Autism Spectrum Disorders (ASDs) and Obsessive-Compulsive Disorder (OCD) can and do occur at the same time. OCD is a specific diagnosis under a larger umbrella of anxiety. Children with OCD experience unwanted and intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety. Children with ASD generally have repetitive, perseverative thoughts that are intense in nature, much like children with purely OCD symptoms. The big difference is that children with OCD do not like the experience of having repetitive thoughts and would do anything to get rid of the thoughts (such as washing one’s hands 25 times). Children with Autism Spectrum diagnoses are not bothered by their repetitive behaviors and thoughts, and instead are usually comforted by them (such as playing with a train in a repetitive fashion for hours at a time).
Anxiety is highly prevalent among children with Autism Spectrum diagnoses (greater than 35% of children experience both). This is due to a combination of genetics, brain development, and higher levels of stress. The error that many schools and therapists often make is attributing a child’s anxiety symptoms to his or her Autism diagnosis (i.e., “The only way to really reduce anxiety and aggression is to treat the Autism.”) For example, many children are referred into social skills groups when what they really need is help with anxiety that is interfering with their social functioning. Highly anxious children with OCD may begin to act out behaviorally in school prompting teachers to encourage (some might say ‘coerce’ or ‘force’) parents to begin medicating the behavior. The concerns here is twofold: 1) the behavior is numbed with medication and the root anxiety is never truly addressed (i.e., stop the medication and everything returns to the way it was), and 2) the school may begin to implement safety nets such as increased para support to keep the behaviors from occurring while again failing to adequately address the underlying anxiety symptoms.
The question often asked is, “Can you really treat a child who has both an autism spectrum diagnosis and OCD?” The answer is “yes” and new research is beginning to show that there are some exciting recent behavioral treatments out there for these children. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for anxiety that has been established by the American Psychological Association as effective for children. A recent study of CBT for neurotypical children with anxiety (Wood et al., found):
- Childrens’ school performance improved & they attended school more regularly
- Children had more friends & better quality friendships
- Children got along better with family members
- Children had higher self-esteem
The authors of that study have adapted the neurotypical CBT protocol for children with autism spectrum and are finding some promising results. In general the results suggest that the authors’ adaptations of the pre-existing CBT manual can be effective for treating anxiety such as OCD in children with autism (research article link). This treatment manual is available to practitioners and families, a sample of which can be viewed here. Thus, there is hope for effective anxiety treatment for your child who also has an autism spectrum diagnosis. It is highly recommended that you seek out services from a pediatric specialist who has training and experience treating children with co-occurring anxiety and autism spectrum diagnoses.
On a personal note and aside, I will be spending tomorrow with noted Asperger’s guru Dr. Tony Attwood so stay tuned for a blog later this week where I hope to share some new ‘nuggets’ of information.
Dr. Mark Bowers is a Licensed Pediatric Psychologist and Autism/Anxiety expert at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.
© 2009 Mark Bowers, Ph.D.
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