"How do I know whether or not my child's 'special interest' is actually an Obsessive-Compulsive Disorder?"
The term “Obsessive-Compulsive Disorder” (OCD) is a clinical diagnosis that only a doctor can make. Many Aspergers and high functioning autistic (HFA) kids also share an OCD diagnosis, but the Diagnostic and Statistical Manual definition for Aspergers and HFA calls for very OCD-like behavior as one criterion.
It can be very confusing for parents, and even diagnosticians, as to whether or not the “special interest” is simply an Aspergers or HFA trait, or part of another diagnosis (in this case, OCD).
So, when is a “special interest” simply a “special interest,” and when is it legitimate OCD?
Obsessive-compulsive disorder is a chronic illness, a type of anxiety disorder characterized by obsessive thoughts and compulsive behavior. Unlike other anxiety disorders, the child knows that such thoughts and behaviors are irrational and silly, but cannot prevent themselves from having them.
(Note: There is a difference between OCD and Obsessive-Compulsive Personality Disorder (OCPD). OCPD is a mental disorder that is characterized by "preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.")
With OCD, there are obsessions. Obsessions are defined as “distressing ideas, images or impulses that repeatedly intrude into the child’s awareness.” These thoughts are typically experienced as inappropriate, anxiety-arousing, and contrary to the child’s will or desires. Common obsessions include:
a need to have things "just so"
a need to tell, ask, or confess
contamination (e.g., fear of germs, dirt, etc.)
excessive religious or moral doubt
forbidden thoughts
imagining having harmed self or others
imagining losing control of aggressive urges
intrusive sexual thoughts or urges
However, obsessions are not the only telltale sign for OCD. Another symptom of OCD is compulsions. Compulsions are "repetitive behaviors or rituals that the child performs to counteract the anxiety and distress produced by obsessive thoughts." Common compulsions include:
• checking
• counting
• hoarding
• ordering/arranging
• praying
• repeating
• touching
• washing
Some of these compulsions are easily witnessed, but this is not always true. Not all compulsions are obvious; many are mental processes (e.g., counting, praying) and harder – if not impossible – to notice. Typically the compulsions correspond to the obsessions. For example:
aggressive, sexual, religious and somatic anxieties result in checking
an obsession with hoarding leads to hoarding and collecting
fears of contamination are accompanied by hand washing and cleaning
need for symmetry produces ordering, arranging, counting and repeating rituals
OCD kids usually have obsessions and corresponding compulsions, but may have either obsessions or compulsions alone. Observing these obsessions and compulsions may be difficult for a parent to notice, because the child may hide his symptoms. Noticing obsessions and compulsions is the first step in discovering whether or not a child has OCD, but several other conditions must be met for the diagnosis to be made. For you to diagnose your child as having OCD (instead of being just a little strange), a few other factors must be present.
If your child really has OCD, he will recognize that the obsessions or compulsions are excessive or unreasonable – he knows that what he is doing makes no sense. Many people who developed OCD did so as a child, and report knowing that there was something different (or wrong) about them in comparison to other children.
Another factor of OCD is that the obsessions and compulsions:
are inordinately time-consuming
cause marked distress
significantly interfere with the child's normal routine, occupational functioning, or social activities or relationships
OCD occurs when your youngster has thoughts (obsessions) or physical actions (compulsions) that seem out of his control, such that it becomes unpleasant, very stressful, or harmful in some way. This may - or may not - involve his special interest. It may involve some new, seemingly odd or purposeless focus on a bodily function, for example, or the need to repeatedly check his hands for cleanliness. If you notice that your child does have obsessions or compulsions that cause him to avoid people and social activities, than he may indeed have OCD. Some “red flag” indicators of OCD include:
The need to indulge in his activity causes him to lose sleep, skip meals, or be late for school.
He cannot seem to focus on - or discuss anything - but the activity.
He has lost interest in his appearance, dress, and hygiene because the activity has become all-consuming.
He is quick to lash-out and becomes verbally and/or physically abusive when you try to redirect him away from the activity of interest.
He withdraws from family, friends, and pets in favor of spending unusual amounts of time involved in the special activity.
If you note any of these changes in your youngster, it will be important for you to gather information about what you are observing in order to prepare for meeting with a Child and Adolescent Psychiatrist for a comprehensive psychiatric evaluation.
Even with all these symptoms, it is often difficult to diagnose a child with OCD. Since the OCD youngster knows his thoughts and actions are irrational, he may tend to conceal his problems. Often, parents will bring the child they suspect of OCD to a doctor's attention. Sometimes the disorder is revealed through secondary symptoms (e.g., dry hands from excessive hand washing). However, the diagnosis must be made by specific questioning by a doctor. Clinical interviews establishing a history of obsessive thought or ritualistic behavior is the primary method of diagnosis.
There are some things you can do to determine if your child should be evaluated for OCD. You could ask him the following questions: "Do you find yourself doing something unusual repeatedly? Does this seem normal to you - or does it seem weird?" You could also make it fun and use a diagnostic scale as a magazine quiz (these surveys pretty much work the same way as most magazine quizzes). The most commonly used is the Yale-Brown Obsessive Compulsive Scale (available online). Also, the Work and Social Adjustment Scale (often used in combination with other diagnostic scales), and the Maudsely Obsessive Compulsive Inventory are good tools as well. There are also several online resources, such as the Obsessive Compulsive Screening Checklist and the National Institute of Mental Health Screening Test.
(Note: You should not attempt to make such a diagnosis on your own. The online resources above are only to help you determine whether your child has symptoms of OCD in order for him to seek a professional diagnosis.)
If your youngster's “special interest” fit the criteria for OCD, you may need to reinforce parental parameters by being very firm about scheduling activities and responsibilities and holding your youngster accountable. Use visual time frames (e.g., calendars, clocks and watches, personal schedules) to set limits for the amount of time your youngster is permitted to indulge in his special interests. Your child’s teachers will also need to be clear and concrete about rules and responsibilities during the school day. Apply appropriate disciplinary measures once you ensure all expectations have been made clear to your youngster.
