The treatment of choice for young people with anorexia nervosa is (FT-ED), eating disorders focused family therapy with the Maudsley Approach of Locke and LeGrange and Eisler’s family therapy for anorexia nervosa the two most popular models. Both rely on parents to take an active role in weight restoration as the first stage to reverse the effects of starvation and begin to change problematic behaviors. In a 2025 paper, Le Grange reports that 70% of patients reach goal weight by the conclusion of treatment and at 5 years 75%-90% are fully recovered. However, 10%-15% remain ‘seriously ill’. Understanding this cohort is important given the lethality of this disorder.
Who Benefit Less?
While LeGrange speaks about difficulties where there is a high level of negativity and criticism of the young person there is another group for whom the approach may not be as applicable. Adolescents who are autistic or have autistic traits show comparable physical outcomes but require more intensive inpatient or day treatment and have longer admissions, with one study showing a 34% likelihood of this requirement compared to 15% of non-autistic peers. Some practitioners have reported misattunement between parents, young person and clinician which has been explained as due to a breakdown in ‘reciprocity and mutual understanding’ between people who experience the world differently. Others suggest that the ‘language of externalisation and the use of circular questions may not align with autistic cognitive and communication styles.’
How Do Parents Explain This?
Given the crucial early role played by parents, Nimbly et al (2026) were interested to explore caregivers experience and insights that may support adapting the approach to families where the child is autistic. Twelve parents were interviewed and content analysed to identify key themes.
What Feedback Did They Receive?
Four key themes were identified; questioning the principles of FT‐ED, navigating the FT‐ED process, parental (dis)empowerment and adapting FT‐ED. Specifically parents noted that externalisation was helpful to them but the young person experienced it as ‘challenging and invalidating’ and ‘may be at odds with some autistic characteristics, including managing abstract concepts.’ Another concern was the adoption of an agnostic stance, which for some led to a lack of appreciation of the role autism played.
These Concerns May be More general.
The feedback was similar to that previously received from families whose child was not autistic. This included issues with inflexibility of service delivery, the emotional cost to the whole family and the initial rejection of externalisation. The authors suggest that the difficulty ‘may lie in the delivery of externalisation as promoted in some manualised therapies, where it can be reduced to a strategy to support behavioural change’ and broadening the concept to include information about neurobiology and the effects of starvation may address this issue.
In Conclusion
While this limited study does point to adaptations that may be appropriate when a young person is autistic, it is also a warning against rigidly manualized therapy that fails to see the person behind the symptom. These approaches are well validated and remain the treatment of choice, especially when coupled with sensitive modifications that account for the individual and their family.
Le Grange, Daniel (2025) The Maudsley family-based treatment for adolescent anorexia nervosa World Psychiatry 4:3 – October 2005
Nimbley, E, Peebles, Loomes, R Clark, E Austin, A Fiona Duffy, F (226) ‘That’s Not Our Pathway’: Parent and Carer Experiences of Eating Disorder Focused Family Therapy (FT‐ED) for Autistic Young People with Anorexia Nervosa European Eating Disorders Review, 2026; 34:1130–1139 https://doi.org/10.1002/erv.70096
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