What’s the Link Between OCD and Autism?

I recall a teenager named Graham who already had OCD for 10 years, had nine therapists and had been on 3 psychiatric medications before he started our BrainBehaviorReset™ Program. Within just a few weeks he progressed more than he had in 10 years with a combination of different science-backed natural therapies, including but not limited to neurofeedback. 

OCD, or Obsessive-Compulsive Disorder, is challenging to treat on your own without support from clinical psychology experts. Many try to manage their own OCD without ever really finding a treatment that helps. 

Complicating matters is that research shows that OCD often co-occurs with other mental health issues, particularly anxiety, autism (ASD), and mood disorders (LaSalle et al., 2004). 

Understanding how OCD and autism manifests in your child will give you an excellent headstart into giving them the support they need whether at home, in school, or in the community. 

What Happens When Your Child Has OCD?

When a child has OCD, they often feel compelled to repeat mental or physical rituals to cope with irrational fears. At its heart, OCD is driven by anxiety, which transforms into fears so powerful they begin to dictate a child’s behavior.

Children with OCD genuinely believe their fears, rituals, and the consequences are connected. They may think, “If I do XYZ, I can stop something bad from happening.” Unfortunately, the brain reinforces these rituals through something called the negative reinforcement cycle, which makes them harder to resist over time.

OCD doesn’t just impact your child—it can disrupt their development, relationships, and future. Left unchecked, it can spiral and affect the whole family, pulling everyone into its grip.

While most people associate OCD with compulsive behaviors, obsessive thinking is actually even more common. These intrusive thoughts are quieter and harder to spot, which is why OCD can sometimes go undetected for so long.

The good news is that early intervention can make a world of difference. With the right support, your child can learn to manage these obsessions and compulsions before they take a lasting toll. The challenge, however, is finding a qualified mental health professional who specializes in OCD—something many parents struggle with.

How to Tell If Your Child Has Autism?

The core symptoms of autism, or Autism Spectrum Disorder (ASD), are typically difficulties with social communication and interaction and restricted, repetitive patterns of behavior, interests, or activities.

• Difficulty with Social Reciprocity:

Struggles to engage in back-and-forth conversations or social exchanges. For example, they might not respond to their name or may have difficulty sharing interests or emotions.

• Nonverbal Communication Challenges:

Issues with interpreting or using nonverbal cues like facial expressions, gestures, eye contact, or body language. This can make understanding social contexts harder.

• Difficulty Developing and Maintaining Relationships:

They may find it challenging to form friendships, play cooperatively, or adjust behavior based on social situations. For some, understanding social rules or norms might feel unnatural.

• Repetitive Movements or Speech:

Engaging in behaviors like hand-flapping, rocking, or repeating words or phrases (echolalia).

• Intense Focus on Specific Interests:

A strong passion for a particular subject, object, or activity, sometimes to the exclusion of other topics. For instance, they might memorize every detail about dinosaurs or train schedules.

• Insistence on Routine or Sameness:

Resistance to change or disruptions in routines. Even small changes, like taking a different route home, can cause significant distress.

• Sensory Sensitivities:

Heightened or reduced sensitivity to sensory input, such as light, sound, textures, or smells. For example, a child might cover their ears in noisy environments or avoid certain fabrics.

• Other Indicators:

Delayed language development, unusual reactions to social situations, difficulty with emotional regulation, challenges with motor coordination

The OCD and Autism Overlap

The interaction between OCD and autism can be overwhelming for parents, teachers, and guardians striving to understand their child’s behaviors. While the symptoms of these conditions often overlap, the underlying motivations can be quite different. 

For instance, a child with autism might line up toys for comfort or sensory satisfaction, whereas a child with OCD may engage in the same behavior out of fear that something bad will happen if they don’t.

Anxiety is another shared hallmark of both conditions, and its presence can intensify when OCD and autism coexist. This heightened anxiety often makes managing either condition more challenging.

Social interactions further complicate the picture. The inherent difficulties of autism can amplify the distress caused by OCD, especially when rituals draw unwanted attention or interfere with forming connections. 

How Common Is OCD and Autism to Co-Occur?

The co-occurrence of Obsessive-Compulsive Disorder (OCD) and Autism Spectrum Disorder (ASD) is relatively common, with studies suggesting a significant overlap between the two conditions. Research indicates that:

Prevalence Rates

• OCD in individuals with Autism:
  Between 17% and 37% of individuals with ASD are also diagnosed with OCD, which is 1-2% higher than the prevalence of OCD in the general population (Van Steensel et al., 2011 and Ruzzano et al., 2015). 
• Autism in individuals with OCD:
  Studies have found that up to 20% of individuals with OCD may meet the criteria for ASD or exhibit autistic traits, such as difficulties with social communication or rigid routines.

Why Do OCD and Autism Often Co-Occur?

While the exact reasons for this overlap aren’t fully understood, several factors may contribute:

1. Shared Neurobiological Pathways:
   Both OCD and autism involve disruptions in brain circuits related to executive functioning, emotional regulation, and repetitive behaviors.
2. Cognitive Rigidity and Repetitive Behaviors:
   Both conditions involve rigid thinking patterns and repetitive behaviors, though the motivations differ. In OCD, rituals are driven by anxiety, while in autism, repetitive behaviors often provide comfort or stem from sensory needs.
3. Sensory Processing Differences:
   Sensory sensitivities common in autism may exacerbate OCD symptoms, particularly those related to contamination fears or a need for symmetry.
4. Genetic and Environmental Factors:
   Both conditions have strong genetic underpinnings, and families may have a history of either or both disorders. Environmental influences during development might also play a role.