Parents have the right to have expectations of their Aspergers or HFA youngster. You expect your youngster to uphold the standards you've set with regard to house rules and other obligations (e.g., doing chores, completing homework, showing respect, etc.). It is also fair to set parameters around the amount of time your youngster indulges in his special interest – especially if you can readily foresee the potential for him to get “lost” in it for long periods of time.
“My 5 year old son is high functioning autistic and has an obsession for fans, and it’s been going on almost 6 months now. He talks and even draws a table fan constantly. He calls anything round a fan (even though he knows the real name of the object), but he imagines it to be a fan and moves those objects like a top. He can spend hours playing with them. He will collect all the fans in the house and line them up like toy soldiers. I am concerned that his passion for fans has turned into an obsession. In fact, now he knows more about them, the hand fan, ceiling fan, table fan, exhaust fan, and so on. This is the only ‘peculiar’ issue I have with him (for the moment anyway). What does all this mean? Should I be concerned? Should I do something about it? If so, what?!”
Rituals and obsessions are one of the hallmarks of High-Functioning Autism (HFA) and Asperger’s (AS). In order to cope with the anxieties and stresses about the chaotic world around them, these children often obsess and ritualize their behaviors to comfort themselves. While some may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items, or even doing things which put them or others in danger.
Some kids with HFA develop a resistance to (or fear of) change, that then involves being rigid in their approach to their environment. Insistence on sameness, routines and rituals begin. For example, certain items must be placed in particular places and not moved, certain routes must be followed to and from familiar places, objects may be stacked or lined up in a repetitive manner, or particular silverware and plates must be used - or the youngster refuses to eat or drink.
Confusion about coping in a world that is overwhelming influences this behavior, so the youngster with HFA responds to this uncertainty by being in control of their immediate environment, the objects in that environment, and the people in it. Repetitive motor mannerisms may occur when autistic kids are excited, anxious, or worried. For others, sensory sensitivities and the physical enjoyment may drive repetitive jumping, arm flapping, twiddling of fingers in front of their eyes, and covering ears and eyes with their hands.
The memory of a youngster with HFA is no better than that of “typical” children, but the huge collection of facts he knows (in this case, about fans) usually represents the amount of time and effort that has gone into accumulating knowledge on the subject to the exclusion of much else. The obsessions are not necessarily characterized by memorization of data alone.
The term “systemizing” applies to the “fascination with data” that has inherent networks (e.g., maps, weather patterns, airline schedules, etc.). Although it is commonly thought that obsessions can be strengths that can be utilized in the educational process, these obsessions can interfere significantly with other important daily functions. Children with HFA are more interested in systems that can be described as “folk physics” (i.e., an interest in how things work) versus “folk psychology” (i.e., an interest in how people work).
Repetitive behaviors and mannerisms in HFA children is a somewhat neglected area of research. In the past, these behaviors were associated with lower levels of functioning, because repetitive motor mannerisms are also seen in kids with intellectual disability who do not have an autism spectrum disorder. These behaviors were also thought to increase during the preschool years. There is now some evidence that repetitive motor mannerisms develop differently to “insistence on sameness,” and these behaviors follow different paths over time.
Restricted and repetitive behaviors show different patterns of stability in HFA kids based partly on the ‘subtype’ they belong to. Young kids with low NVIQ (i.e., non-verbal IQ) scores often have persistent motor mannerisms. However, these behaviors often improve in kids with higher nonverbal IQ scores. Many autistic kids who do not have “insistence-on-sameness behaviors” at a young age acquire them as they got older, and some who had these behaviors sometimes loss them.
Obsessions aren't always so bad, especially if they have some educational or healthful value. But, when mixed with the mental makeup of a child on the autism spectrum, problems may arise. Kids with HFA and AS have trouble with social and emotional development and understanding the nonverbal cues in a conversation. While they are more than happy to start discussing their subject of obsession to another person, they won’t notice whether or not the other person is interested. They may not get the hint of a person's disinterest or lack of time to talk. They may instead proceed to follow another person around continuing to talk on and on about their area of fascination. They may go right up to someone else already engaged in conversation and interrupt them to begin associating their topic of interest with their obsession, or they may take over a conversation and talk endlessly not leaving much time or room for any feedback from the other person.
Kids with HFA and AS may become so obsessed with a particular item, toy, game, or subject, that they may push friends away unknowingly. They may leave little time for anything else, thus homework and chore assignments often suffer. Also, they may become too easily distracted, always thinking back to their obsession and unable to stay on task.
Examples of obsessive, ritualistic behaviors include:
cleaning rituals
compulsion to make lists and/or schedules
counting rituals
feelings of excessive doubt and caution
hoarding and collecting things
obsessive need for cleanliness
ordering or arranging objects
perfectionism (that may sometimes interfere with task-completion)
preoccupation with order and organization
preoccupation with remembering and paying attention to minute details and facts
repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting)
rigid following of rules and regulations
rigidity or inflexibility of beliefs
rituals to prevent harming self or others
rituals to undo contact with a "contaminated" person or object
stubbornness
touching rituals
unreasonable insistence that others submit to his way of doing things
How parents can deal with rituals and obsessions in their HFA:
1. Promote social skills— A youngster with HFA does not learn the social norms and common sense ideas the same way “typical” kids do. He may never completely understand the reasons why things matter socially. He may not see any reason why he shouldn't devote all his time to his one major fascination. Moms and dads can take consideration for their child’s passion, but also help him become a more socially rounded person. It is important, however, if a child fixates on a particularly bad habit or inappropriate subject matter, that the parent put an end to it immediately.
2. Choose battles wisely— Breaking an obsession or ritual is like running a war campaign. If not planned wisely, or if parents attempt to fight on many fronts, they are guaranteed to fail. Not only is it time consuming and tiring, it means the parent can't devote 100% to each particular area. So, for example, if you have a youngster with (1) a game obsession, (2) a phobia of brushing his teeth, AND (3) bedtime troubles, choose only one to deal with. Deal with the worst problem first!
3. Consider multiple therapies— Many children can do well with behavioral therapy alone, while others will need a combination of behavioral therapy and medication. Therapy can help your youngster and family learn strategies to manage the ebb and flow of symptoms, while medication often can reduce the impulse to perform rituals. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps children learn to change thoughts and feelings by first changing behavior. It involves gradually exposing children to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease, and that no disastrous outcome will occur.
