on Mediterranean Diet

Barnhill notes that we are seeing more and more solid research emerging about how dietary intervention benefits individuals across the board, highlighting that there is no one-size-fits-all approach for any of us and what that means for clinical applications. She outlines a 2025 evaluation of all studies on children (6-16 years) with autism and ADHD, examining responses to nutritional interventions (16:06). The paper concluded that 70% of individuals who followed a Mediterranean diet showed significant improvement in ADHD symptoms. It also noted significant improvements in depression (80%) and anxiety (50%). The speaker states that these results suggest that focusing on a whole, unprocessed Mediterranean-style diet can be a profound and effective intervention for improving neurological and mental health symptoms. 

Mediterranean Diet and Mental Health in Children and Adolescents: A Systematic Review (Camprodon-Boadas et al., 2025)

Study on Gluten- and Casein-Free Diet

The speaker outlines another 2025 study that evaluated a 12-week trial involving 80 children (4-10 years), using a strict, prescribed gluten- and casein-free diet in combination with and separate and distinct from a neurodevelopmental physical therapy program (19:28). Barnhill notes that families prepared meals on their own, meaning there was no technical control group. Researchers saw significant gains in gross motor skills and cognitive function only when the diet was combined with the therapy program. The dietary group alone showed no significant changes. This study suggests that a multidisciplinary, holistic approach is key, and that dietary interventions may be more effective when combined with other therapies.

Effect of Therapeutic Diet Along with Special Physiotherapy Program on Gross Motor Development and Cognitive Function in Autistic Children: A Randomized Controlled Trial (Alsayegh et al., 2025)

Review on Ketogenic Diet

A review of all published papers on the ketogenic diet for individuals with autism found that the diet is not appropriate for everyone due to the high heterogeneity of autism. However, Barnhill continues, it does hold great potential for some individuals by reducing bacterial dysbiosis, decreasing pro-inflammatory cytokines, enhancing gut health, and providing a neuroprotective effect via ketone bodies (21:48). Barnhill underscores that while the ketogenic diet can be effective for the right patient, it should only be implemented with professional guidance due to its complexity and potential dangers when applied inappropriately. More research is needed.

Exploring the potential of the ketogenic diet in autism spectrum disorder: metabolic, genetic, and therapeutic insights (Schrickel et al., 2025)

Food, Nutrition, and Autism

The presenter provides a summary article describing our current understanding of nutrition and autism from a societal and cultural perspective. The paper tangentially addresses all the issues that people in the US should be aware of and attuned to, including environmental and food exposures from prenatal to childhood. Barnhill asserts this study is foundational for building an appropriate dietary approach and understanding what barriers might exist (26:16). 

Food, nutrition, and autism: from soil to fork (Shepard et al., 2024) 

Systematic Review – Food as Medicine

The speaker notes a recent systematic review that addresses the use of dietary intervention and therapeutic nutritional support across various diagnoses (27:57). The authors highlight several publications that support the idea that food can be considered a form of medicine and is increasingly understood as a pharmaceutical component in health and medical diagnoses. Barnhill emphasizes the importance of not viewing food choices and dietary recommendations for autism as “other” to the general population’s nutritional understanding. Culturally, we continue to recognize that our diets are integral to health and need to be taken seriously. She states that “we need to hold autism research and interventions to the same standards.” This study ultimately resolidifies the interconnectedness of the gut and brain by highlighting the impact of microbiome health in the GI system on both the vagal nerve and cognition (31:00). 

Nutraceuticals in Psychiatric Disorders: A Systematic Review (Bozzatello et al., 2024)

Clinical interpretation and application

According to the presented information, Barnhill asserts that clinicians should assume that diet matters and that a nutritionist or dietary specialist should be included in care counseling and planning for children and adults with autism (34:40). She underscores the importance of avoiding packaged food products, ensuring fiber and water intake are sufficient, and addressing feeding concerns with care and compassion. She also suggests incorporating family and community into diet changes, meal preparation, and eating habits. The speaker also suggests working with a professional to outline any specialized diets (37:40). 

Micronutrients & Therapeutic Support

Barnhill lists common micronutrient deficiencies, including B vitamins, fat-soluble A and D, and Omega-3 fatty acids. She notes that addressing gaps with supplemental support is reasonable and appropriate to meet the minimal needs in the case that someone doesn’t have access to those nutrients via diet (40:30). She cautions viewers about the supplement market, noting that it is not regulated; and suggests consulting with someone well-versed in what’s needed and the efficacy of different brands before the Q&A (44:10). 

