What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a developmental condition characterized by a number of unique strengths, differences, and challenges. The actual experience of ASD can vary from person to person. Here is a list of some of the most common characteristics associated with ASD:
- Difficulty understanding non-verbal cues (the communication that occurs between people without using words)
- Difficulty engaging in back and forth conversations. Responses to others may be “pre-programmed” or based on rules the person has developed over time (i.e. Say this when meeting a new person, Say this when seeing a friend on the street, etc.)
- General quirkiness and uniqueness with regards to dress, speaking style, and overall way of looking at things
- Restricted Repetitive Behaviors (RRBs):
- Sensory motor behaviors (also called self-stimming behaviors): Stereotyped movements such as hand flapping and/or repetitive use of specific objects
- Insistence on “sameness” behaviors or ritualistic habits
- Self-injurious RRBs: Hitting one’s head against the wall repetitively, for example. More common in younger and “lower functioning” individuals
- Inflexible adherence to routines. A dislike of change. Difficulty with transitions
- Lack of interest in sharing internal experiences, like thoughts and emotions, with others
- Difficulty differentiating between emotions. May not, for example, be able to tell the difference between feeling anxious and feeling joyful
- Highly restricted and fixated interests abnormal in intensity and focus. May, for example, have a singular focus on trains (drawing them, visiting them, looking at books about them)
- Over-sensitivity to certain sensations and stimuli (not liking any tags on clothing)
- Under-sensitivity to certain sensations and stimuli (comfortable wearing shorts in winter)
- Some people with ASD may possess unusual gifts and abilities
- Intense focus and attention to detail.
- Difficulty switching attention from one thing to another.
- Difficulty processing sensory information, which can lead to decreased motor skills
- Sleep issues. Reversed sleep/wake issues with occasional episodes of little to no sleep. May not like time changes. May not like traveling to different time zones
- Synesthesia: This is when input in one sense triggers a response in a different sense. For example, some autistic individuals will experience words as certain colors. They may report being able to “feel” music or “taste” sounds.
- Many people with ASD also struggle with mental health issues, including Body Dysmorphic Disorder (BDD), Hoarding, Hair-Pulling, Skin-Picking, ADHD and Obsessive-Compulsive Disorder.
Obsessive Compulsive Disorder (OCD) with Autism Spectrum Disorder (ASD)
OCD is a disorder that causes sufferers to engage in repetitive behaviors in an attempt to get rid of uncomfortable thoughts and emotions. These repetitive behaviors can be things like washing hands, performing mundane tasks over and over again, repeating a word or phrase over and over again, or excessively checking and re-checking homework answers. OCD can also include avoidance strategies such as not touching certain surfaces, avoiding certain triggering rooms in the house, or not going to school.
Autistic individuals are vulnerable to developing OCD symptoms. Researchers have found that approximately 35% of young ASD patients have OCD (Leyfer et al. 2006). Given that ASD and OCD both include “repetitive behaviors” as symptoms, it is often hard to tell the difference between an Autistic repetitive behavior and an OCD compulsion/ritual. The key to differentiating between the two is understanding that 1) OCD Compulsions are a desperate attempt to get rid of anxiety and discomfort while 2) performing ASD behaviors provides the individual with pleasure, enjoyment and a sense of calm. If an individual appears to be worked up and/or agitated while performing the activity, this may be a sign that it’s an OCD ritual. If the person has a peaceful smile on their face while completing the behavior, this may indicate that they are engaging in a repetitive behavior associated with their Autism diagnosis. Generally speaking, OCD rituals that are disruptive and distressing can, and should be, targeted in treatment, while restricted repetitive behaviors related to Autism may be less appropriate for treatment, since they provide the person with enjoyment, are a trait of their autism, and may be less “changeable.” However, even some Autistic repetitive behaviors can become the focus of treatment if they are disrupting the individual’s life in some way.
It is recommended that Autistic individuals who have OCD receive the same treatment for their OCD symptoms as those without ASD. This means seeing a therapist who specializes in Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) for OCD, and potentially augmenting therapy with medication when symptoms are severe and/or intractable. Finding a CBT therapist who has experience working with Autistic individuals is recommended because, while the CBT treatment will be largely the same as that delivered to someone without Autism, there are some adjustments that should be made to account for the specific challenges experienced by Autistic people. For example, Autistic clients may require very specific/concrete directions, and may have different motivations in life than the average person with OCD. If you are someone with Autism looking for help with OCD, or know someone who is, please feel free to contact us to discuss treatment options.