4. Limit special interests— Moms and dads need to take care to allow their HFA youngster to be passionate about certain subjects, but to not let it entirely rule his life. If, for example, he is overly obsessed with playing video games, it is appropriate to give him some time to play, but the time should be limited. Even if the subject of fascination is reading books or doing science experiments, it is still important that time be given to other subjects, or just to get out to get some exercise.
5. Use the “special interest” as a learning tool— Moms and dads should take some time (emphasis on “some”) to listen to their child as he talks about his special interest, and even learn about what is so fascinating. For example, a parent who will take the extra initiative to go visit a planetarium for their child interested in space, or take a trip to a dinosaur museum for the child obsessed with dinosaurs, will give their child the extra support and assurance he needs.
6. Weigh the pros and cons— Parents should ask themselves the questions “How much of a problem is it?” …and “Who for?” The answer is often that these behaviors are a problem for parents and teachers rather than the youngster himself (who is very happy to be preoccupied with his favorite activity). Thus, it is unlikely that the youngster will want to change his behavior. The rules of thumb when making decisions about whether or not to intervene or change routines and rituals are to ask yourself the following: Does the behavior endanger the youngster or others? Does the behavior increase the likelihood of social rejection or isolation? Does the behavior interfere with or preclude participation in other enjoyable activities and an education program? If the answers to these questions are “yes,” then an intervention is highly recommended.
7. Find the right therapist— Repetitive rituals and routines can sometimes worsen if it's not treated in a consistent, logical and supportive manner. So, it's important to find a therapist who has training and experience in treating this issue. Just talking about the rituals and fears has not been shown to help repetitive rituals, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a youngster cope with repetitive rituals.
8. Teach self-talk methods— Some treatment plans involve having the youngster "bossing back" the repetitive rituals, giving it a nasty nickname, and visualizing it as something he can control. Over time, the anxiety provoked by certain unwanted stimuli in the environment and the urge to perform rituals gradually disappear. The youngster also gains confidence that he can "fight" repetitive rituals.
9. Remain calm— When tackling any problem with your youngster, it's always best to remain calm at all times. “Special needs” children will feed off the parent’s anger, frustration and anxiety. So, keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.
10. Provide predictability— If your HFA youngster has trouble managing his mood and behavior when changes in his daily routine occur, try to provide him with as much predictability as possible. This can be accomplished by creating a highly structured environment where daily tasks take place in a certain order, and things are physically in order. For example, (a) warning your child ahead of time of upcoming changes in order to help prevent upset, or minimize it; (b) providing lists, charts and calendars on the wall to help your youngster see what will happen each day; and (c) using bulletin boards with individual cards for each task that you can move around with pins, calendars you make on your computer, or dry-erase boards that will make it easy for you to post the changes without having to recreate the list every time there is a change.
While many young people with an autism spectrum disorder display inflexibility and rigidity, sometimes the symptoms are extreme and may warrant an additional diagnosis of Obsessive-Compulsive Disorder (OCD). If your child’s obsessions negatively affect daily functioning (i.e., interferes with school work or personal hygiene, compromises social interactions, produces a sedentary lifestyle, etc.), then consider seeking advice from a professional who is an expert in autism spectrum disorders. So, when is a “special interest” simply a “special interest,” and when is it legitimate OCD?
OCD is a chronic illness, a type of anxiety disorder characterized by obsessive thoughts and compulsive behavior. Unlike other anxiety disorders, the youngster knows that such thoughts and behaviors are irrational and silly, but can’t prevent himself from having them.
With OCD, there are obsessions. Obsessions are defined as “distressing ideas, images or impulses that repeatedly intrude into the child’s awareness.” These thoughts are typically experienced as inappropriate, anxiety-arousing, and contrary to the child’s will or desires. Common obsessions include (a) the need to have things “just so”; (b) the need to tell, ask, or confess; (c) contamination (e.g., fear of germs, dirt, etc.); (d) excessive religious or moral doubt; (e) forbidden thoughts; (f) imagining having harmed self or others; (g) imagining losing control of aggressive urges; and (h) intrusive sexual thoughts or urges.
However, obsessions are not the only telltale sign for OCD. Another symptom of OCD is compulsions. Compulsions are "repetitive behaviors or rituals that the youngster performs to counteract the anxiety and distress produced by obsessive thoughts." Common compulsions include checking, counting, hoarding, ordering/arranging, praying, repeating, touching and washing.
Some of these compulsions are easily witnessed, but this is not always true. Not all compulsions are obvious; many are mental processes (e.g., counting, praying) and harder – if not impossible – to notice. Typically, the compulsions correspond to the obsessions. For example, (a) aggressive, sexual, religious and somatic anxieties result in checking; (b) an obsession with hoarding leads to collecting; (c) fears of contamination are accompanied by hand washing and cleaning; and (d) the need for symmetry produces ordering, arranging, counting and repeating rituals.
If your HFA youngster really has OCD, he will recognize that the obsessions or compulsions are excessive or unreasonable – he knows that what he is doing makes no sense. Many people who developed OCD did so as a child, and report knowing that there was something different (or wrong) about them in comparison to other kids.
Bottom line: If you have your child tested for OCD, and the professional has ruled that out, then you can "rule in" the fact that your child's "obsession" is likely to be a temporary phenomenon.
More resources for parents of children and teens on the autism spectrum:
• Anonymous said… It will change. Unless he's going to stick his fingers in it I would worry to much. My son is now 15. His obsessions changed, I find that with are kids you really need to pick and choose you battles.
• Anonymous said… It's multi-sensory. That's so interesting. I love fans too and used to think it was so much fun to talk into them!
• Anonymous said… My 12 year old son has been obsessed with Apple products, cars and now his new obsession is music. Chances are his interest will change and in the meantime he is learning. My sons obsession with music has lead to a desire to learn the guitar.
• Anonymous said… My son has a similar "obsession" but his collections are small electrical that he takes apart and puts back together and most recently rubiks cubes. I love it. Sounds silly maybe but I love watching him focus so intensely. He lines up his rubiks cubes also and plays with them one at a time. He can solve every one of them and it just amazes me the way his brain works.
