Autism and OCD

July 7, 2015

When most people think about Obsessive Compulsive Disorder (OCD) , they picture  the stereotypical image  put forth in movies and on television.  Over the past few decades viewers can think back to main characters with OCD such as Dustin Hoffman in “Rain Man”, Bill Murray in “What About Bob,” or Jack Nicholson in “As Good As It Gets.”  Obsessive Compulsive Disorder is an anxiety disorder with two main components:  the obsession characterized by persistent and distressing thoughts and the compulsion which is characterized by repetitive behavior that the person is compelled to perform.  Most people with OCD believe irrationally that the behaviors will keep the bad thing from happening.

According to Seattle’s Children’s Hospital, typical obsessive themes in childhood include worries about germs, harm coming to self or others, distinguishing right from wrong (guilt about morals), or religiosity. Therefore, typical compulsions might include ritualized washing, checking, ordering and/or rearranging, apologizing, or mental rituals (such as counting or praying). The University of Amsterdam did a comprehensive study in 2011 analyzing the frequency of anxiety in children with autism.  The study found that about 40% of children on the spectrum have at least one comorbid anxiety disorder- OCD was one such disorder.

Unfortunately many symptoms of autism overlap and are confused with OCD.  It can be difficult to distinguish those that are related to an individual’s autism from those that are part of another condition. OCD therefore, is often confused with the special interests or preoccupations characteristic of autism. For example, children with ASD may perform repetitive or ritualistic behaviors, such as ordering, arranging, counting, or touching/tapping. Children with ASD are also less likely to be using their ritualized behaviors to “neutralize” fear or anxiety and/or “keep bad things from happening” (as would be true for OCD). Rather, ritualized behaviors associated with ASD may satisfy other needs, such as modifying sensory input, gaining reinforcement from the environment, or preserving “sameness” in their daily lives. (Source: Seattle’s Children’s Hospital)

Consulting with your child’s pediatrician would be a good first step in diagnosing and treating any OCD that you suspect may be causing ritualistic behaviors.  Treatments of OCD range from Behavior Treatments, Cognitive Treatments, medications or any combinations of these.  A specific technique used in Cognitive Behavioral Therapies is called Exposure and Ritual Prevention. This involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior.  Discuss your child’s behaviors with his/her teachers and doctors to decide what method of treatment might be best.