When it comes to Autism (ASD) and Obsessive-Compulsive Disorder (OCD), prevailing thought has been that repetitive behaviors exhibited by Autistic people are part and parcel to Autism (i.e. idiosyncracies not appropriate as a focus of treatment). And in many cases this is true. Many autistic people like to repeat certain physical behaviors for the stimulation they provide. It is also common for autistic people to have “restricted interests,” meaning they will focus on a specific past time for longer lengths of time and with more focus than people without autism would generally devote to a single interest. But many Autistic people also struggle with OCD, and exhibit anxiety-driven behaviors that cause distress, interfere with their life, and are in fact treatable. So it was with a great deal of interest that I attended the Conference on Treating OCD in the Autism Community, which was held in Pittsburgh this past April, hoping to gain some insight on how to know the difference between the two, and what can be done to help. Here are some of my takeaways from what turned out to be a great event:
1. An interesting analogy: One of the speakers described the two game shows Jeopardy and Family Feud, noting that Jeopardy is about answering questions while Family Feud is about guessing how other people answer questions. He then went on to say that many people with autism can be very adept at the facts and trivia you might find on Jeopardy, and struggle to develop insight into the thoughts of others that would be needed to excel at Family Feud. He shared that one of the really important tasks for parents, teachers, and other professionals is to help autistic clients expand their Family Feud skills.
2. Some characteristics associated with Autism that may impact treatment:
- Dichotomous thinking – preferring extremes to being in the middle.
- Emotions tend to be discrete experiences – an emotion is either “on or off.”
- Sensory differences: over-sensitivities (tags on shirts) and under-sensitivities (wearing shorts in the cold)
- Low interest in sharing thoughts, feelings, and interests with others
- Limited use and understanding of non-verbal social cues
- A desire for structure and predictability
- Repetitive body movements
- Restricted interests
3. Differentiating between Autistic repetitive behaviors and OCD repetitive behaviors:
- Repetetive behaviors are normal and are a big part of ASD. If the repetitive behavior provides pleasure, it’s an ASD, or normal, behavior.
- Autistic individuals will typically appear calm when engaging in normal repetitive behaviors associated with Autism (rocking, jumping, humming).
- When it comes to OCD repetitive behaviors (aka rituals), the person will often appear anxious when engaging in the behavior.
- It is typical for people with Autism to seek out information about schedules and details about the day. However, if the person seems to be fixated on certain details, and asks the same question over and over again, this can be a sign of a person seeking reassurance to deal with OCD doubts.
- Overall, it is necessary to differentiate OCD thoughts and urges from Autistic interests. It is typical for people with Autism to have distress when they can’t engage in one of their interests (they like thinking about the interest and want to do it). People with OCD have distress when they are experiencing an OCD thought or urge (they don’t like thinking the thought or feeling the urge).
- If the repetitive behavior/ritual wasn’t evident earlier in life, it’s more likely OCD, because ASD is lifetime, neurological condition.
4. Treatment of OCD for Autistic clients:
- We don’t have to change people. There are going to be things about a person that they don’t want to change (and that maybe can’t be changed anyway). Someone with Autism doesn’t have to become like someone without ASD.
- Exposure therapy works for Autistic people experiencing OCD symptoms.
- Clients with OCD and ASD often need to increase their ability to identify, communicate, and modulate emotions. This can be as simple as helping a client to differentiate “I’m enjoying this activity” from “I’m triggered and anxious.”
- Clients with ASD and OCD are often less able to see their intrusive thoughts as an OCD symptom (i.e. not their own thought). It may not be helpful to try and separate the person from their OCD. It may be more useful to help the individual label their triggering thoughts as worry thoughts or unhelpful thoughts.
- Treatment may need to be broken down into small, manageable parts.
- Exposures may need to be repeated more than with non-ASD clients before OCD symptoms respond.
So overall, a great and informative conference. And I hope this post may be of help to others looking for help in this area. In October, I’m also off to an advanced training on OCD that will include a full day devoted to OCD and Autism, so it looks like this topic is starting to receive some much needed attention. As always, I’ll be sure to update with any new knowledge.
And if you’re out there looking for OCD treatment for someone with or without ASD in the Pittsburgh area, you’ll find our contact info here. Or you can always check the IOCDF website for qualified treatment options in your area.