• Anonymous said… My son has been obsessed with fire alarms for several years. It began after a fire drill at his preschool and I'm guessing its his way to cope with the fear.
• Anonymous said… my son too- how good it feels to know there is another boy out there that is the same- my son is 13 and collects them and knows all about them and even has his own fire alarm panels, alarm and strobes!
• Anonymous said… Oliver is 6 and has a growing collection as well 🙂 I had no idea there were so many different kinds and systems. We have friends in the fire department who are arranging for him to go on one of their inspections.
• Anonymous said… With my grandson, we went through Thomas and all things train, weather/storms, and now as a teen he's settled on WWll and history. These things change over time.
• Anonymous said… Wow I had almost forgotten about my AS daughter's similar obsession with fans! Good article.
• Anonymous said… Your son has a creative and scientific mind- he may change his interests but will likely still only ever like similar electrical items. My son started off with plugs and cables and taking things apart when he was 3. he is now 13 and has collections of all kinds of things electrical and has enough knowledge to go into the electrical business now. Encourage it, don't take it away, just be sure to set limits as it does take over. Objects are as important to him as you are, you might not like that, but it will be part of his life and you have to respect it too. Best wishes.
* Bev said... Thank you so much for sharing these experiences. My grandson is 2 years 6 months now and has been obsessed with fans since he was about 6 months old..... He's so different to other toddlers, so advanced - his intellect and vocabulary is on another level and he is just brilliant and observant, and yet we worry about the social negativities associated with As. To us he is incredibly special and wonderful, but the world can be so cruel. Thank you all very much for sharing about your unique children too, it helps to know that my grandson isn't alone in being different.
Obsessive-Compulsive Disorder (OCD) is a complex mental health condition that affects individuals of all ages, characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform. For children on the autism spectrum, navigating the dual challenges of OCD and Autism Spectrum Disorder (ASD) can be particularly difficult. This article aims to provide an in-depth exploration of how OCD manifests in children with autism, approaches to treatment, and practical strategies for supporting these children and their families.
The Relationship Between Autism and OCD
Research indicates a significant correlation between ASD and OCD, with children with autism being at a notably higher risk of developing OCD than their neurotypical peers. While OCD can occur independently, many of its symptoms can be misinterpreted as traits of autism, making accurate diagnosis and treatment essential. For instance, both conditions can include rigid behaviors and an intense preference for routine—features commonly observed in children on the spectrum.
Detailed Examination of Symptoms
Children with autism who also experience OCD display a unique combination of symptoms that can complicate the clinical picture:
**1. Obsessions:** Obsessive thoughts can take many forms; however, in children with autism, these obsessions often revolve around specific interests or themes. For instance, a child might develop an intense fear that something terrible will happen if they do not engage in a particular behavior, such as counting or checking objects repeatedly. These obsessions can disrupt the child’s ability to focus on schoolwork or enjoy play, leading to increased anxiety.
**2. Compulsions:** Compulsive behaviors may appear similar to the repetitive actions typical in autism, such as hand-flapping or spinning objects. However, compulsions driven by OCD may manifest more urgently, such as needing to touch or arrange items in a particular order to alleviate the anxiety tied to their obsessive thoughts. Children might perform these rituals several times a day and may become very upset if they cannot complete them.
Key Signs of OCD in Children with Autism
Identifying OCD in children with autism requires careful observation to distinguish it from typical autistic behaviors. Some key signs that may indicate the presence of OCD include:
- **Heightened Distress:** A child may show significant emotional distress, such as crying or tantruming, if they feel they cannot perform their compulsive rituals, indicating a level of anxiety beyond typical discomfort.
- **Excessive Time Commitment:** OCD behaviors often require a considerable time commitment, typically defined as more than an hour a day. This can severely impede the child’s ability to participate in other essential activities, such as school, playdates, and family time.
- **Avoidance Behavior:** Children may strategically avoid situations that trigger their obsessions, which could include foregoing social gatherings or school events, further isolating them from peers and exacerbating their anxiety.
The Impact of OCD and Autism on Daily Life
The co-occurrence of OCD and autism has a profound impact on a child's daily functioning. The persistent anxiety and compulsive behaviors associated with OCD can hinder various aspects of life. Social interactions may become increasingly limited due to compulsive routines, and academic performance can decline as a child struggles to focus on tasks amid intrusive thoughts.
Additionally, families may experience increased stress as they strive to understand and support their child. Parents often feel overwhelmed navigating the challenges of dual diagnoses and may be unsure of how best to support their child practically and emotionally.
Diagnosis and Assessment
A meticulous evaluation process is crucial for diagnosing OCD in children on the autism spectrum. This evaluation typically includes:
- **Comprehensive Clinical Interviews:** Mental health professionals conduct in-depth interviews with caregivers, seeking to understand the child's thoughts, behaviors, and routines. This dialogue is crucial for distinguishing between OCD symptoms and autism-related behaviors.
- **Standardized Assessment Tools:** Specially designed instruments, such as the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), facilitate a structured evaluation of OCD symptoms. These assessments gauge the severity and frequency of obsessions and compulsions.
- **Collaboration with Multiple Sources:** Engaging with teachers, therapists, and caregivers provides valuable insights into the child’s behaviors across different settings, enriching the overall assessment.
Treatment Approaches
**1. Cognitive Behavioral Therapy (CBT):** CBT is highly effective for treating OCD and is particularly beneficial for children. This therapy focuses on helping children identify and alter negative thought patterns and behaviors. A specific subtype of CBT, known as Exposure and Response Prevention (ERP), involves gradually exposing the child to anxiety-producing situations while teaching them to resist compulsive behaviors.
**2. Medication:** In some cases, particularly where symptoms are severe and impair functioning, medical intervention may be necessary. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to help regulate mood and reduce the intensity of OCD symptoms. Any medication protocol should be closely monitored by healthcare professionals familiar with the unique needs of children with autism.
**3. Parental Involvement and Family Therapy:** Involving parents in the therapeutic process can significantly enhance the effectiveness of treatment. Family therapy may provide a space for open communication, where family members can express their feelings and learn to support each other better.
