AuDHD DD is underweight with food issues- where to get help

[Dokushozanmai]

My 19 yo DD has a diagnosis of AuDHD and has always had issues with food. She eats about 30 types of foods but will quite often forget to eat if she’s busy or focused on something else. Her BMI is about 17 and she has been told she cannot get any more ADHD medication until her BMI is over 20.

She’s at university and is finding it hard to focus on lectures etc without her meds.

She has asked for a GP appointment and been told they may be able to see her before Christmas but she can’t book an appointment for another couple of weeks. She tried to see the GP at home last year before she started her first year but they didnt have space to see her and then it fell away with the transfer of care to the Uni GP.

She hasn’t historically found CBT useful so it doesn’t look like private therapy is necessarily the best way forward. We ere wondering whether a dietician would be a good idea - to find foods that will help her put weight on.

Has anyone found a way forward with this? Is there any private support available or should we wait for the NHS?

I just wanted to say my DS is in the same boat. BMI is 17 and ADHD medication withdrawn. He can go all day without eating easily. And since they have suddenly stopped his meds he’s lost weight. But he comes from a very skinny tall family too so his genetics are against him.

I feel like the NHS need to do more. Because so many YP with ADHD are caught between a rock and a hard once. A friend whose DS has ADHD got the medication privately and weight was low but they monitored him and kept him on it.

Yes, a dietitian could help. I would also look at strategies to improve interoception (the ability to notice physiological sensations in the body, such as hunger). These strategies are things like mindfulness, body scanning etc. Simple strategies like pre-packing portion sized bags of high calorie snacks like nuts, seeds, cubes of cheese that she can add to her routine in the morning (grab one and go) so that she has something with her she can graze on may be helpful.

That's really tough and sounds like a vicious circle.
It's so easy to forget to eat food when you are distracted.
Is there anyway she can put reminders on her phone for before she goes out to take some things with her and then to eat during the day?
Maybe prep some food then night before it pots, so she can just take them with her.
Then have timers during the day?
Slightly different, but we have to feed our young son regularly, as he seems to have incredibly high metabolism. He gets very grumpy when he's hungry. We sometimes loose track of time and then realise when he's getting irritable that we're missed a food top up!! He's getting better at remembering and getting food himself.

We’ve been getting the meds privately but they’ve now said they won’t prescribe anymore. She went on the pill and put a couple
of kilos on, but had huge sensory issues with it so had to stop and has stopped putting weight on and lost a little bit which didn’t help.

Thank you very much - I will suggest this to her. I don’t think nuts are currently one of her foods but will suggest that she tries cheese. I’m also trying to get her to have some milkshakes as it seems to be easier for her to drink all sorts of weird flavours (boba is fine!) than to eat the same thing. I’ll have a look at dietitians as well.

I have suggested timers and been told there are REASONS why they won’t work, but she is now quite committed to making it work so she can have meds so timers with eating reminders and to do a quick body scan may now work. Thank you!

I’m sorry that your DD is having difficulties. Does she have DSA or any contact with the Disability service at Uni? I know she might be reluctant.
Brain in Hand can be tailored to support individual needs.

Kelly Mahler has lots of resources and books on Interoception.

Adding calories often involves full fat milk, cream and butter. Does she have milky drinks? Would she have hot chocolate with her in an insulated cup?
Blended soups with added cream and butter. Mash with cream and butter.

Any fast food outlets pie shops like Greggs etc on campus? Would she respond to prompts to get food from there 2 or 3 times a week finds allowing?

She does have DSA although she and her mentor mostly seem to have lovely chats about computer games and comics (current hyperfixation!) but I will suggest that she raises it. She doesn't like full fat milk or cream but will have butter and normal milk so I have suggested some milkshakes and will look up those resources on interioception.

There is pizza on campus and she lives very close to a coop so she can buy food, but won't eat panini which seems to be a canteen staple and so ends up not eating during the day if she hasn't remembered to take some packed food with her.

Thank you very much!

Milkshakes are a good option. I know how hard it can be with restricted diet and Interoception. Also tough admitting help is needed and seeking it. Good luck.

Would DD add ice cream to her milkshakes?

What does DD like to eat?

I doubt it. She will eat ice-cream but Cookie Dough or Mint choc chip and only drinks strawberry milkshake.

Her diet would be quite healthy if she wasn't so thin! She eats all meat (no fish) potato, chips, pasta, hot cheese on pizza or pasta, white bread, pancakes, pitta and houmous, garlic bread, milk, some ice cream, crisps, popcorn, peas, sweetcorn, cabbage and broccoli and sweets.

She won't eat fish, curry, things with sauce, chocolate (inc Nutella), eggs, cold cheese etc so it is quite tricky to hide the high fat foods that she doesn't like the taste of in other tastes.

If DD will tolerate fortifying foods, you can add olive oil and butter to pasta as well as the cheese she will have on top. Does DD have a sauce with her pasta?

Will DD eat mash potato? If so, you can add olive oil, butter, cheese, skimmed milk powder and/or cream if DD will tolerate that added to the potato. Even though she doesn’t like cream normally, in mash potato it isn’t quite the same as e.g. adding it to a milkshake.

I know you said DD doesn’t like eggs, but does she make pancakes with eggs? If so, duck eggs have more calories. If she makes pancakes rather than pre-made bought ones, would she try adding ground nuts? Would she add a syrup to the top of pancakes?

It does change the taste slightly so if DD is will only work if willing to experiment, but adding coconut oil or avocado oil to milkshakes can work.

Thank you - I will suggest these to her. The sauce she usually has with pasta is tomato based but will suggest adding oil or butter to cooked pasta as well as cheese and we can definitely try the egg swap for pancakes.