Does Your "Obsessive" Child on the Autism Spectrum Have OCD?

"My child (with HFA) does obsess about certain things, but how can I tell if he has full-blown obsessive compulsive disorder?"

Obsessive compulsive disorder (OCD) is described as a condition characterized by recurring, obsessive thoughts and compulsive actions. Obsessive thoughts are ideas, pictures of thoughts or impulses that repeatedly enter the mind, while compulsive actions and rituals are behaviors that are repeated over and over again.

The obsessions seen in kids with Asperger’s (AS) and High-Functioning Autism (HFA) differ from the youngster with obsessive compulsive disorder. The youngster with AS or HFA does not have the ability to put things into perspective. Although terminology implies that certain behaviors in AS and HFA are similar to those seen in obsessive compulsive disorder, these behaviors fail to meet the definition of either obsessions or compulsions.

They are not invasive, undesired or annoying, which is a prerequisite for a diagnosis of obsessive compulsive disorder. The reason for this is that children with severe autism are unable to contemplate or talk about their own mental states. However, obsessive compulsive disorder does appear to coincide with AS and HFA.

Szatmari et al (1989) studied a group of 24 kids. He discovered that 8% of the kids with AS and 10% of the kids with HFA were diagnosed with obsessive compulsive disorder. This compared to 5% of the control group of kids without autism, but with social problems. Thomsen el at (1994) found that in the kids he studied, obsessive compulsive disorder continued into adulthood.

  • become preoccupied with whether something could be harmful, dangerous, wrong, or dirty
  • experience a need for symmetry, order and precision
  • experience intrusive sounds or thoughts
  • feel like they must perform the task or dwell on the thought
  • feel strong urges to do certain things repeatedly (i.e., rituals or compulsions) in order to banish the scary thoughts or ward off something dreaded
  • have a difficult time explaining a reason for their rituals
  • have a fear of contamination
  • have a fear of illness or harm coming to oneself or relatives
  • have a strong belief in lucky and unlucky numbers
  • have an "overactive alarm system" 
  • have upsetting or scary thoughts or images that pop into their minds that are hard to shake
  • may have preoccupation with body wastes
  • may have religious obsessions
  • may have sexual or aggressive thoughts
  • realize that they really don't have to repeat the behaviors, but the anxiety can be so great that they feel that repetition is "required" to neutralize uncomfortable emotions
  • try to relieve anxiety via the use of obsessions and compulsions
  • want to feel absolutely certain that something bad won't happen 
  • worry about losing things, sometimes feeling the need to collect these items, even though the items may seem useless to others
  • worry about things not being "in order" or "just right"

Compulsions that are most common include: 
  • cleaning rituals
  • counting rituals
  • grooming rituals
  • hoarding and collecting things of no apparent value
  • ordering or arranging objects
  • repeatedly checking homework
  • repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting, etc.)
  • rituals to prevent harming self or others
  • rituals to undo contact with a "contaminated" person or object
  • touching rituals

Moms and dads can look for the following possible signs of obsessive compulsive disorder in their AS or HFA child:
  • a continual fear that something terrible will happen to someone
  • a dramatic increase in laundry
  • a persistent fear of illness
  • a sudden drop in test grades
  • an exceptionally long amount of time spent getting ready for bed
  • constant checks of the health of family members
  •  high, unexplained utility bills
  • holes erased through test papers and homework
  • raw, chapped hands from constant washing
  • reluctance to leave the house
  • requests for family members to repeat strange phrases or keep answering the same question
  • unproductive hours spent doing homework
  • unusually high rate of soap or paper towel usage

 ==> "OCD: What To Look For" - Excerpt from Mark Hutten's Lectures

If your AS or HFA youngster shows signs of obsessive compulsive disorder, talk to your physician. In screening for obsessive compulsive disorder, the physician will ask your youngster about obsessions and compulsions in language that he or she will understand, for example:
  • Are there things you have to do before you go to bed?
  • Do things have to be "just so"?
  • Do you collect things that others might throw away (e.g., hair, fingernail clippings, dead batteries, etc.)?
  • Do you count to a certain number or do things a certain number of times?
  • Do you have to check things over and over again?
  • Do you have to wash your hands a lot?
  • Do you have worries, thoughts, images, feelings, or ideas that bother you?


The most successful treatments for AS and HFA children with obsessive compulsive disorder are cognitive-behavioral therapy (CBT) and medication. CBT helps these “special needs” children learn to change thoughts and feelings by first changing behavior. The therapy involves gradually exposing children to their fears, with the agreement that they will not perform rituals in order to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur.

Just talking about the rituals and fears have not been shown to help obsessive compulsive disorder, and may actually make it worse by reinforcing the fears and prompting extra rituals. Thus, for CBT to be successful, it must be combined with “response prevention,” in which the youngster's rituals or avoidance behaviors are blocked (e.g., a youngster who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly).

Many children can do well with CBT alone, while others will need therapy and medication. Selective serotonin reuptake inhibitors (SSRIs) often can reduce the impulse to perform rituals. Once a youngster is in treatment, it's important for moms and dads to participate, to learn more about obsessive compulsive disorder, and to modify expectations and be supportive.

AS and HFA kids with obsessive compulsive disorder get better at different rates, so parents should try to avoid any day-to-day comparisons and recognize and praise any small improvements. Also, try to keep family routines as normal as possible.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

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