Blythe A. Corbett, Ph.D., discusses her lab’s research on puberty, adolescence, and mental health in autistic individuals. She emphasizes puberty as a period of significant biological maturation involving several physical, biological, hormonal, and social factors. The speaker details her lab’s latest research on pubertal onset, mental health, hormonal changes, and gender identity in autistic young people compared to allistic (non-autistic) groups. Corbett repeatedly emphasizes how puberty can be particularly complex for autistic youth (especially those assigned female at birth), who are already vulnerable to change and stress. She summarizes the presentation and underscores the importance of exploring how puberty’s hormonal, psychological, and social changes interact with the autism phenotype before the Q&A.

Handouts are online HERE

In this webinar:

1:15 – Outline
5:10 – Adolescence, puberty & associated risks
9:25 – Measuring puberty
13:15 – Autistic vs. allistic pubertal onset
19:00 – Cortisol levels in autistic young people
25:25 – Depression in young people with autism
32:15 – Testosterone and development
37:00 – Gender identity
43:00 – Conclusions & future research
47:30 – Q&A

Adolescence & puberty in autism

Corbett describes autism as a neurodevelopmental condition characterized by differences in social communication (e.g., social-emotional reciprocity, non-verbal communication) and restricted, repetitive patterns of behavior, interests, or activities (e.g., insistence on sameness, sensory sensitivities) (01:35). Adolescence, she explains, is a transformative stage characterized by significant psychological, social, emotional, and hormonal shifts, typically spanning ages 10 to 24. Within this broader period of adolescence, puberty specifically marks the biological maturation that leads to reproductive capacity and further psychosocial development (5:10). For autistic individuals, who often experience challenges with social communication, adaptability to change, and sensory sensitivities, navigating these developmental milestones can be particularly complex.

The presenter explains that early onset puberty can increase the risk for mental health problems, such as anxiety, depression, and suicidality, which are already more prevalent in adolescents with autism (05:58). Until recently, research on puberty and autism has been limited. Some recent studies suggest that while social cognition might improve during puberty, social withdrawal can intensify, and about a third of youth experience significant psychosocial problems. Further, female-presenting autistic people have reported challenges with emotion regulation and heightened sensory experiences during menstruation (08:06).

• A Two-Hit Model of Autism: Adolescence as the Second Hit (Picci & Scherf, 2015)
• Changes in Maladaptive Behaviors From Midchildhood to Young Adulthood in Autism Spectrum Disorder (Anderson et al., 2011)
• Autism after Adolescence: Population-based 13- to 22-year Follow-up Study of 120 Individuals with Autism Diagnosed in Childhood (Billstedt et al., 2005)
• Autism spectrum disorders and menstruation (Hamilton et al., 2011)
• In Search of Explanations for Early Pubertal Timing Effects on Developmental Psychopathology (Ge & Natsuaki, 2009)
• Pubertal Timing, Depression, and Externalizing Problems: A Framework, Review, and Examination of Gender Differences (Negriff & Susman, 2011)
• Other-Sex Relationship Stress and Sex Differences in the Contribution of Puberty to Depression (Llewellyn et al., 2012)
• Depressive and Anxiety Symptom Trajectories From School Age Through Young Adulthood in Samples With Autism Spectrum Disorder and Developmental Delay (Gotham et al., 2015)

Puberty onset and measurements

Corbett briefly describes methods for measuring puberty, including Tanner staging (physical exam), parent report (e.g., Pubertal Development Scale), and self-report (e.g., gender-specific self-assessment questionnaire) (09:27). She outlines a recent publication by her team which found that pubertal assessments by parent or child are not reliable indices of precise pubertal staging, compared to physical exams (11:05). Corbett and her team use all three methods of measurement in their studies to compare perceived development with physical indices. The speaker touches on models and frameworks used to help understand the links between mental health, puberty, and autism.

A study published by Corbett and colleagues in 2020 shows that autistic females experience significantly earlier breast development and onset of menses compared to typically developing females, while pubertal onset for autistic males is similar to neurotypical males (13:15). A longitudinal study assessing the progression of puberty in the same participants between 10 and 15 years of age verified these findings. Corbett reiterates that pubertal onset “sets into motion a cascade of events which may magnify and further complicate an already vulnerable trajectory, especially in females (17:00).” 

