How to Treat OCD in Autistic Children & Adults

Elemy
Updated: January 10, 2021

Autism is a neurodevelopmental disorder characterized by social and communication difficulties as well as behaviors that are repetitive and often ritualistic. Obsessive-compulsive disorder (OCD) is an anxiety disorder that also includes repetitive, ritualistic behaviors (compulsions) as well as recurring thoughts (obsessions).

These two disorders often overlap.

When autism and OCD occur in the same person at the same time, these disorders are said to be comorbid. They should be treated together through a complete treatment plan that can help to alleviate anxiety and manage symptoms of both disorders. Behavioral therapies can help to identify symptom triggers and positively modify behaviors.

Autism & OCD

Both autism and OCD are shown to have genetic links, making them heritable disorders that also involve similar overlapping regions of the brain. Brain function and structure that are impacted by autism can also be impacted by OCD.

Having one disorder increases the risk for also having or developing the other at some point. For example, a study shows that people diagnosed with autism are twice as likely to also develop OCD, and those with OCD are four times as likely to be diagnosed with autism.

OCD and autism can also closely resemble each other, making a diagnosis of one or the other, or both at the same time, sometimes difficult. There are differences that can be spotted, however. For instance, someone with OCD will feel compelled to do a certain ritualistic behavior in the same way in order to ease anxiety, while someone with autism will engage in a variety of repetitive behaviors and not necessarily the same one each time.

The stress of communication difficulties related to autism can exacerbate symptoms of OCD. Someone with both disorders is likely to respond in an unusual way to sensory experiences, such as loud noises.

Comorbid autism and OCD can make it even harder to perform daily life tasks. This can lead to more tantrums, behavior issues, and difficulties functioning.

Rate of Comorbidity Between Autism & OCD

People with autism have at least one anxiety disorder around 40% of the time. Rates of comorbidity with OCD specifically range between 17% and 37%, studies show.

Obsessive-compulsive disorder is one of the most common anxiety disorders to occur concurrently with autism. Rates vary since it can be tricky to diagnose both disorders together and distinguish them from each other. Comorbid rates can also be skewed due to misdiagnosis or missing the diagnosis altogether.

People with autism have a much greater incidence of having OCD over the general population. It is important to recognize when both disorders co-occur in order to tailor treatment specifically. If a person has autism and OCD, but only the autism is diagnosed and treated, they won’t be able to effectively manage their symptoms.

Managing OCD in Autistic Children

Research is ongoing to discern the environmental risk factors for OCD. However, we know that because it is an anxiety disorder, it can be triggered by prolonged and pronounced stress. Increased anxiety can lead to OCD behaviors as well as emotional and physical outbursts.

For parents, keeping your child (and those around them) safe is the first concern. To do this, the goal is to keep your child calm and reduce potential stressors.

Here are some tips:

Be aware of your child’s triggers. Once you identify these, alter the environment when needed. If loud noises are an issue, consider noise-cancelling headphones. If your child is hypersensitive to bright lights, keep the room dim
Work together on communication methods. Autistic children often have difficulties expressing their emotions and needs. Alternative forms of communication, such as using pictures and special communication devices, can help.
Create a structured schedule. This kind of routine can minimize anxiety by helping a child to understand what is going to happen when. Set schedules help to prevent tantrums and ease stress.
Talk through changes and transitions. Children with OCD and autism are often inflexible and resistant to change. Uncertainty can increase anxiety. Role-playing exercises, discussions about upcoming changes, and learning to manage transitions can be very beneficial.
Include the entire care team. Everyone who is involved in caring for your child should be on board with the treatment plan, including teachers, counselors, therapists, and other caregivers. All team members can then work together to keep stress levels low.

Talk to your child’s doctor about your concerns if you suspect OCD, autism, or both. Early intervention and treatment for autism can help to reduce anxiety as well as manage symptoms of autism. This translates to a better overall quality of life and a higher degree of productivity and functioning.

