Obsessive Compulsive Disorder and Autism Spectrum Disorder

OCD and ASD: How are they different?

We often get questions from parents about their child’s behaviors that have an “OCD” feel to them. They wonder if this is true Obsessive Compulsive Disorder or part of their child’s autism diagnosis. For answers to these questions, we went to two of our psychologists here at the Seattle Children's Autism Center. Here’s what they had to say.

What is OCD?

Obsessive Compulsive Disorder is an anxiety disorder characterized by a) persistent and distressing thoughts and b) behaviors used to “cope with” those thoughts. A person with OCD often feels “compelled” to perform compulsive behaviors and believes that performing these behaviors will “keep bad things from happening.” OCD is more common in boys than girls. 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).

What is the difference between obsessions/compulsions and “repetitive behaviors” associated with autism spectrum disorder (ASD)?

There is overlap between behaviors seen in children with OCD and the ritualized/repetitive behaviors commonly observed in children with ASD. Children with ASD may perform repetitive or ritualistic behaviors, such as ordering, arranging, counting, or touching/tapping.  However, children with ASD are not likely to think (“obsess”) about their rituals and are more likely to simply act upon their urges.  Children with ASD therefore, may present with limited insight into the “reason” behind their ritualized behaviors. 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.

Can a child with ASD also have OCD?

Yes. Children with autism have a much higher rate of anxiety disorders than children in the typically-developing population. One recent study reported that approximately 17% of children with ASD also meet criteria for OCD (van Steensel, Bogels, and Perrin, 2011). Children with ASD who also meet criteria for OCD will present with clear anxiety-driven obsessions and will engage in compulsive behaviors as a way of reducing their anxiety.

What should parents do if their child has autism and they suspect they also have OCD?

Parents can ask their pediatrician for a referral to a psychologist or other mental health professional who is trained in working with children with anxiety and autism. The clinician would begin by taking a thorough history of the presenting problem, making diagnostic decisions based on that history, and devising a treatment plan to help the child and parents begin treatment.