Autism and OCD

Since many people with autism are also diagnosed with obsessive-compulsive disorder, scientists have been studying how these two conditions impact each other and differ from one another. A recent article written by Daisy Yuhas and published online on February 28, 2019, in Scientific American, “Untangling the Ties Between Autism and Obsessive-Compulsive Disorder,” compares and contrasts these two disorders. [To read this article, please click here.]

Research indicates that up to 84% of people with autism suffer from some form of anxiety, and up to 17% of people with autism spectrum disorders also have obsessive-compulsive disorder. People with autism and/or OCD may respond to sensory stimuli in unique ways; sensory overload can cause anxiety, which is part of OCD. Typically, those with OCD deal with obsessions, or recurring thoughts, feelings, and ideas. They may also be driven to engage in ritualistic, repetitive behaviors, or compulsions, attempting to get rid of these unwanted obsessive thoughts.

In studies, researchers have observed that OCD rituals appear quite similar to repetitive behaviors found in autism. For example, those who have obsessions with cleanliness may wash their hands over and over, or those who have obsessions with safety may repeatedly check to make sure doors are locked and appliances are turned off. Typical repetitive behaviors in autism include lining up toys or other objects in a certain order, flapping hands and/or rocking the body, or watching a scene from a video repeatedly.

While both conditions involve repetitive behaviors, differences exist between OCD rituals and autism behaviors. To illustrate, OCD rituals are quite specific and must be performed in a certain way to relieve anxiety. However, autism behaviors tend to be more generalized. Those with autism usually have various repetitive behaviors they can choose to calm themselves. As Columbia University professor of psychiatry Jeremy Veenstra-VanderWeele notes, “They’re [people with autism] just looking for anything that’s soothing; they’re not looking for a particular behavior.”

Although the reasons for repetitive behaviors in OCD and autism may differ, the parts of the brain associated with both conditions appear to be the same. Recently, scientists have discovered common pathways and brain regions in both autism and OCD, namely the caudate nucleus located in the brain’s striatum. The striatum area of the brain is linked to voluntary movement and reward processing. The neural circuits running through the striatum are involved in how behaviors start and stop, including in how habits form.

Additionally, the caudate nucleus deals with memory, specifically storing and processing prior knowledge and experiences to help in making future decisions. Moreover, the caudate nucleus is crucial for using language and learning. According to research, the caudate nucleus tends to be unusually large in people with autism and in people with OCD. Scientists have theorized that in people with OCD, the caudate nucleus may not be able to control transmission of worrisome thoughts, which affects their actions and decisions. Hence, rituals are used to cope with anxiety associated with obsessive thoughts.

While the most common intervention for OCD is cognitive behavioral therapy, those who have dual diagnoses of autism and OCD usually do not benefit from this treatment method. In cognitive behavioral therapy (CBT), therapists help people discover new coping techniques by changing their thought patterns. However, researchers note that people with autism tend to have difficulties imagining situations and alternative outcomes. For this reason, CBT may need to be individualized to meet the needs of each person. For example, children with autism may benefit from having their parents included in the therapy sessions. Other people with autism may find CBT more useful if language is adapted, visuals are provided, and/or rewards are offered. While personalization of CBT therapy may require more effort, the effectiveness of this therapy will likely increase.

Even though autism and OCD share common characteristics, such as repetitive behaviors in response to sensory overload and anxiety as well as involvement of a specific area of the brain, differences exist between ways of seeking calming behaviors and the effectiveness of standard treatment. For those dealing with both autism and obsessive-compulsive disorder, therapists need to individualize methods of treatment, teaching calming skills and coping methods so that their clients can enjoy a better quality of daily life.

“For the Lord your God is living among you. He is a mighty savior. He will take delight in you with gladness. With His love, He will calm all your fears. He will rejoice over you with joyful songs.” Zephaniah 3:17