Helping Autistic Adults With OCD

Obsessive-compulsive disorder is typically diagnosed in late adolescence, although it can be recognized in children before then. Adults and teenagers with autism are more prone to OCD than their peers without autism.

OCD-related thoughts and behaviors can get in the way of social interactions and make friendships difficult. The disorder’s symptoms can also make it hard to keep up with schoolwork or hold down a job.

Adults with comorbid OCD and autism can benefit from various treatment approaches.

Support groups: These peer support groups provide structured social interactions in a safe and secure environment, helping individuals to feel more connected and less isolated.
Social skills groups: These groups teach real-life skills that help members to function in everyday life. These skills can help with obtaining and maintaining a job as well as with self-care to foster independence.
Medications: These can be helpful to manage anxiety symptoms, but they can also come with side effects that may be enhanced in people with autism. Talk to your doctor about the potential benefits versus the risks.
Therapy: Group and individual therapy aims to work on specific symptoms of both OCD and autism. In therapy, clients can develop coping skills and tools for everyday life.

A More Complex Treatment Plan

Treatment for comorbid autism and OCD can present its own set of difficulties that need to be addressed. It is essential to know which behaviors are autistic and which stem from obsessive-compulsive disorder.

Cognitive behavioral therapy (CBT) is typically the most helpful treatment for OCD, and it is also used in treating OCD with autism. This behavioral intervention relies on uncovering potential triggers and learning how to manage them. It also focuses on gaining an understanding into how thoughts, emotions, and actions are all connected.

Issues with treatment for comorbid OCD and autism can include difficulties connecting emotionally and socially, which can make it harder to understand social cues and relate to others, including a therapist.

Autistic people may lack insight into their behaviors, which can make it hard for them to see the connection between their obsessions and compulsive behaviors. While someone with OCD uses the ritualistic behavior to dispel anxious thoughts, someone with autism will engage in these behaviors because they feel good without regard as to why they feel good.

Therapists have to break down the overlap between symptoms and help clients to effectively manage symptoms of both disorders. There is no cure for either disorder.

Behavioral Therapy

CBT for comorbid autism and obsessive-compulsive disorder will need to be modified and adapted to suit the individual and manage both disorders simultaneously.

Angry outbursts, frustration, unpredictable mood swings that take longer to regulate, and impulsivity are additional concerns to address with therapeutic interventions. Anger management and desensitization techniques involving exposure therapy, or exposure and response prevention (ERP), with CBT can help.

Some of the hallmarks of a modified CBT model for comorbid OCD and autism include:

High level of parental and/or caretaker involvement in sessions and beyond.
Visual cues.
Reward system and use of the client’s interests.
Adjustments to the language and management of communication deficits.
Increased structure in sessions.

Applied behavior analysis (ABA) is a model that rewards desirable behaviors through positive reinforcement. It can also help to decrease undesirable behaviors. This is one of the top treatment methods for autism. Its adaptability allows it to be beneficial in treating comorbid disorders, including co-occurring autism and OCD, as well.

Treatment for OCD often uses a form of exposure therapy to decrease the need to use ritualistic behaviors as a method of self-soothing. When someone also has autism in conjunction with OCD, this form of treatment will need to be more gradual and specific. This is because the ritualistic behaviors are generally pleasurable, and therefore, it will be harder to see the need to stop doing them.

Trained mental health professionals work with clients to design a specific treatment model that will work best for their individual situations.

Resources for Autism & OCD

If you or a loved one has autism, OCD, or both, here are some resources that can help:

International OCD Foundation (IOCDF): IOCDF provides outreach, information, details on support groups, and community events for people affected by OCD.
Autism Society: This autism support organization provides resources and information to people and families impacted by autism.
Anxiety and Depression Association of America: ADAA hosts information on online support for OCD.
Your primary care provider: Your doctor, or your child’s pediatrician, can link you with local resources and provide necessary referrals for evaluations and specialized treatment providers in your area. This may include referrals to mental health specialists, neurologists, developmental specialists, occupational therapists, behavior therapists, and other professionals.