Psychological therapy works best when it fits how a person thinks, communicates and takes in information. This page looks at practical ways to adapt therapy and support for neurodivergent people with an eating disorder.
Why adapt therapy?
Most psychological therapies for eating disorders were not designed with neurodivergence in mind. Many rely on talking, abstract ideas and a fast pace, which can be hard for some autistic people and people with ADHD.
When therapy does not fit, a person can seem unmotivated or stuck when the real barrier is the format. Adapting therapy does not change its aims. It changes how the work is done, so the person can take part more fully.
What the research tells us
A 2025 study of the PEACE Pathway in UK eating disorder services found that teams adapted therapy to suit different thinking and processing styles. They changed the pace and structure of sessions, used visual aids and written materials, and allowed extra time to respond.
One clinician described using clear and concrete language and they also found that extra psychoeducation helped people understand how neurodivergence and their eating disorder might affect each other.
Adapting communication
Everyone communicates differently. Small changes can make therapy easier to follow and take part in. For example:
- Use clear, literal language and avoid metaphors and idioms
- Check understanding by asking, rather than assuming
- Offer written, visual or typed options alongside talking
- Allow extra time to think and respond
- Read the person’s PEACE Communication Passport if they have one, before you meet, so you know their preferences
Making sessions structured and predictable
- Share an agenda at the start of each session
- Give a written summary afterwards
- Consider shorter or more frequent sessions if possible
- Offer breaks and the chance to move
- Reduce sensory demands in the room, such as bright lights or background noise
- Explain any changes in advance
Some autistic people value routine and knowing exactly what will happen. Some people with ADHD find reminders, written summaries and varied activities help them stay engaged. Many people find a mix of these helpful. We recommend agreeing a structure with the person, then adjusting it as you learn what works for them.
Adapting formulation and therapy content
A formulation is a shared understanding of how a person’s eating disorder developed and what keeps it going. A neurodivergent-informed formulation also includes sensory needs, communication and information processing.
This can help separate what is linked to neurodivergence from what is linked to the eating disorder. For example, eating a narrow range of foods may relate to sensory needs rather than worries about weight or shape. A person’s strengths and interests can also become part of therapy.
Offering extra psychoeducation and support
Psychoeducation means information that helps a person understand their own experiences. Extra sessions or resources about how autism, ADHD and eating disorders interact can help people make sense of their treatment. Families and carers may find this helpful too.
Reviewing adaptations throughout treatment
Needs and preferences can change during treatment. We recommend discussing, recording and reviewing adaptations regularly, for example at care reviews. Gather feedback in accessible ways, such as written questions or simple rating scales, and update the person’s PEACE Communication Passport when things change.
What the PEACE approach to therapy and support can look like in practice:
Adapting communication
- [PEACE Communication Passport]LINK
- [Recognising Feelings]LINK
Structuring therapy and formulation
- [Collaborative Formulation worksheet]LINK
- [Back Up Plan]LINK
Psychoeducation and extra support
- [What you need to know: understanding neurodivergence in eating disorders]
- [Eating and ADHD]
- [Sensory Wellbeing Booklet]
- [My Sensory, Cognitive and Social World]
- [Inside My Head: A Workbook for Food, Feelings and Self Care]
- [Caring in Context, for families and carers]