• Pubertal Development Measurement in Children With and Without Autism Spectrum Disorder: A Comparison Between Physical Exam, Parent- and Self-Report (Corbett et al., 2019)
• Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder (Corbett et al., 2020)
• Examination of pubertal timing and tempo in females and males with autism spectrum disorder compared to typically developing youth (Corbett et al., 2022)

Altered cortisol levels in autism

The speaker describes the Hypothalamic-Pituitary-Adrenal (HPA) axis, which plays a vital role in our stress response by triggering a neuroendocrine cascade to produce cortisol. Cortisol, she continues, is a widely used biological marker found in blood and saliva (19:00). Normally, cortisol levels peak in the morning and decline throughout the day. However, Corbett’s research consistently shows that autistic children exhibit significant variability in cortisol levels, with persistently elevated evening cortisol and a “blunted slope” compared to their allistic peers. This means their cortisol doesn’t rise or drop to the same level, impacting their ability to feel energized during the day and rest well during the night (20:30). Another longitudinal study on cortisol trajectory further revealed that HPA axis maturation is impacted by age, puberty, sex, and an autism diagnosis, where females had higher overall cortisol and higher evening cortisol than the males in both groups (22:00). 

• The developmental trajectory of diurnal cortisol in autistic and neurotypical youth (Corbett et al., 2023)

Psychological well-being: depression in autistic adolescence

The presenter notes that half of all people who will suffer from mental illnesses have their onset by age 14, making adolescence a critical period for mental health, especially for autistic youth. A study conducted by Corbett and Dr. Jessica Schwarzman found that depressive symptoms are significantly higher in both autistic males and females as early as 10-13 years of age. Parents corroborated these findings, reporting higher depressive symptoms in their autistic children, especially in females (25:25). The presenter therefore asserts that screening and intervention for depressive symptoms for autistic individuals should begin very early in adolescence. She notes that symptoms were often related to interpersonal problems and feelings of worthlessness, which are crucial intervention targets (28:00).

Corbett outlines a recent longitudinal study on the trajectory of depressive symptoms which revealed that while autistic individuals reported significantly higher depression symptoms at age 10, their symptoms actually decrease through adolescence, contrasting with an increase seen in allistic youth around ages 14-15 (30:00). The speaker notes that if replicated, this data warrants significant attention, potentially pointing to earlier identification and treatment for autistic youth.

• Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers (Schwartzman & Corbett, 2020)
• Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents (Schwartzman et al., 2022)
• Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth (Corbett et al., 2024)

Hormonal differences

Corbett explains that imbalances in hormones such as testosterone may modulate autism phenotypes. However, there is limited research regarding variations in testosterone during adolescence in autism (34:15). She details a recent study comparing salivary testosterone between autistic and allistic groups and male vs. female participants, with considerations of developmental stage. Data show that in autistic youth, both males and females exhibited significantly elevated testosterone compared to allistic youth. While male testosterone levels rapidly increased as expected during adolescence, females initially had higher testosterone until around 11.5 years of age before plateauing. Corbett states that these findings may suggest testosterone does play a role in autism, especially during periods of hormonal change (36:00). 

• Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis (Muscatello et al., 2022)

Gender diversity in autistic young people

Adolescence is a time of profound self-exploration, including gender identity, or a person’s innate sense of gender. The speaker highlights recent research suggesting a higher prevalence of gender diversity in individuals diagnosed with autism or having autistic traits compared to their allistic peers. Corbett’s team used both self-report and parent report questionnaires to confirm this finding in autistic children (37:00). Parents of autistic children reported significantly greater “gender body incongruence” in their children compared to parents of allistic children. Furthermore, within the autistic group, those assigned female at birth reported significantly more experiences of gender body incongruence than those assigned male. Self-reports from autistic youth also indicated significantly more reports of both “gender diversity” and “non-binary diversity” (40:00).

A follow-up study assessing gender diversity throughout adolescence found that gender incongruence was relatively stable across puberty in males (autistic and allistic). In contrast, autistic females endorsed greater incongruence around age 10, followed by a short plateau and then another increase. Allistic females reported the opposite pattern. Corbett summarizes these findings, highlighting the sex-based differences that indicate greater gender diversity in autistic females assigned at birth (AFAB). She also reiterates that gender identity formation is nuanced and likely influenced by pubertal progression, hormone patterns, and psychosocial factors (42:00). 