Practical Strategies for Parents and Caregivers
Supporting a child with both autism and OCD requires a well-rounded approach characterized by empathy, understanding, and structure. Here are several practical strategies parents and caregivers can utilize:
- **Establish Clear Routines:** Maintaining a predictable daily schedule can offer a sense of security and help mitigate anxiety related to the unknown.
- **Gradual Exposure Techniques:** Parents can facilitate gradual exposure to anxiety-inducing situations in a safe and supportive manner, allowing the child to build confidence while developing coping mechanisms.
- **Encourage Open Communication:** Create an environment of trust where children feel safe discussing their thoughts and anxieties. This dialogue can help them verbalize their feelings and decrease the power of their obsessive thoughts.
- **Utilize Resources:** Numerous organizations provide resources, support groups, and educational materials to assist families in navigating the complexities of ASD and OCD. Connecting with these resources can offer additional strategies and emotional support.
OCD in children with autism presents a multifaceted challenge that requires careful understanding and tailored approaches to treatment. By recognizing the specific symptoms and impacts of both disorders, caregivers and mental health professionals can implement effective interventions that promote understanding and healing.
With appropriate therapeutic strategies, parental support, and a commitment to fostering an accepting and structured environment, children with autism and OCD can learn to manage their symptoms and lead fulfilling, meaningful lives. This journey requires patience, compassion, and collaboration among all parties involved, but with dedicated effort, positive outcomes are achievable for these children and their families.
Resources for parents of children and teens on the autism spectrum:
More articles for parents of children and teens on the autism spectrum:
Social rejection has devastating effects in many areas of functioning.
Because the ASD child tends to internalize how others treat him,
rejection damages self-esteem and often causes anxiety and depression.
As the child feels worse about himself and becomes more anxious and
depressed – he performs worse, socially and intellectually.
Meltdowns are not a pretty sight. They are somewhat like overblown
temper tantrums, but unlike tantrums, meltdowns can last anywhere from
ten minutes to over an hour. When it starts, the Asperger's or HFA child
is totally out-of-control. When it ends, both you and your child are
totally exhausted. But... don’t breathe a sigh of relief yet. At the
least provocation, for the remainder of that day -- and sometimes into
the next - the meltdown can return in full force.
Although Aspergers [high-functioning autism] is at the milder end of the
autism spectrum, the challenges parents face when disciplining a
teenager on the spectrum are more difficult than they would be with an
average teen. Complicated by defiant behavior, the teen is at risk for
even greater difficulties on multiple levels – unless the parents’
disciplinary techniques are tailored to their child's special needs.
Your older teenager or young “adult child” isn’t sure what to do, and
he is asking you for money every few days. How do you cut the purse
strings and teach him to be independent? Parents of teens with ASD face
many problems that other parents do not. Time is running out for
teaching their adolescent how to become an independent adult. As one
mother put it, "There's so little time, yet so much left to do." Click here to read the full article…
Two traits often found in kids with High-Functioning Autism are
“mind-blindness” (i.e., the inability to predict the beliefs and
intentions of others) and “alexithymia” (i.e., the inability to
identify and interpret emotional signals in others). These two traits
reduce the youngster’s ability to empathize with peers. As a result, he
or she may be perceived by adults and other children as selfish,
insensitive and uncaring. Click here to read the full article...
Become an expert in helping your child cope with his or her
“out-of-control” emotions, inability to make and keep friends, stress,
anger, thinking errors, and resistance to change.
A child with High-Functioning Autism (HFA) can have
difficulty in school because, since he fits in so well, many adults
may miss the fact that he has a diagnosis. When these children display
symptoms of their disorder, they may be seen as defiant or disruptive.
"Why is my 6-year-old son (high functioning autistic) so engrossed in Minecraft, and how can I tell if it is an unhealthy obsession rather than just a fun time activity for him?"
The intensity and duration of the child’s interest in
a particular topic, object or collection is what determines whether or not it has become an “obsession.” Children
with Aspergers and High-Functioning Autism (HFA) will often learn a lot about a thing they are obsessed with, be intensely
interested in it for a long time, and feel strongly about it. There are several
reasons why these kids may develop obsessions, including:
they can get a lot of enjoyment from learning about a particular subject or
gathering together items of interest
those who find social interaction difficult might use their special interests as a
way to start conversations and feel more self-assured in social situations
obsessions
may help children cope with the uncertainties of daily life
obsessions
may help children to relax and feel happy
obsessions
may provide order and predictability
obsessions
may provide structure
Many children with Aspergers and HFA have sensory sensitivity and
may be over- or under-sensitive to sights, sounds, smells, taste and touch.
This sensitivity can also affect children’s balance ('vestibular' system) and
body awareness ('proprioception' or knowing where our bodies are and how they
are moving). Obsessions and repetitive behavior can be a way to deal with sensory sensitivity.
Although repetitive behavior varies from child to child, the
reasons behind it may be the same:
a source
of enjoyment and occupation
a way to
deal with stress and anxiety and to block out uncertainty
an
attempt to gain sensory input (e.g., rocking may be a way to stimulate the
balance or vestibular system; hand-flapping may provide visual stimulation)
an
attempt to reduce sensory input (e.g., focusing on one particular sound may
reduce the impact of a loud, distressing environment; this may particularly be
seen in social situations)
some
adolescents may revert to old repetitive behaviors (e.g., hand-flapping,
rocking if anxious or stressed)
Reality to a child on the autism spectrum is a confusing, interacting
mass of events, people, places, sounds and sights. Set routines, times,
particular routes and rituals all help to get order into an unbearably chaotic
life. Trying to keep everything the same reduces some of the terrible fear.
Many children with the disorder have a strong preference for
routines and sameness. Routines often serve an important function. For example,
they introduce order, structure and predictability and help to manage anxiety.
Because of this, it can be very distressing if the child’s routine is
disrupted.
Sometimes minor changes (e.g., moving between two
activities) can be distressing. For others, big events (e.g., holidays, birthdays,
Christmas, etc.), which create change and upheaval, can cause anxiety.
Unexpected changes are often most difficult to deal with.
