Secondary school
Potential challenges around food
Click on the titles below to see a list of potential challenges that an autistic young person with a co-occurring eating disorder may face at school:
- Bright lights
- Smells (cooking, other people’s food etc.)
- Noise (chatting, chairs scraping, cutlery clashing)
- People brushing against you
- Busy environment
- Temperature of food
- Textures of certain foods
- Foods touching on the plate may create visual overwhelm
- Feel of cutlery in hands/ mouth
- Internal physical sensations around eating
Multiple social demands in addition to eating:
- Feeling pressure to socialise, maintain conversation and eye contact
- Reading social cues and responding appropriately
- Experiences of bullying
- Menu changes
- Food products/brand changing
- Lunch timings changing
- Timings not matching routine at home
- Environment changes
- Not being able to eat preferred foods in school
- Having to eat in certain environments
- Having to eat in an order (pudding after savoury)
- Not allowed a packed lunch
- Be aware that autistic young people may take messages around healthy eating and exercise literally
- Consider delivering balanced messages around food (avoiding categoric words like ‘bad’ or ‘unhealthy’)
The reasonable adjustments duty
“The duty is ‘to take such steps as it is reasonable to have to take to avoid the substantial disadvantage’ to a disabled person caused by a provision, criterion or practice applied by or on behalf of a school, or by the absence of an auxiliary aid or service.” (Equality and Human Rights Commission, 2022)
Three main areas to consider for reasonable adjustments
- Auxiliary Aids and Services (a piece of equipment or support from a member of staff).
- Physical alterations (access for disabled pupils to the curriculum, the physical environment and to information).
- Provisions, criteria, and practices (the way in which a school operates on a daily basis, including its decision and actions).
Here are a few examples of reasonable adjustments that could be made for an autistic child with eating differences:
- Regular decompression breaks built into the school day, where they can engage in activities which help them to feel calm.
- Uniform adjustments, such as wearing extra clothes or different clothing.
- A quiet place where they can focus upon eating and eat undisturbed.
Lived experience perspective
Please note that the responses and advice on this page are from the BOB PEACE participation group. The group was made up of four autistic individuals who have experienced a co-occurring eating disorder. It is important to consider the individual needs of the young person and family as everybody is so unique.
It is important to consider that:
Autistic people often really want to learn. If a young person struggles at school, it does not mean they are not interested in their education.
It can be easy to assume that the young persons’ goal is to return to school as soon as possible. School may have been a distressing place for an autistic individual.
Autistic people may face expectations about what they ‘should’ be doing versus what is best for them. This may be around academic pressures, socialising or going to the canteen to eat.
Autistic young people may interpret information quite literally about what is important in life. The messages given at school may be misinterpreted or not relevant (healthy eating, exercise, or academic achievement for example).
It is important to understand the young person’s individual goals around education and ensure that the family know all of the options available in terms of education.
Think about what is motivating a young persons’ view about returning to school. If they want to return to school, is it because they feel that they ‘should’ go back, despite considerable challenges associated with this. These difficulties need to be managed and supported first.
transitioning back to shool after a period of absence
Returning to school after an absence related to an eating disorder can feel overwhelming for young people, their families and staff too. It is important that before a young person returns to school, there is a clear plan in place. The plan should be developed alongside the young person, their family, key members of school staff (e.g. Head of Year, SENCO, Form Tutor) and the CAMHS ED team. When developing the plan, it would be helpful to consider:
Developing a core support group which includes the young person, their family, key members of school staff (e.g. Head of Year) and health care professionals (e.g. CAMHS ED Team). This is also key in relapse prevention planning.
Identifying a key person in school, who can help to co-ordinate and facilitate communication within and between the core support group.
The young person is still in recovery from an eating disorder and this should be remain the priority. The young person may need help to reset their expectations about what they are able to do on their return to school. For example, they may need to cut down on sports, extracurricular activities and the number of subjects.
A gradual return, perhaps starting with lessons or teachers that the young person feels more familiar/confident with and building from there. How many lessons the young person attends each week and how quickly the number of lessons increases will vary greatly and should be decided in consultation with the core support group.
Can the young person work at home for some of the week? How will the work be shared with the young person? How will they gain feedback on work completed?
What will the young person’s support system look like in school? Will they have regular check ins with an identified person? If so, when/where will this take place?
What safe coping mechanisms will the young person use if they are feeling overwhelmed in school?
Support for managing the peer group reaction to the young person returning. How does the young person want their absence to be explained and to who?
How will friends be supported? Do they know what to do if they have concerns?
When will the return to school plan be reviewed? How often will the reviews take place and who will be in attendance? Can an earlier review be called if it is needed?
Do school staff know who to contact and how they can contact them if they have concerns about the young person?
How will time away from school to attend medical appointments be managed? How will the young person catch up on any work that has been missed?
If it is required, how will supervised eating be managed in school? Can you the young person begin to slowly align their current eating schedule at home so it more closely aligns with the routine they will have in school?
Remember, every young person is unique so it is important to consider their individual needs when developing a plan.
Seeking support
It can be hard to know when to seek support from the GP, school nurse or mental health services. If you are worried about a child or young person, please refer to the guidance on ‘when to get help’ on your local CAMHS websites.
If you live in Buckinghamshire or Oxfordshire, this information can be found here:
When to get help | Oxford Health CAMHSOxford Health CAMHS
If you live in Berkshire, this information can be found here:
Berkshire children’s eating disorder service (berkshirehealthcare.nhs.uk)
Talking about eating disorders and engaging with healthcare professionals can be challenging for autistic children and young people.
Here are some ideas to make the process more manageable:
- Share any visual resources that are available with young people to give information about what to expect during appointments and assessments (e.g. pictures of healthcare professionals, pictures of the building, structure of the appointment). If they are not available on the website of the service, contact them to see if they can share them.
- Sharing young peoples’ communication preferences in advance of their appointment, or their communication passport if they have one.
- Sharing young peoples’ sensory preferences and needs with healthcare professionals (e.g. preferring lower levels of lighting, bringing in a weighted blanket, using fidget tools).
- If it is possible, visit the building before the appointment to reduce the amount of uncertainty on the day.
Remember- it is okay to ask for adaptations!
Further information
We understand that it can be difficult to know when and where to seek support or advice. We have collated a list of relevant organisations and information that may be helpful to look at (ctrl+click on links):
National Autistic Society
Information about Eating Disorders and Autism
Eating disorders (autism.org.uk)
Adapting support for autistic people with eating disorders (autism.org.uk)
Pathway for Eating Disorders and Autism developed from Clinical Experience (PEACE) London
A comprehensive collection of resources about the overlap between Autism and Eating Disorders.
SPOT from BEAT Eating Disorders
Information on the School professionals online training (SPOT) from BEAT and how to access it.
SPOT – Online Training for Schools – Beat (beateatingdisorders.org.uk)
Knightsmith, Treasure and Schmidt (2013)
An article about spotting and supporting eating disorders in school: recommendations for school staff.
The National Centre for Eating Disorders
A non-profit organisation providing eating disorder treatment and recovery.
Equality and Human Rights Commission. (2022, 08). Reasonable adjustments for disabled pupils. Retrieved from Sheffield City Council : https://www.sheffield.gov.uk/sites/default/files/2022-08/reasonable-adjustments-disabled-pupils-guidance.pdf
The Equality Act. (2010). The Equality Act. Retrieved from legislation.gov.uk: ://www.legislation.gov.uk/ukpga/2010/15/contents