Many children diagnosed with Autism Spectrum Disorder (ASD) show ritualistic behaviours, such as obsessing over stock-taking and making sure things are in order. These symptoms of Autism tend to overlap with Obsessive Compulsive Disorder (OCD). A study by Meier et al. (2015) observed that individuals diagnosed with ASD were twice as likely to be diagnosed with OCD later on, and those with OCD were four times as likely to have ASD.
This article will further discuss what OCD is, the overlap between ASD and OCD, and ways to help a child who has been diagnosed with both disorders.
What is Obsessive Compulsive Disorder (OCD)?
OCD is a disorder where an individual experiences obsessions and compulsions. Obsessions can be described as unwanted thoughts, images, and/or impulses that are repetitive and intrusive. These obsessions are often accompanied by feelings of fear, disgust, or anxiety.
Some common obsessive thoughts in children and teens include (What Are Signs of OCD in Children and Teens?, 2013):
Fear of dirt and germs
Fear of contamination
Of germs, diseases, body fluids
Symmetry, order, precision
Obsessive concern with being right/wrong about morals
Lucky and unlucky numbers
Fear of harm or illness to self or relatives
Intrusive sounds, words, or images
Subsequently, compulsions can be described as repetitive behaviours that an individual engages in to counteract, neutralize, or make their obsessions go away. Engaging in these compulsions can also be used to avoid a situation that may trigger an obsession.
It has to be understood that not all repetitive behaviour that an individual engages in does not necessarily become a compulsion or ritual. Many children have to practice some tasks repetitively to be able to learn a new skill (such as writing, or how to kick a ball) – these are part of daily life. However, in OCD, compulsive behaviours are used to escape or reduce anxiety. Compulsive behaviours can be very time consuming (for example, washing hands for an hour straight), and can be very disrupting to daily life.
Some common compulsive behaviours in children and teens include (What Are Signs of OCD in Children and Teens?, 2013):
Washing and cleaning
Repetitively washing hands, showering, brushing teeth, grooming
Repetitively cleaning the house
For example, turning on and off the lights a certain number of times, going in and out of the door again and again, needing to move in a special way, rereading, erasing and rewriting
Repeatedly checking if the door is locked, their homework, or if an appliance is turned off
Arranging or placing objects in order
Having to arrange their toys, books, personal belongings, and other objects in a certain way
Having to count objects over and over again – as a means of stock keeping
Collecting and keeping items that have no significant value
OCD and Autism
Those diagnosed with ASD may experience and carry out repetitive behaviour, which can be seen as similar to OCD rituals. However, the overlap is still unclear in research. It has been observed that individuals with either disorder experience anxiety and/or have unusual responses to sensory information. The behaviours and characteristics in both OCD and ASD can be very difficult to distinguish, hence the higher rates of missed diagnosis of either disorder (Yuhas, 2019).
With a missed diagnosis of OCD or ASD, it may be difficult to apply the most effective treatment or therapy for the individual.
Ways to Help
Exposure Response Prevention (ERP), a type of Cognitive-Behavioural Therapy (CBT), can be beneficial for children diagnosed with OCD and ASD (Gorbis & Dooley, 2017).
During ERP treatment, individuals are exposed to the thoughts, images, impulses, or situations that triggers anxiety under the guidance of a therapist. During the exposure period, the therapist assists the individual in managing their anxiety responses and teaches them skills to regulate their emotions when they have an intrusive thought or impulse. Over time, the child is able to learn how to manage their own symptoms and commit to not engage in their compulsive behaviours. As they stop doing the compulsive behaviours, they would typically experience a drop in anxiety levels [Exposure and Response Prevention (ERP), 2018].
Although treating individuals who are diagnosed with OCD and ASD would require more intense intervention and time, it has been observed that these individuals are able to retain their improvement well (Gorbis & Dooley, 2017)!
Written by Ashely
Exposure and Response Prevention (ERP). (2018, July 23). Retrieved October 18, 2020, from https://iocdf.org/about-ocd/ocd-treatment/erp/
Gorbis, E., & Dooley, L. (2017, December 27). Treatments for Obsessive-Compulsive Disorder comorbid with Autism Spectrum Disorder. Retrieved October 18, 2020, from https://iocdf.org/expert-opinions/treatments-for-obsessive-compulsive-disorder-comorbid-with-autism-spectrum-disorder/
Meier, S. M., Petersen, L., Schendel, D. E., Mattheisen, M., Mortensen, P. B., & Mors, O. (2015). Obsessive-Compulsive Disorder and Autism Spectrum Disorders: Longitudinal and Offspring Risk. Plos One,10(11). doi:10.1371/journal.pone.0141703
What Are Signs of OCD in Children and Teens? (2013, August 26). Retrieved October 18, 2020, from https://www.nationwidechildrens.org/family-resources-education/700childrens/2013/08/what-are-signs-of-ocd-in-children-and-teens
Yuhas, D. (2019, February 28). Untangling the ties between autism and obsessive-compulsive disorder. Retrieved October 18, 2020, from https://www.spectrumnews.org/features/deep-dive/untangling-ties-autism-obsessive-compulsive-disorder/