• Greater Gender Diversity among Autistic Children by Self Report and Parent Report (Corbett et al., 2023)
• Gender diversity in autistic and neurotypical youth over adolescence and puberty: A longitudinal study (Corbett et al., 2024)

Conclusions & future research

Corbett summarizes the presentation, highlighting that autistic females enter puberty earlier than autistic males and allistic groups. Autistic young people also have a higher rate and earlier onset of depression and a greater prevalence of gender diversity, especially in females. The speaker underscores the need for comprehensive measurements of psychological variables based on self-report, parent-report, and clinical-report. She emphasizes the need to identify risks and opportunities for resilience to elucidate and support the dynamic transition of puberty (43:00). 

Corbett and her team recently received funding to renew their longitudinal study of pubertal development. The renewed study aims to examine pubertal development through age 17 by observing physical development, hormones, menstruation, social communication, and internalizing symptoms. It also aims to observe the nervous system during these periods in a group of more than 300 participants (45:00). She notes an ongoing female development study before the Q&A (47:30). 

Originally published January 29th, 2025

Mojdeh Mostafavi, MD, shares her deeply personal journey as a sibling supporting a loved one with profound autism. She describes her experiences from early childhood through adulthood, highlighting the challenges and triumphs that her family and care team have experienced. The speaker shares ten meaningful insights about her family’s journey, highlighting the importance of communication and advocacy from a very young age. Mostafavi emphasizes the complexities of ever-evolving sibling relationships before the Q&A. 

In this webinar

2:00 – Introduction
4:30 – Early life, diagnosis, and family response
9:00 – The role of siblings and at home care
14:05 – Behavioral challenges during adolescence
17:00 – Adulthood milestones and medical crises
21:30 – Ongoing care and the unknown future
23:00 – Welcome to Holland – a sibling’s perspective
27:00 – Ten reflections from an adult sibling of someone with profound autism
34:00 – Communication challenges and triumphs
43:00 – Family, community, care teams — the importance of support
47:40 – Q&A

Early Life, Diagnosis, and Family Response

Mostafavi’s brother was born in 1995, when she was just two years old. During pregnancy and early infancy, his development seemed uncomplicated. However, at around 18 months, their parents, both medical professionals, noticed a profound developmental regression. He began losing words as he learned new ones, stopped responding to his name, started to avoid eye contact, and exhibited classic stimming behaviors like lining up toys, hand flapping, and finger twisting. The speaker explains that this regression occurred within a five-or six-week period, during which his preschool teacher suggested they get an autism assessment (4:30).  

In 1996, her brother was diagnosed with autism; this was a traumatic experience for her parents, who received a largely negative prognosis. Her parents recall being told that he would likely never speak or live independently and that many strongly suggested institutionalization. Mostafavi reminds viewers that during the mid-1990s, autism prevalence was reported as 1 in 10,000, so there was very little understanding or resources available (7:00). Undeterred, her parents embarked on a journey of self-education, extensively researching interventions and support strategies. They successfully pioneered a home-based program to address their son’s profound needs in an area with few specialized services.

The Sibling’s Role: Integration and Transformation

Growing up, Mostafavi’s life was intrinsically linked to her brother’s care. Their home was a hub for various therapies, including occupational therapy (OT), speech-language pathology (SLP), and ABA. From a young age, she was actively involved in these sessions, often tasked with modeling behaviors or assisting therapists. The speaker emphasizes how this deep involvement made her feel valued and important, which mitigated feelings of being a “glass child” and fostered an understanding and supportive sibling relationship (9:00). It was in her elementary years, around ages six to eight, that she first recognized the unique differences in her family life compared to her peers (12:00). 

Adolescence and Behavioral Challenges

Adolescence proved to be an exceptionally challenging period for her brother, particularly due to his limited verbal communication skills and subsequent difficulty expressing his needs and emotions. These challenges often led to intense behavioral outbursts, primarily aggression, including hair pulling, scratching, and biting, usually received by herself or her mother (14:05). Mostafavi underscores that her brother showed remorse after such outbursts, highlighting not only their close bond, but also the lasting distress externalized behaviors can have on everyone involved. The hormonal shifts of puberty further complicated her brother’s ability to self-regulate. The presenter recalls the incredible support they received from her brother’s care team and how they assisted in navigating this challenging moment for their family (15:00). Mostafavi notes her brother’s naturally loving disposition, stating that, even in these hard moments, 95% of the time, it was just awesome. It was that 5% where he struggled with communication that would result in aggressive behaviors.