Scientists have identified shared brain regions and pathways in both autism and OCD, particularly focusing on the striatum, which is involved in motor functions, rewards, and behavior regulation. 

Studies show that both conditions may involve an unusually large caudate nucleus within the striatum and anomalies in the cortical-striatal-thalamic-cortical loop, which helps control behavior and habit formation (Ting Q, et al., 2015).

Treatment for OCD and Autism

If your child has OCD and comorbid ASD, conventional OCD therapy will not work, and vice versa. Therefore, an essential aspect of diagnosis is determining whether a patient's behaviors are related to ASD or OCD. Unfortunately, treating patients with both neurological disorders has proven to be challenging for most parents.

• Exposure and Response Prevention

Exposure and Response Prevention, or ERP, is an effective treatment for OCD. It is a type of CBT that exposes an individual to their trigger so they'll learn how to be uncomfortable until they can ignore it

Step 1: Identify all triggers

Step 2:  Therapist will expose the child or teen to the situations that trigger their anxiety, obsessions, and compulsions.

Step 3: Gradually intensify triggers until it gets moderate and until the child learns to deal with the discomfort rather than avoid them.

• Neurofeedback

Neurofeedback can also help significantly in young people with OCD and autism. Regular neurofeedback therapy sessions reduce an autistic or OCD child's overactive brainwaves and retrain the brain to reduce the symptoms of obsessive-compulsive disorder. 

With both conditions, the brain has hyper communication that needs to be regulated and that is exactly what neurofeedback does. All these make neurofeedback an effective ASD and OCD treatment.

Recent studies tested neurofeedback as a treatment on ten children ages 4 to 7 years old diagnosed with high-functioning autism suffering from speech impairment and having trouble communicating. Results show that there were changes in the children's behavior. They were more cooperative and less aggressive. They also exhibit better communication, higher attention spans, and improved sensory motor skills (Zivoder et al., 2015).

• Pulsed Electromagnetic Fields 

Pulsed Electromagnetic Fields, or PEMFs, ease the brain to think, focus, and take action. PEMF is an excellent treatment since it calms the body and relieves those uncomfortable sensations, especially in addressing anxiety related to autism and OCD.

These are just some natural solutions supported by clinical trials that can work for your child with OCD or ASD. If you're looking for a treatment plan that will work for your kid without using medications, we can help. At our Ridgefield center and virtually, we help parents get an accurate diagnosis of OCD or ASD for their child and manage their anxieties and common obsessions.

Getting the right OCD or ASD diagnosis is critical to ensure your child receives the right treatment plan to address their nervous system and functional impairments.The correct treatment plan won't just provide temporary relief but a way to lead them to the first steps toward a calmer happier life.

• Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, or CBT, works at the conscious level. CBT works by correcting the misperceptions around how people perceive a situation and its connection to their reactions rather than to the situation itself.

CBT combines talk and behavioral therapy to reframe one's negative or unwanted thoughts and turn them into positive ones and is a great treatment option for those experiencing anxiety.

Citations 

Devnani, P., & Hegde, A. (2015). Autism and sleep disorders. Journal of Pediatric Neurosciences, 10(4), 304. https://doi.org/10.4103/1817-1745.174438

Hazen, E. P., Reichert, E. L., Piacentini, J. C., Miguel, E. C., do Rosario, M. C., Pauls, D., & Geller, D. A. (2008). Case Series: Sensory Intolerance as a Primary Symptom of Pediatric OCD. Annals of Clinical Psychiatry, 20(4), 199–203. https://doi.org/10.1080/10401230802437365

LaSalle, V. H., Cromer, K. R., Nelson, K. N., Kazuba, D., Justement, L., & Murphy, D. L. (2004). Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder. Depression and Anxiety, 19(3), 163–173. https://doi.org/10.1002/da.20009

Ruzzano, L., Borsboom, D., & Geurts, H. M. (2015). Repetitive behaviors in autism and obsessive-compulsive disorder: New perspectives from a network analysis. Journal of Autism and Developmental Disorders, 45(1), 192-202. https://doi.org/10.1007/s10803-014-2204-9

Ting, Q., Chen, C., Yun L., Chao, YX., Ting, X., Xiang, X., Yun, H., Kang, K., Lewis, M., Xiaoyan, K. (2015). Two years changes in the development of caudate nucleus are involved in restricted repetitive behaviors in 2-5-year-old children with autism spectrum disorder. Developmental Cognitive Neuroscience, 19:137-143. https://doi.org/10.1016/j.dcn.2016.02.010

Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of Anxiety Disorders, 17(2), 233–242. https://doi.org/10.1016/s0887-6185(02)00182-2

Van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis. Clinical Child and Family Psychology Review, 14(3), 302–317. https://doi.org/10.1007/s10567-011-0097-0

Zivoder, I., Martic-Biocina, S., Kosic, A. V., & Bosak, J. (2015). Neurofeedback application in the treatment of autistic spectrum disorders (ASD). Psychiatria Danubina, 27 Suppl 1, S391-394. https://pubmed.ncbi.nlm.nih.gov/26417802/