Some children on the spectrum have daily timetables so that
they know what is going to happen, when. However, the need for routine and
sameness can extend beyond this. You might see:
a need
for routine around daily activities such as meals or bedtime
changes
to the physical environment (e.g., the layout of furniture in a room), or the
presence of new people or absence of familiar ones, being difficult to manage
compulsive
behavior (e.g., the child might be constantly washing his hands or checking
locks)
rigid
preferences about things like food (e.g., only eating food of a certain color),
clothing (e.g., only wearing clothes made from specific fabrics), or everyday
objects (e.g., only using particular types of soap or brands of toilet paper)
routines
can become almost ritualistic in nature, having to be followed precisely with
attention paid to the tiniest details
verbal
rituals, with a child repeatedly asking the same questions and needing a
specific answer
Children's dependence on routines can increase during times
of change, stress or illness and may even become more dominant or elaborate at
these times. Dependence on routines may increase or re-emerge during
adolescence. Routines can have a profound effect on the lives of children with
Aspergers and HFA, their family and care-takers, but it is possible to make a child
less reliant on them.
Obsessions versus Hobbies—
Most of us have hobbies, interests and a preference for
routine. Here are five questions that can help us distinguish between
hobbies/interests versus obsessive behavior:
Can the
child stop the behavior independently?
Does the
child appear distressed when engaging in the behavior or does the child give
signs that he is trying to resist the behavior (e.g., someone who flaps their
hands may try to sit on their hands to prevent the behavior)?
Is the
behavior causing significant disruption to others (e.g., moms and dads,
care-takers, peers, siblings)?
Is the
behavior impacting on the child’s learning?
Is the
behavior limiting the child’s social opportunities?
If your answer to any of the questions above is 'yes', it
may be appropriate to look at ways of helping your youngster to reduce
obsessive or repetitive behavior. Think about whether, by setting limits around
a particular behavior, you are really helping your youngster. Is the behavior
actually a real issue for him, for you, or for other people in his life?
Focus on developing skills that your youngster can use
instead of repetitive or obsessive behavior. Try to understand the function of
the behavior, then make small, gradual changes and be consistent. Here are some
ideas to help you:
1. Coping
with change: If unexpected changes occur, and your youngster is finding it hard
to cope, try re-directing them to a calming activity, or encourage them to use
simple relaxation techniques such as breathing exercises. You could use praise
or other rewards for coping with change. In the long term, this may help make
your youngster more tolerant of change.
2. Explore
alternative activities: One way to interrupt repetitive behavior is for a
youngster to do another enjoyable activity that has the same function (e.g., a
youngster who flicks their fingers for visual stimulation could play with a
kaleidoscope or a bubble gun; a
youngster who puts inedible objects in their mouth could have a bag with edible
alternatives that provide similar sensory experiences such as raw pasta or
spaghetti, or seeds and nuts; a youngster who rocks to get sensory input could
go on a swing; a youngster who smears their poop could have a bag with play
dough in it to use instead).
3. Intervene
early: Repetitive behaviors, obsessions and routines are generally harder to
change the longer they continue. A
behavior that is perhaps acceptable in a young child may not be appropriate as
they get older and may, by this time, be very difficult to change. For example,
a youngster who is obsessed with shoes and tries to touch people's feet might
not present too much of a problem, but a teenager doing the same thing -
especially to strangers - will obviously be problematic. It will help if you
can set limits around repetitive behaviors from an early age and look out for
any new behavior that emerges as your youngster gets older. Making your
youngster's environment and surroundings more structured can help them to feel
more in control and may reduce anxiety. If anxiety is reduced, the need to
engage in repetitive behavior and adhere strictly to routines may also, in
time, be reduced.
4. Pre-planning:
You may be able to help your youngster to cope with change, or activities and
events that could be stressful, by planning for them in advance. Change is unavoidable, but it can be really
difficult for many children with the disorder. You may not always be able to
prepare for change a long time in advance, but try to give your youngster as
much warning as possible. Gradually introducing the idea of a new person,
place, object or circumstance can help them cope with the change. Try to talk
about the event or activity when everyone is fairly relaxed and happy. Presenting information visually can be a good
idea, as your youngster can refer to it as often as they need to. You could try using calendars so that your
youngster knows how many days it is before an event (e.g., Christmas) happens.
This can help them feel prepared.
Your youngster might also like to see photos
of places or objects in advance so they know what to expect (e.g., a picture of
their Christmas present) or a photo of the building they are going to for an
appointment. Using social stories could also be helpful. These are short
stories, often with pictures, that describe different situations and activities
so that children with Aspergers and HFA know what to expect. Pre-planning can also involve structuring the
environment.
For example, a student with HFA might go to use a computer
in the library at lunchtime if they find being in the playground too stressful
– or if a youngster has sensory sensitivity, minimizing the impact of things
like noises (e.g., school bells) or smells (e.g., perfumes or soaps) can help
them to cope better. It is possible that
more structured environments may reduce boredom, which is sometimes a reason
for repetitive behavior. You might prepare a range of enjoyable or calming
activities to re-direct your youngster to if they seem bored or stressed.
5. Self-regulation
skills: Self-regulation skills are any activities that help your youngster to
manage their own behavior and emotions.
If you can help your youngster to identify when they are feeling
stressed or anxious and use an alternative response (e.g., relaxation
techniques or asking for help), you may, in time, see less repetitive or
ritualistic behavior. Research has also
shown that increasing a child’s insight into an obsession or repetitive
behavior can significantly reduce it. This includes children with quite severe
learning disabilities.
6. Set
limits: Setting limits around repetitive behavior, routines and obsessions is
an important and often essential way to minimize their impact on your
youngster's life. You could set limits in a number of ways depending which
behavior concerns you. For example, you can ration objects (e.g., can only
carry five pebbles in pocket), ration places (e.g., spinning only allowed at
home), and ration times (e.g., can watch his favorite DVD for 20 minutes twice
a day). Everyone involved with your youngster should take the same consistent
approach to setting limits. Have clear rules about where, when, with whom and
for how long a behavior is allowed. You could present this information
visually, with a focus on when your youngster can engage in the behavior. This
may help if they feel anxious about restricted access to an obsession or
activity.
7. Social
skills training: Teaching social skills (e.g.,
how to start and end a conversation, appropriate things to talk about,
how to read other people's 'cues') may mean someone with Aspergers or HFA feels more
confident and doesn't need to rely on talking about particular subjects (e.g.,
a special interest).
