Autism And OCD

February 13, 2023

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OCD symptoms are often portrayed in Hollywood as cute or quirky, but the fact is they are anything but. When combined with autism, OCD can be complicated for parents to manage. Let’s explore how to best provide support for your child living with autism and OCD. 

What is OCD?

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts or urges that cause distress, anxiety, and repetitive behaviors to reduce stress. OCD often co-occurs with other disorders, such as autism. 

While scientists have yet to determine the cause of OCD, they suspect a combination of biological and environmental factors may be at play.  In fact, studies have found that children diagnosed with autism are more likely to be diagnosed with OCD than those without autism. 

The two disorders share some overlapping symptoms, so let’s investigate.

Is OCD similar to autism?

When it comes to understanding the complexities of mental health, parents of children with autism often find themselves in uncharted waters. Autism and OCD are two different conditions that can often be confused due to their similarities in terms of behavior patterns.

A few of these common characteristics can include:

• Repetitive behavior. Both OCD and autism can involve an individual engaging in repetitive behaviors, known as stimming, such as hand-washing, counting, and arranging objects. 
• Social interaction difficulties. An individual with either autism or OCD may have difficulty communicating and interacting socially with others due to a lack of understanding of social cues or boundaries.
• Rigid adherence to routines. Individuals on the spectrum may display a strong preference for sticking to rituals or schedules that provide comfort and predictability, while those with OCD might be prone to compulsions that must be completed for them to feel “right” inside their heads.

Let’s go one step further and divide these similarities into two categories of behaviors exhibited by both groups. 

Obsessions shared by people with autism and OCD

OCD and autism sufferers frequently have similar obsessions in these areas:

• Aversion to contamination
• Concerns about accidentally leaving the lights on or the doors unlocked
• Fear of behaving in a shameful or degrading manner
• Discomfort with the things in their environment being out of order
• Health anxiety and hysteria
• Excessive religious, guilt, shame, and purity-related thoughts

Often, due to the anxiety created by these obsessive behaviors or thoughts, people with autism or OCD will develop compulsive behavior to manage their stress load.

 

Compulsions shared by people with autism and OCD

Here are examples of a few of the common compulsions shared by these two groups of people:

• Excessive washing of hands and cleaning
• Repeatedly inspecting appliances, locks, and doors
• Arranging and moving things
• Rituals intended to prevent coming into contact with magical items
• Chanting or praying to stop terrible things from happening
• Hoarding

These shared symptoms clearly demonstrate there is more going on here with regard to the OCD-autism connection so let’s examine just how often a person is diagnosed with both disorders.

Co-occurrence of OCD and Autism

A recent study found that almost 1 in 5 children with autism also have obsessive compulsive disorder.  More research suggests that the number of people with both conditions is likely to be even higher, as some family members of those diagnosed with autism were found to be twice as likely to develop OCD later on. 

Similarly, members of families affected by OCD were four times more likely than average also to receive a diagnosis of autism later in life. 

Backing up these statistics is yet another research project in the UK that found that nearly half of adults being treated for OCD also had traits associated with autism. About one-quarter of these individuals even met the full criteria for an autism diagnosis. 

Taken as a whole, these findings suggest that a larger percentage of people with OCD may also have autism than previously thought. So the question remains, how do concerned parents tell if their child has OCD, autism, or both?

How to spot the difference

When it comes to your child’s autism, try to figure out why they might be doing certain repetitive behaviors. Ask yourself if the behavior is connected with any fear or anxiety that your child may have. 

If their behavior seems related to obsessive-compulsive disorder, then their compulsions will develop to manage their obsessions and alleviate their stress.

Because it is so common for children with autism also to have OCD, it’s a good idea to screen them for autism regularly. You can do this by using an Autism Quotient (AQ) test or another approved screening tool.  

By testing often, you will keep abreast of any changes in your child’s symptoms or diagnoses and get a jump on strategies and treatments they may need. Along with these written tests, remember to observe not only your child’s behavior but also the way they think.

