Exploring Autism and OCD

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It is normal to question whether your child with autism has OCD when they show a new repetitive behavior. A parent’s concern over a new compulsive habit or a new stim is justifiably correct.

There is an undoubted overlap in characteristics between autism and OCD, and even though they co-occur at high rates, they are distinct from each other. The key to understanding the disorders is knowing and understanding their differences, which can lead to appropriate treatment.

Autism Spectrum Disorders

Autism Spectrum Disorder (ASD) is in a category of developmental disorders, and often includes Autistic Disorder and Asperger’s Disorder. Scientists have found that rare gene mutations are involved, implying a strong genetic cause for autism, while a growing area of research is on the interaction of environmental and genetic factors.

Obsessive and ritualistic behaviors are one of the fundamental traits that make up autism, and it commonly presents with challenges in communication and behavior. Children with autismspectrum disorder may experience a sensory overload, which can lead to anxiety and distress. They may communicate, behave, learn and interact in ways that are different from most other people, and have repetitive behaviors or restricted interests. Those suffering from autism may interpret language too literally, or be reluctant to look at things differently while needing to stick to a routine. This makes developing and maintaining friendships hard, as well as understanding expected social or work behavior.

To feel more secure or alleviate agitation, compulsive behavior in children with autism spectrum disorder is innate and driven by the brain. ASD patients could attempt to drown out subtle noises that other individuals may never notice, by humming, for example. They may be hyper-focused on specific topics or items or need things to look or happen in a certain way.

Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is in the category of anxiety disorders, whereby a person suffers from uncontrollable obsessions, which lead to compulsive behaviors in an attempt to deal with severe anxiety.

Those suffering from OCD may have unreasonable worries and fears or obsessive and intrusive thoughts. This could be a fear of dirt or contamination, needing things to be orderly or perfectly symmetrical, or having difficulty with any uncertainty. Unwanted and frequently occurring images, ideas, or sensations, such as aggressive thoughts about the loss of control and harming oneself and others, or unwanted thoughts on sexual or religious subjects are also common.

These obsessions can drive someone with OCD to act in a repetitive, ritual manner, known as compulsive behaviors, to cope. This could include continuous hand washing, hair-pulling, skin picking, hoarding or arranging things very systematically.

Having Both OCD and Autism: Do They Relate or Differ?

Autism and OCD are separate conditions, which may seem at first glance to have not much in common. But many symptoms of autism overlap with those of OCD. Often the repetitive behaviors seen in autism can look like OCD compulsions and vice versa.

Apart from restricted, repetitive behaviors, severe anxiety and obsessive behaviors are also present in both conditions, affecting daily life. All these overlaps often lead professionals to dismiss OCD symptoms as traits of autism, thereby underdiagnosing patients.

Those that suffer from both autism and OCD often have unique experiences which differ from those of either OCD or autism on its own. The co-occurrence of these conditions requires the right diagnosis for treatment to be truly effective.

Similarities

People with obsessive-compulsive disorder and autism share the trait of having increased grey matter in a region of their brains. This area, called the caudate nucleus, is associated with repetitive behaviors. With similar neural circuits in the brain, compulsive behavior in OCD is associated with stereotyped behaviors, such as sticking to a routine, in autism.

A fixation on routines or ritualistic behavior, as well as having restricted interests are also common traits of the two conditions. The reaction if someone attempts to stand in the way of repetitive or compulsive behavior is in both cases agitation or aggression.

Both children with autism and children with OCD often show rigid thinking, and both OCD and autism cause resistance to change.

Differences

Even though many behaviours are shared, OCD and autism have differences.

Anxiety disorders are one of the most common co-occurring conditions in autistic people, and studies have shown that obsessive-compulsive disorder specifically co-occurs in 17.4% of young people with ASD, but the causes of anxiety are different in each condition. In autistic people, anxiety can be caused by impulsivity, sensory overload, a change of environment, misunderstandings of social cues, or a routine change. In OCD, anxiety can be caused by unwanted obsessive thoughts or images, or the fear of bad things happening.