8. Understand
the function of the behavior: Obsessions, repetitive behavior and routines are
frequently important and meaningful to children on the spectrum, helping them to
manage anxiety and have some measure of control over a confusing and chaotic
world. For others, the behavior may help with sensory issues. Take a careful
look at what you think might be causing the behavior and what purpose it might
serve. For example, does your youngster
always seem to find a particular environment (e.g., a classroom) hard to cope
with? Is it too bright? Could you turn off strip lighting and rely on natural
daylight instead?
9. Visual
supports: Visual supports (e.g., photos, symbols, written lists or physical
objects) can really help children with Aspergers and HFA. A visual timetable could help your youngster
to see what is going to happen next. This makes things more predictable and
helps them to feel prepared. It may lessen their reliance on strict routines of
their own making.
Visual supports like egg timers or 'time timers' can help
some children with an autism spectrum disorder to understand abstract concepts like time, plan
what they need to do, when in order to complete a task, and understand the
concept of waiting. Visual supports can
also be useful if your youngster asks the same question repeatedly. One parent
wrote down the answer to a question, put it on the fridge and, whenever her son
asked the question, told him to go to the fridge and find the answer. For kids
who can't read, you could use pictures instead of words.
10. Make use
of obsessions: Obsessions can be used to increase your youngster's skills and
areas of interest, promote self-esteem, and encourage socializing. You may find
you can look at a particular obsession and think of ways to develop it into
something more functional. Here are some examples:
A child
with a special interest in historical dates could join a history group and meet
others with similar interests.
A child
with knowledge of sport or music would be a valuable member of a pub quiz team.
A strong
preference for ordering or lining up objects could be developed into housework
skills.
An
interest in particular sounds could be channeled into learning a musical
instrument.
An
obsession with rubbish could be used to develop an interest in recycling, and
the youngster given the job of sorting items for recycling.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
• Anonymous said… Mine is 17 and still obsessed. I think we have every game, plus the cards, and watch the cartoon. HELP! • Anonymous said… My 14 year old- obsessed with Pokemon. Sets him noticeably apart from his peers, and is definitely an issue. frown emoticon • Anonymous said… my 25 year old son with ASPERGERS is obsessed with stunt riding.. he is getting good at it. came 12th in the british stunt championships last year. wink emoticon • Anonymous said… My Aspie son was too at that age. Rest assured, he will move on to other things but with just as much obsession! Whatever makes them happy..... • Anonymous said… My lad of 21 now he has aspergers.was mad on pokemon and digimon. • Anonymous said… My son is obsessed with this too! • Anonymous said… My teenager( Aspergers) at age 6 was obessed with Spongebob. We would turn the Television and he could repeat the episode without pictures or words. I think that they just love different things and have a likeable interest. My normal 6 year old is obsessed with Sonic. He is at the top of his class and this is the 2nd 9weeks weeks of report cards. He wants every character. At least it is a good thing and not something bad. • Anonymous said… Pokemon was created by an autistic man, so I can see why they can become an interest. • Anonymous said… Sounds familiar our 12 year old loves pokemon magic the gathering mine craft and Spider-Man • Anonymous said… This is an excellent article! Our 7-year-old grandson is obsessed with Minecraft. We have to curb his enthusiasm for discussing Minecraft every single minute of the day, or we would go completely batty! We tell him that although he loves Minecraft, not everyone shares his interest, and it's important to find out what other people's interests are, and not to monopolize conversations talking about his interests only. • Anonymous said… When our Aspergers son got into Pokemon it was actually a HUGE help for him socially. Since all the kids were into it, he actually had common interests and they could all talk Pokemon. We saw a lot of social growth during this phase so the obsession was actually very healthy for him.
* Anonymous said...I have a 9 year old son. He was assessed two years ago by a Dr. at Stanford University. I went in there thinking he would come out with a diagnosis for ADHD Inattentive at the bare minimum, but instead we walked out an hour later being told he was only dyslexic. I still don’t understand how that one was the official diagnosis because I really don’t see a connection with him. He doesn’t have troubles reading, and he never complains about the letters looking different. Fast forward to today. At 9 years old his mannerisms are starting to really stick out from other kids his age. You can’t really play it off as him being a “little” boy because he is acting sort of immaturely for a 9 year old. He is also very in tune with remembering dates to when certain people were born. When certain musicians first played a rock and roll song and when movies we’re first released. He then compares that to something like when he was born. “Mom you know that movie, (movie title) came out on November five, 1987”. (He says “five” rather than saying “fifth). Then he says, “that means it came out 27 years before I was born!” Mind you, no one inquired about the song or asked him anything about it but he’s correct on the dates and feels the need to tell you about it. He’s also obsessed with space and Roblox right now and loves informing you on all things associated with them. With all his knowledge of dates and times in history, he absolutely struggles in school. He’s in speech because he has a little trouble speaking and pronouncing sounds. He’s also in “Learning Lab” getting extra one-on-one help with school work with a school resource teacher. Ask him to write an essay about a certain topic and he can’t form thoughts and write them down. The teacher wants a intro. paragraph, main body and a conclusion. He writes random sentences that are not cohesive and go way off track. Have him read a one page, age appropriate news article written for kids and he can’t answer a 5 question quiz afterwards of what they just read. It’s very interesting how he can be so correct with recalling dates off the top of his head but his short term memory is so much different. I just feel like something is going on with this wonderful child of mine. He’s so quirky and ridiculously sweet, I love him to bits but I’m concerned about him. :-/
My Aspergers son spends all his time collecting and ruminating over his baseball cards. That’s ALL he talks about, all day long: baseball trivia (names of teams, names of players, player stats, and on and on...). Is this Aspergers related behavior, and how can I get him to broaden his interests?
Answer
Rituals and obsessions are one of the hallmarks of Aspergers (high functioning autism) and other Autistic Spectrum Disorders. In order to cope with the anxieties and stresses about the chaotic world around them, children often obsess and ritualize their behaviors to comfort themselves. While some children may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items, or even doing things which put them or others in danger.