Adulthood and medical crises

Mostafavi highlights that her experience differs from many because all the support systems they had took place in their home. During early adulthood, her brother reached many key milestones, like going to the movie theater, getting his first hair cut at the barber, and getting his wisdom teeth removed (17:00). The speaker briefly describes the first severe medical crisis her brother had when he was 27, which led to hospitalization and an induced coma. The cause was eventually traced to severe, unexpressed pain, leading to extensive medical evaluation and ultimately a diagnosis and intervention. The presenter comments on how disruptive it was to the entire family to be unable to manage and care for her brother at home. This process forced the family to reassess their resources, their son’s evolving needs, and the family’s well-being. It was a transformative period that instilled a deeper sense of awareness and appreciation for the ongoing challenges of supporting a loved one with profound autism (20:00).

Her brother remains at home with their parents, benefiting from a consistent care team, some of whom have been involved for over a decade. While aggression has subsided, he still experiences self-injurious behaviors, mainly head-hitting, often linked to unexpressed pain. The family is actively working with his medical team to mitigate these symptoms and behaviors. Despite these ongoing challenges, a home-based program with his long-standing care team remains the most effective option for his needs (21:30).

Reflections on the complexities of being a sibling

To articulate the sibling experience, the speaker references Emily Pearl Kingsley’s poem, Welcome to Holland, originally about the parental journey of having a child with special needs. Mostafavi adapts this analogy to the sibling perspective, explaining that a child growing up in “Holland” (a life with a sibling with autism) doesn’t initially understand the concept of “Italy” (a typical life). As they grow, they begin to recognize differences and form their understanding of the world, realizing that “Holland” is the only life they’ve ever known. This perspective highlights that the complexity and evolution of their unique life journey only become fully appreciated in adulthood (23:00). 

The speaker provides ten insights/reflections on her experiences as a sibling of someone with profound autism. She emphasizes the multifaceted and ever-evolving nature of the sibling relationship, explaining that their dynamic constantly shifts as both individuals navigate life stages—childhood, adolescence, and adulthood. For Mostafavi, this role often includes aspects of caregiving and, in the future, the role of guardian (27:00). She clarifies that her experience doesn’t align with the “glass child” concept because of her deep integration into her brother’s care, which made her feel valued. However, she acknowledges the profound and complex emotional and psychological impact, including feelings such as hurt, anger, guilt, frustration, love, sadness, and grief. All of these require continuous coping strategies even today (30:00). 

A significant aspect of the speaker’s experience is the unique “language” or means of communication she shares with her brother and sister. Living with someone with substantial verbal communication challenges has honed her ability to understand and interpret non-verbal cues (34:00). She touches on the importance of advocacy and empowerment from a young age and the complexities of planning for the future (40:00). Mostafavi asserts the importance of finding “your people” and navigating social life and relationships. The power found in people who support, nourish, and understand the nuances of your life cannot be understated (43:00). The speaker ends by reminding viewers that these are her experiences and that this may look different for everyone. During the Q&A, she discusses therapy for siblings and much more (47:40). 

Originally published on January 6th, 2025

Francesca Solmi, Ph.D., discusses the intricate link between autism and eating disorders. She outlines common eating disorders, noting their overlapping symptoms and similarities to autism traits. The speaker explores potential mechanisms for the connection between eating disorders and autism, including communication difficulties, sensory sensitivities, and emotion regulation. Solmi emphasizes Avoidant/Restrictive Food Intake Disorder (ARFID) and its relevance to autism, underscoring the need for more research and services for this often overlooked condition. The presenter considers future research directions before the Q&A.  

Handouts are online HERE

In this webinar:

1:30 – Common eating disorders
8:00 – Autism and eating disorders
11:00 – Trajectories of autistic traits and eating disorders
20:00 – Potential linking mechanisms
28:00 – Emotion regulation
34:50 – Avoidant/Restrictive Food Intake Disorder (ARFID) and Autism
40:00 – Future research
42:00 – Q&A

Overview of Eating Disorders 

Solmi defines eating disorders as severe psychiatric conditions that typically emerge in early to mid-adolescence. She describes common eating conditions, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and OSFED (Other Specified Feeding or Eating Disorder), highlighting the significant symptom overlaps across conditions (1:35).

• Anorexia Nervosa – frequently the youngest age of onset. Characterized by an intense fear of weight gain, extreme dietary restriction, and often low body weight. Some individuals may also engage in bingeing and purging.
• Bulimia Nervosa – slightly later onset and involves episodes of binging followed by compensatory behaviors like self-induced vomiting or excessive exercise.
• Binge Eating Disorder – the most recently recognized diagnosis. It involves bingeing without compensatory behaviors, often accompanied by feelings of shame or guilt.
• OSFED (Other Specified Feeding and Eating Disorder) is a residual category for individuals whose symptoms don’t fully meet the criteria for other diagnoses. 