Obsessions and compulsions, or OCD rituals are seen as intrusive or unwanted, whereas people diagnosed with autism may find it relaxing, and may not want to stop. In children with autism, repeated behavior like tapping feet, twisting hair, cracking knuckles, or biting nails can be done to ease anxiety, boredom, or sensory overload. These behaviors may be similar to obsessive-compulsive disorder, but there they are instead compulsions that a person is driven to perform.

Repetitive patterns or behaviors can be seen as a venting mechanism in those with OCD. Being driven to create repetitive patterns is part of a mental process. There is a functional relationship between repetitive behavior and fear, and compulsions are a way of reducing and coping with obsessions and the anxiety caused by it.

Compulsive behaviors have complicated motives, but children with OCD will be able to explain why they need something to be done in a specific way. In contrast, autistic people may have a variety of repetitive behaviors to choose from, as a method of self-soothing and as a tie to sensory processing.

A good example is repeatedly flicking a light switch on and off. An autistic person may do this because they receive visual feedback when the light goes on and off, and they may like the clicking sound of the switch. An individual diagnosed with OCD may do this because they believe that something terrible may happen. if the switch is not flicked multiple times.

The public reaction to tendencies of OCD in autism also differs. Someone diagnosed with OCD may feel shame or feel embarrassed about their actions, whereas someone with autism may not be as affected by others’ thoughts.

Treatment for Obsessive-Compulsive Disorder Comorbid ASD

Obsessive-compulsive disorder can be difficult to treat on its own. When it exists alongside other disorders, it can be much more challenging. Patients with OCD comorbid with ASD often present the following difficulties:

  • Difficulty to connect emotionally and socially
  • A lack of insight
  • Frequent, unpredictable, and extreme mood changes
  • Impulsivity
  • Outbursts of anger

Typical OCD treatment interventions in someone that has both OCD and autism, will not be effective. The same goes for the other way around. While treatment for both conditions may present more challenges and take more time, it is so vital to distinguish which behaviors are caused by OCD and which are caused by ASD.

This difference can lead to accurate treatment, and patients who have received proper treatment for both disorders tend to keep their improvement much longer.

What Are the Treatment Methods?

One part of the treatment includes social skills training. In ASD patients, this may take longer, but by beginning with basic social skills training, the following therapy will be much more effective.

Teaching anger management and mindfulness training is often next, followed by a gradual introduction to Exposure Response Prevention (ERP). As a type of cognitive behavioral therapy that focuses on facing fears and simultaneously preventing compulsive behavior, ERP could be used in some cases for OCD patients. However, autism is a different case. As the source of anxiety differs for those with autism, the treatment approach should turn towards treating the behavior itself.

In OCD, conscious reasoning is part of the base, meaning that cognitive behavior therapy treatments that are made to address patterns of thought may be effective, altering the mental element behind behaviors. With autistic people, where compulsions are driven at an instinctive level, applied behavior analysis is more needed.

Cognitive behavioral therapy (CBT) works for treating people who have both autism and OCD but requires some adapting. Those who have both conditions can have unusual sensory experiences, so incorporating more special interests can greatly improve therapy. More time for processing information, using more written and visual information, or adding emotional recognition into treatment can help. Including parents in the treatment and adjusting the length of treatment may also be necessary.

Contact Us

At The Wave, we are passionate about young people overcoming difficulties in mental health. We are proud to be able to treat our neurodivergent community. We know how vital mental health is, and that is why our therapy programs create solid foundations for anyone struggling with OCD and autism, starting with an accurate diagnosis.

Our specialists in neuropsychiatric treatment, and family support programs, can help you and your child overcome the difficulties faced on your journey. Contact us today to improve your child or young person’s quality of life.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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