By Dr. Melissa Fasteau 

Autism Spectrum Disorder (ASD) and OCD

It is tricky to differentiate between symptoms of Obsessive-Compulsive Disorder (OCD)  and Autism Spectrum Disorder (ASD). In fact, there is a high comorbidity rate between the two disorders. Patients with OCD have a 13 times higher risk of having an ASD diagnosis, and a history of OCD quadruples the risk of one having ASD (Meier et al., 2015).

There are many overlapping symptoms in both ASD and OCD. For instance, it is common for someone with ASD and OCD to have both repetitive behaviors, repetitive speech, rigidity with routines, and sensitivity to the environment. These behaviors may look the same on the surface, so it is imperative to understand the function underlying each behavior. Is the repetitive behavior aimed at reducing anxiety to a certain fear or is the repetitive behavior an attempt to regulate overstimulation in an environment? Is being stuck attributed to doing a ritual just right or being engaged in an enjoyable task? Differential diagnosis is challenging!

Treatment:

Having an accurate diagnosis is imperative and the first step to starting treatment. ASD can be diagnosed by a neuropsychologist, with the ADOS-2 (Autism Diagnostic Observation Schedule- 2^ndedition), OCD diagnosed with the YBOCS (Yale-Bown Obsessive Compulsive Scale), among other measures. Understanding an accurate diagnosis is helpful for a psychologist to develop a treatment plan and tailor it to the individual’s needs.

Exposure and response prevention (ERP) is an evidence-based treatment for OCD for those with ASD. As with any treatment, the patient’s willingness to participate is crucial. It may take longer to develop rapport between the patient and provider. It is also important to expect a longer treatment plan to allow for additional practice for exposures. Treatment can include behavioral strategies to treat overlapping ASD and OCD symptoms. Treatment should also include family involvement, increased use of visual aids, using concrete examples, short and clear instructions, and positive reinforcement (Kose et al., 2018).

Helpful Links:

https://iocdf.org/expert-opinions/treatments-for-obsessive-compulsive-disorder-comorbid-with-autism-spectrum-disorder/

https://iocdf.org/expert-opinions/expert-opinion-aspergers-and-ocd/

References:

Centers for Disease Control and Prevention. (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morbidity and Mortality Weekly Report, 67(6). Retrieved from https://www.cdc.gov/mmwr/volumes/67/ss/pdfs/ss6706a1-H.pdf

Kose, L. K., Fox, L., & Storch, E. A. (2018). Effectiveness of cognitive-behavioral therapy for individuals with autism spectrum disorders and comorbid obsessive-compulsive disorder: A review of the research. Journal of developmental and physical disabilities, 30(1), 69-87.

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), e0141703. doi:10.1371/journal.pone.0141703\

Van Steensel, F., Bogels, S.M., and Perrin, S. (2011) Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis. Clin Child Fam Psychol Rev, 14(3): 302–317.

DISCLAIMER: The content found here is intended to serve as educational content and is not intended to replace therapy. For treatment-related questions, please be sure to work with your local provider or contact a local clinician.

Videos: Autism Spectrum Disorder (ASD)

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