Differences in information processing

To function daily, people must not only take in millions of bits of sensory information, but they must also be able to understand, organize, prioritize, act on and store that information. 

Children with autism tend to be bottom-up thinkers, while children with OCD tend to be top-down thinkers. Bottom-up thinking tends to focus on details, while top-down thinking focuses more on the big picture.

Another giveaway that your child has autism and not OCD is if they absorb visual stimuli better because that is how their brain processes information, rather than auditory stimuli. 

Additionally, children with autism tend to prefer consistency and structure in their environment so they know what to expect and can feel secure in the setting. On the other hand, children with OCD may struggle more with changes or surprises, even if it’s a positive change, due to the unpredictability of it all.

 

Consider the sensory profile

It is helpful for parents to develop a sensory profile for neurodivergent children. A sensory profile is a way of understanding how a person processes information from the environment. It can help parents better understand their child’s behavior and provide strategies to support them. 

Children with autism often have difficulty processing sensory information like sound, light, or touch. They may be over- or under-sensitive to certain types of input and may react differently than expected in response to certain stimuli. 

This difficulty with sensory processing can lead to problems with communication and social interaction, as well as difficulties in regulating emotions and managing stress levels.

In contrast, children with OCD tend to respond differently to certain types of input because they are overly sensitive or anxious. They may be more likely to become fixated on certain topics or rituals that they feel are important and have difficulty shifting away from them. 

It is also common for children with OCD to have difficulty controlling their emotions, often feeling overwhelmed by their thoughts and feelings.

Assess for criteria A

The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism provide a comprehensive and detailed approach to diagnosing autism spectrum disorder. 

Criteria A is a list of the core symptoms of autism, which involves difficulty with social communication and interaction. This includes deficits in nonverbal communication, such as eye contact, facial expressions, body language, and understanding of others’ perspectives. 

It also includes difficulties with initiating or sustaining conversations, responding to verbal cues appropriately, developing close relationships with peers, expressing empathy towards others’ feelings or experiences, and using appropriate social skills in different settings. 

By comparing your child’s observable behaviors, you can better understand whether they may have signs and symptoms of autism or OCD or both.

Differences between OCD and autism

OCD is characterized by recurring obsessions and compulsions that can take up a significant amount of time and interfere with daily life. Autism, on the other hand, does not typically involve obsessive or compulsive behavior. 

Obsessive thoughts in OCD usually last for more than an hour each day, while autistic behaviors may come and go quickly without impacting daily life significantly. 

Compulsions associated with OCD are often repeated behaviors that people do to reduce anxiety caused by their obsessions; however, this is not typical in autism cases. 

People with OCD tend to be aware of their behavior and its irrationality, while people with autism may not be aware of their behavior and its impact on others. 

People with OCD are typically more focused on feeling in control or avoiding potential harm, while those with autism may be more likely to engage in repetitive behaviors for sensory or other rewards.

Can you have both OCD and autism?

Yes, you can; in fact, both conditions have high comorbidity, which is just a fancy way of saying they often happen together. Research conducted in 2015 that studied 3.4 million people over 18 years in Denmark concluded that those with autism are more likely to be diagnosed with OCD than the general population. 

Additionally, the study showed that individuals with OCD are more likely to be diagnosed with autism further down the line. This important research provides insight into the potential connections between these two conditions and can help us better understand our children’s mental health needs if they have been diagnosed with either disorder.

A diagnosis is the first step

As parents, we are responsible for ensuring our neurodivergent children have the best quality of life possible. With an accurate diagnosis and professional support, we can provide them with the best opportunities for success in all areas of life. 

Taking the step to get a diagnosis can be daunting, but it is essential to getting your child the treatment and resources they need. If you suspect your child has autism, OCD, or both, don’t hesitate; seek out a professional today who understands autism and OCD so you can start giving yourself and your child the support you both deserve.

If you are ready to work with the best ABA therapy provider in New York, New Jersey or Indiana, give us a call at (732) 402-0297. Our dedicated team is ready to help and we will treat you like family.