BACKGROUND Many women with eating disorders (EDs) have social impairments and difficulties with flexibility. It is unclear to what extent these are manifestations of an underlying autism spectrum disorder (ASD); or whether they are instead the consequence of starvation, anxiety, low mood or obsessive compulsive disorder, all of which are highly prevalent in EDs. The resolution of this clinically and theoretically important uncertainty will require the use of gold-standard ASD assessment measures. To date these have not been employed in ED research. This case series is the first report of a well-validated, direct-observational measure of ASD, the Autism Diagnostic Observation Schedule (ADOS), being administered to women with EDs. We aimed to learn about the feasibility of the ADOS in this population, and to contribute to debates about whether a sub-group with EDs really have ASD. METHODS Ten women (mean age = 26.4 years, range = 19 to 38 years) who had a suspected ASD due to social and flexibility difficulties and were receiving treatment for ED (seven anorexia, two ED not otherwise specified, one bulimia) at a specialist service (four inpatient, six outpatient) received an ADOS Module 4 assessment. RESULTS All 10 participants completed all activities of the ADOS Module 4. Five scored in the ASD range on the ADOS diagnostic algorithm. An additional two were judged likely to have ASD, even though they scored below the ADOS's diagnostic threshold. This was on the basis of clinical observation, participant self-report and parent report. The seven women who we estimated to have ASD all reported autistic difficulties prior to the onset of their ED. They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy. Only one had a childhood diagnosis of ASD. CONCLUSIONS A substantial proportion of women with EDs who present with social and flexibility difficulties may have an unrecognised ASD, indicated by a constellation of autistic difficulties that appears to predate the onset of their eating problems. The ADOS is a useful component of an ASD assessment for adult women with ED.

中文翻译：

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饮食失调的妇女在社交和柔韧性方面有困难，他们真的患有自闭症吗？一个案例系列。

背景技术许多患有饮食失调（ED）的妇女具有社交障碍和灵活性困难。目前尚不清楚这些自闭症谱系障碍（ASD）的表现在多大程度上；或它们是否是饥饿，焦虑，情绪低落或强迫症的结果，这些在ED中非常普遍。要解决这一在临床上和理论上很重要的不确定因素，将需要使用黄金标准的ASD评估措施。迄今为止，这些还没有用于ED研究中。该病例系列是对患有ED的女性进行有效验证的，直接观察性的ASD（自闭症诊断观察计划表（ADOS））的首次报告。我们旨在了解ADOS在这一人群中的可行性，并为有关具有ED的小组确实具有ASD的辩论做出贡献。方法十名女性（平均年龄= 26.4岁，范围从19到38岁）由于社交和灵活性困难而怀疑患有自闭症，并且正在专科医生接受ED治疗（七名厌食症，两名未另外指定的ED，一名贪食症）服务（四名住院病人，六名门诊病人）接受了ADOS Module 4评估。结果所有10位参与者都完成了ADOS模块4的所有活动。在ADOS诊断算法上，有5位在ASD范围内得分。即使另外两个得分低于ADOS的诊断阈值，也被认为可能患有ASD。这是基于临床观察，参与者自我报告和家长报告的基础。我们估计患有ASD的7名女性在发生ED之前均报告了自闭症困难。他们通常描述长期存在的非自闭症神经发育问题，包括诵读困难，诵读困难和癫痫病。只有一个儿童时期诊断为ASD。结论相当一部分患有社交和灵活性困难的ED妇女可能患有无法识别的ASD，这表现为自闭症患者的星座似乎早于其饮食问题的发作。对于患有ED的成年女性，ADOS是ASD评估的有用组成部分。结论相当一部分患有社交和灵活性困难的ED妇女可能患有无法识别的ASD，这表现为自闭症患者的星座似乎早于其饮食问题的发作。对于患有ED的成年女性，ADOS是ASD评估的有用组成部分。结论相当一部分患有社交和灵活性困难的ED妇女可能患有无法识别的ASD，这表现为自闭症患者的星座似乎早于其饮食问题的发作。对于患有ED的成年女性，ADOS是ASD评估的有用组成部分。