The speaker emphasizes the severity of these conditions, noting their association with higher mortality rates (5:00). Despite this, eating disorders are often under-researched compared to other mental health disorders. She also notes their high prevalence in girls and women, suggesting underdiagnosis in men (6:30).  

The Link Between Autism and Eating Disorders 

Solmi discusses the connection between autism and eating disorders. A study by Westwood and colleagues revealed elevated autistic traits in people with anorexia nervosa. Similarly, people with autism and anorexia nervosa mentioned rigidity or rules, intense interests, difficulties recognizing hunger, and social difficulties (8:00). A significant challenge in this research, the presenter explains, is distinguishing between pre-existing autistic traits and those that may be mimicked by severe malnutrition in anorexia nervosa. 

Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review (Westwood et al., 2016)

Research on Autistic Traits and Disordered Eating Trajectories

Solmi presents findings from a study investigating whether autistic traits were present before the onset of disordered eating behaviors (11:00). Researchers found that children who later developed disordered eating behaviors exhibited higher levels of autistic traits at age seven, and these differences persisted throughout adolescence. The speaker asserts that these findings suggest autistic traits may precede the onset of disordered eating (17:00). The study also revealed that more severe eating disorder symptoms correlated with higher autistic trait scores from age seven onwards, indicating a strong association with more severe presentations of eating disorders.

Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study (Solmi et al., 2020)

Potential Mechanisms Linking Autism and Eating Disorders 

The presenter explores several mechanisms as potential links between autism and eating disorders. For example, as friendships become more important in adolescence, struggles with social interaction can exacerbate mental health difficulties, with eating disorders potentially serving as a coping mechanism. Children with social communication difficulties may also be more susceptible to bullying, which can lead to internalized weight-stigmatizing thoughts and behaviors like dieting (20:00). Young people with autism often exhibit more sedentary behaviors compared to their peers, which can increase BMI and vulnerability to weight-based stigmas (23:00). 

Emotion regulation difficulties are also common in both autism and eating disorders. Solmi outlines a recent study showing that individuals who later developed anorexia nervosa symptoms exhibited less improvement in emotion regulation skills from early to mid-childhood compared to their peers, where differences emerged around age five (30:00). Further, in girls, social cognition explained around half of the association between emotion regulation difficulties and disordered eating. The association in boys was less clear, likely due to smaller sample sizes (35:00).

The presenter notes that sensory sensitivities, a core aspect of avoidant/restrictive food intake disorder (ARFID), are frequently reported by people with anorexia nervosa. For example, in a qualitative study on autism and anorexia in women, emerging themes included difficulty with sensory sensitivities, social interactions and relationships, and challenges with emotions (33:00). 

A mixed-methods approach to conceptualizing friendships in anorexia nervosa (Datta et al., 2021)

Autism Spectrum Disorder and Obesity in Children: A Systematic Review and Meta-Analysis (Sammels et al., 2022)

Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways (Warne et al., 2022)

“For Me, the Anorexia is Just a Symptom, and the Cause is the Autism”: Investigating Restrictive Eating Disorders in Autistic Women (Brede et al., 2020)

Avoidant/Restrictive Food Intake Disorder (ARFID) and Autism

Solmi discusses ARFID, a disorder now included in the eating and feeding disorder family, noting its relevance to autism. Its three main aspects include limited interest in food, sensory sensitivities (e.g., avoiding specific foods due to texture), and concerns about adverse consequences from eating (34:50). The speaker emphasizes the limited epidemiological research on ARFID, the lack of services (especially for people who are not severely underweight), and the need for more studies to understand its prevalence, risk factors, and effective treatments (37:00).

Future Research Directions 

According to the presenter, future research should aim to understand the complex links between autism and eating disorders more comprehensively. Key areas of investigation include the connections between sensory sensitivities and ARFID, gender differences in the association of autistic traits and eating disorders, links between other autistic traits and different eating disorder presentations, physiological factors like the gut-brain response, and age of autism diagnosis in those with and without eating disorders. These avenues of research, Solmi asserts, will improve diagnostic tools and help to develop better prevention and care strategies (40:00). The speaker summarizes main points before the Q&A (42:20).