Based on data from psychological testing, it is likely that the memory of the youngster with Aspergers may not be better than others in general, but the huge collection of facts he knows probably represents the amount of time and effort that has gone into accumulating knowledge on one or two subjects to the exclusion of much else. The obsessions are not necessarily characterized by memorization of data alone.
The term “systemizing” applies to the “fascination with data” that has inherent networks, such as maps, weather patterns, or airline schedules. Although it is commonly thought that obsessions can be strengths that can be utilized in the educational process, these obsessions can interfere significantly with other important daily functions. Children with Aspergers are more interested in systems that can be described as “folk physics” (an interest in how things work) versus “folk psychology” (an interest in how people work).
Obsessions aren't always so bad, especially if they are some of educational or healthful value, but when mixed with the mental makeup of a child with Aspergers, problems may arise. Kids with Aspergers have trouble with social and emotional development and understanding the nonverbal cues in a conversation. While they are more than happy to start discussing their subject of obsession to another person, they will most likely not notice if the other person is not interested.
They may not get the hint of a person's disinterest or lack of time to talk. They may instead proceed to follow another person around continuing to talk on and on about their area of fascination. They may go right up to someone else already engaged in conversation and interrupt them to begin associating their topic of interest with their obsession. They may take over a conversation and talk endlessly not leaving much time or room for any feedback from another.
Kids with Aspergers may become so obsessed with a particular toy, game, or subject, that they may push friends away unknowingly. They may leave little time for anything else, and homework may suffer. They may become too easily distracted always thinking back to their obsession and not be able to stay on task.
Moms and dads need to take care to allow their kids to be passionate about certain subjects but to not let it entirely rule their lives. If a child is overly obsessed with playing video games of play on the computer, it is OK to give them some time to play, but the time should be limited. Even if the subject of fascination is reading books or doing science experiments, it is still important that time be given to other subjects or just to get out to get some exercise.
Kids with Aspergers do not learn the social norms and common sense ideas the same way another child does. They may never completely understand the reasons why things matter socially. They may not see any reason why they shouldn't devote all their time to their one major fascination. Moms and dads can take consideration for their passion, but also help them become a more socially rounded person. It is important, however, if a child fixates on a particularly bad habit or inappropriate subject matter, that a parent put an end to it immediately.
Even with Aspergers, a child will eventually notice when a parent is not interested and it may become hurtful. Moms and dads should take the time to listen to their child and even learn about what is so fascinating. A parent who will take the extra initiative to go visit a planetarium for their child interested in space, or take a trip to a dinosaur museum for the child obsessed with dinosaurs, will give their child the extra support and assurance they need.
Choose your battles wisely. Breaking an obsession or ritual is like running a war campaign. If not planned wisely or if you attempt to fight on many fronts, you're guaranteed to fail. Not only is it time consuming and tiring, it means you can't devote 100% to each particular area. So, if you have a youngster with (1) a game obsession, (2) a phobia of brushing his teeth, and (3) bedtime troubles, choose only one to deal with. Deal with the worst problem first!
When tackling any problem with any youngster, Aspergers or not, it's always best to remain calm at all times. Children can feed off your anger, frustration and anxiety, so keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
• Anonymous said... With time obsessions change, evolve...as long as it doesn't interfere with their studies. • Anonymous said... Definitely Asperger's related!! My son used to categorize his trains when he was little by their "usefulness" as he put it. The we moved on to Legos and them needing to be categorized by shape, size, color, etc. Your son will be fine. There is nothing wrong with fixating on one subject or area within a subject...he can't help it. Throughout his life he will go on to other things, on his own time. I myself had a baseball card fixation when I was younger, then I moved on, then ended up coming back, re-sorting previous collections, staring a new one, etc.. • Anonymous said... Don't bother. My son now 21 and in college still crazy about trains. But think of their interest in a broader spectrum is easier. I got Eurail maps for him and he learned geography and history. Be age appropriate but go for it. Baseball is worldwide. There are teams in many other counties. Japan is one. • Anonymous said... I never really felt the need to broaden my sons interests. He has similar behaviors with other things that he perseverates on and I think it is such a unique characteristic to him and other children like him that I try to support it and encourage him to learn in a variety of different ways. I have always made sure that I expose him to a variety of different things and interests and I've always given him many different flavors in life such as different sports different TV shows and now different YouTube channels but in the end I just encourage his interactions with what he enjoys. Because my son would focus on one thing I would use that to my advantage and use that one thing to show him many different avenues with sports you can use statistics for math you can use teamwork for socialization you can use whatever it is that they focus on as your grounds and topic for teaching them important things in life. In the end what really matters I think it's happiness health and being able to function in society. We all have a different purpose in our life and whether your purpose is baseball, teaching or just inspiring others I really try to provide my son with as much support for his purpose as he needs. • Anonymous said... Most children with Aspergers also have OCD (like my son) and the have something that they just cling to. For my son it's the video games Skylanders. The best thing you can do is try to introduce him to as many different things as possible. Now that doesn't guarantee that he won't revert back to the game cards but it will plant seeds for other options. • Anonymous said... My daughter obsessively studies dogs, if we are out and she sees a dog she will ask what breed it is, of course that is not enough, she wants to know its weight, coat type, how much walking it does, how fast it runs, what it was used for in history, what health issues the breed has.... It goes on and on!!... and on. I brought her a note book, and a dog encyclopedia, she can draw a picture and write 5 facts about the particular breed. Works very well. • Anonymous said... My son has his obsession with fish tanks. He's now scuba certified and taught himself to maintain a saltwater reef. Use the obsessions as a life lesson and let them run with it. It's a great thing to watch a child so tuned in and focused.
* Anonymous said... There are a number of issues to overcome....misdiagnosis, wrong medications and side effects, judgemental people in society and of course how the rest of the family is effected!! On top of all this, theres not enough support with regards to assessments and ongoing therapy, especially if your not wealthy! * Anonymous said... Can you tell me what medication your referring to which can assist with obsessive behavior? * Anonymous said... My son has extreme OCD with his Aspergers. Doctors want me to put him on Prozac , which I am etremely hesitant to do. Does anyone else have experience with this?
"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.
AS and HFA kids with obsessive compulsive disorder:
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
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?
Treatment—
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: