Autism vs OCD: Understanding Your Child

Reviewed by Dr Lucy Russell DClinPsyc CPsychol AFBPsS

Perhaps your child has an autism diagnosis and you wonder if they also have OCD?

Or maybe your child has developed obsessive behaviours and rituals and you want to understand what this could be?

In this article I will help you untangle the information!

Autism vs OCD: Key Differences

Autism has features which overlap with mental health conditions including anxiety, ADHD Attention Deficit Hyperactivity Disorder and OCD (Obsessive-Compulsive Disorder).

Despite the overlap in symptoms, autism and OCD are separate conditions. One key difference is that OCD is considered a mental illness from which a child can receive treatment and recover. Autism on the other hand is a difference in “brain wiring”. Autism is considered lifelong and can bring many strengths as well as challenges.

It is possible to:

• Be autistic without OCD;
• Have OCD and not be autistic, or
• Have both diagnoses at the same time.

Obsessive and repetitive behaviour is one of the main “symptoms” of autism.

However, autism is much broader than this. Autistic children also show differences in communication and social interaction, sensory processing, and often in motor skills or co-ordination.

Autism vs OCD: Understanding the Overlap

Recent studies show that people with autism and people with OCD both have an unusually large caudate nucleus (CN) in their brains compared to the general population.

The caudate nucleus is associated with restricted and repetitive behaviours. This may partly explain why autism and OCD overlap.

Diagnosis of OCD in autistic children can be tricky. Missed diagnosis is common.

OCD is one of the most prevalent mental health conditions to exist in conjunction with autism (“comorbid”). Research found that approximately 17% of young people with autism are also clinically diagnosed with OCD.

Next, let’s get clear on exactly what autism and OCD are.

Autism vs OCD: What is Autism?

Autism is a neurodevelopmental difference (a brain difference).

The way autism manifests varies significantly between individuals. No autistic child is the same. Each child has a unique profile of strengths and challenges.

Unfortunately, autistic people are considered to have “neurodevelopmental disorders”. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) it is referred to as Autism Spectrum Disorder.

So-called autism spectrum disorders used to include a number of different categories, such as Asperger’s syndrome.

However, the current diagnostic manual has put them all together as one broad term. Many autistic people, parents and professionals want to get rid of the term “disorder” as it is unfair and misleading.

To qualify for an autistic diagnosis, symptoms must be present in early childhood. However, many children do not receive diagnosis until much later in life, even into adulthood.

Often the reason is that their symptoms are subtle or they are doing an excellent job of “masking” their difficulties.

For many young people autism only becomes more visible when social or sensory demands increase and they can no longer mask their difficulties.

According to the DSM-5 the main characteristics of autism include:

• “Social deficits” such as challenges with social communication, social skills and social interaction. Increasingly these “deficits” are now viewed by many as differences, rather than faults which require “fixing”.
• Restricted and repetitive behaviors, interests or activities.
• Differences in sensory processing. This could include:
  • Heightened sensitivity to sensory stimuli.
  • Increased need for certain sensory stimuli.
  • A mixed pattern of both of the above.

Autism is considered a difference in the way the brain is wired. However, recent research also suggests differences in the peripheral nervous system. The peripheral nervous system controls our sense of touch, pain, and other sensations.

There is an increasing movement towards recognising the incredible strengths that autism can bring. It is also important to recognise the importance of neurodiversity in our society. This video explains more.

Autism vs OCD: What is OCD?

OCD (obsessive compulsive disorder) is a mental health condition which can be broken down into two components:

1. Obsessions: These are usually unwanted thoughts, but can also occur as unwanted images, worries or doubts that repeatedly appear in the mind. They provoke feelings of anxiety. For example, an OCD patient may have an obsession with cleanliness and a fear of germs.
2. Compulsions: These are repetitive activities or behaviours which a child does to dampen the obsessive thoughts. Sometimes they are unrelated to the thoughts. Psychologists call this “magical thinking”. For example, a child might think: “if I tap my knees 100 times, Mum will not die.” By doing the compulsive behaviors, the anxiety goes away temporarily. In other cases, the behaviour is directly related to the fear. For example, the child may engage in hand washing 100 times a day keep their fear of germs ‘under control’. The problem is, the anxiety always comes back. The ritualistic behaviors can end up spiralling out of control as the child tries fruitlessly to get rid of the horrible feelings.

Some other common OCD-related obsessions in children may relate to:

• Responsibility. As children grow up they are expected to take on an increasing level of independence and often OCD can be a sign that a child is struggling with this. For example, if they are the last one in the house, a teenager may check that they have shut the front door 10 times before leaving for school.
• Fear of themselves or others being harmed.
• Religion, with an excessive concern about right/wrong or morality.

According to diagnostic criteria, the presence of obsessions and/or compulsions must be “unreasonable or excessive”.

They must significantly interfere with the child’s daily functioning, for a clinical diagnosis of OCD to be given.

Symptoms of OCD can affect all people, of all ages, but the onset is commonly during early adulthood.

Just like autism, OCD symptoms and characteristics manifest differently in each child or young person.

Autism vs OCD: Exploring Similarities and Their Underlying Differences

Many of the symptoms and behaviours associated with autism and OCD overlap. Such as:

• Repetitive patterns of behaviours
• Obsessions and/or restricted interests
• Feelings of anxiety
• Rigid thinking
• Resistance to change

Let’s delve a little deeper.

Obsessions and/or Restricted Interests:

• For autistic people, obsessions are not always distressing thoughts and repetitive behaviours as they are in OCD. Obsessions can be passions which make an autistic child happy. Obsessions may lead to expertise which can greatly improve a child’s self-esteem. Autistic intense interests can interfere with well-being if they are all-consuming. For example, a child who spends  10 hours per day on Minecraft may not be getting enough exercise, social contact or sleep, and this may negatively impact their mental health.
• For those diagnosed with OCD, the obsessions are unwanted and intrusive. These take the form of uncontrollable and persistent thoughts which can create huge amounts of anxiety. The obsessions then drive behaviours.
• The nature of obsessions within autism vs. OCD can be vastly different. However, within both conditions, they can interfere with attention, concentration and well-being.

Repetitive Patterns of Behaviours:

• For autistic children, some behaviours are not only enjoyable – but also relaxing and calming, for the nervous system. These behaviours can also be referred to as “stimming”. For example, a child may cope with demanding situations by rubbing their fingers and thumbs together repeatedly to provide sensory feedback to the brain. Repetitive behaviours may also include whole body movements or making unusual noises. They are necessary and repetitive, but they are not necessarily problematic and they do not need to be treated. They help a child to manage emotions and act as coping mechanisms for overwhelming situations. However, they may not be seen as “socially acceptable” in some cases. When this happens the child and the adults around them should look at ways to adapt the environment to reduce the need for stimming.
• In children with OCD the repetitive behaviours are very intrusive. The child can feel controlled by the behaviours.  If OCD escalates the behaviours interfere with every realm of everyday life from family and peer interactions to eating and sleep. They can be upsetting/traumatising for the individual and provide anything but enjoyment. Repetitive behaviours often involve repeated cleaning or repeated checking.

Feelings of Anxiety

The causes of anxiety within autism versus OCD condition are different. In autism, the causes of anxiety can include:

• Disruption to routines
• Overwhelming sensory environments, which can cause sensory overload.
• Being misunderstood and/or not being accepted by non-autistic people.
• Difficult social situations.

In OCD, the causes of anxiety might include:

• The underlying fear beneath the intrusive thoughts, such as fear of something bad happening.
• Interrupted rituals (because the child feels if they don’t complete the ritual their fear is more likely to come true).
• Social shame or judgement from others.

If you want to deepen your understanding about anxiety so you feel clear on exactly which steps will help for your child, consider our mini-course, Knowledge is Power!

Rigid Thinking:

• For autistic children, rigidity usually reflects:
  • The child’s need to stick to routines to feel secure,
  • Their literal interpretation of language and
  • Their difficulty looking at/thinking about things in ways other than they were expecting.

Rigid thinking in autistic children is not always a negative trait. It can help them to be more goal-oriented and have a strong work ethic. It can also help children to show resilience and persistence in the face of challenges.

• For children diagnosed with OCD, rigid thinking stems from the urgent need to perform rituals which keep the unwanted thoughts away or protect them from imagined harm. In their eyes rituals must be completed to prevent something bad from happening.

Fear of Change

• For autistic children and teens, fear of change is partly due to their difficulty with flexible thinking and their need to stick to clear routines. Their brains need time to adjust to new activities or changes before partaking in them.  Generally consistency and predictability are helpful for autistic children. They allow the child to feel reassured that they know what will happen next. Sudden changes can force autistic children into situations which are uncomfortable and difficult.
• In OCD, children’s resistance to change stems from the underlying fear that something bad will happen if they do not complete their compulsive behaviour. Any type of change that affects the rituals can cause panic or fear-based aggression.

Treatments For Childhood OCD vs Autism

The goal of any effective treatment is to improve a child’s quality of life.

As you can see, autistic repetitive behaviours do not need “treatment”. However, sometimes a professional (such as a psychologist or occupational therapist) can help families and teachers to adapt an environment if stimming is an attempt to self-soothe.

Autism is not an illness or disease. For many of autistic young people, being autistic is a positive part of their identity.

The main therapeutic treatment for OCD is cognitive behavioral therapy (CBT). In particular, research has found that n element of CBT called ERP (exposure and response prevention) is effective in treating OCD. 

ERP involves reducing the rituals in a graded and controlled way. The child stays fully in control of the pace. Children learn to tolerate  and “sit with” the discomfort caused by their anxiety.

Gradually this treatment decreases their need for ritualistic behaviours to relieve the anxiety.

Selective serotonin reuptake inhibitors (SSRIs) are medicines which are sometimes used in combination with ERP. They can help lower anxiety in severe OCD treatment. SSRIs would not normally be prescribed for young children.

What You Can Do as a Parent If Your Child is Autistic AND Has OCD

To differentiate between autism vs. OCD behaviors, it is often useful to consider the motivations behind the obsessive behaviors. The questions below might help you with this:

Does my child appear to enjoy these behaviours?

If so, their behaviour is most likely a result of their autism.

Do they seem distressed, and display attempts to resist doing these behaviours?

These are likely to be OCD-related behaviours.

The following are some suggestions on how to help your child in their everyday life to cope with the struggles of autism in conjunction with OCD:

Work Together to Improve Communication

Autistic children may find it difficult to express their emotions and needs and may find it difficult to express the motivations of their behaviours.

Using alternative forms of communication such as pictures or colours may help.

Provide Structure by Using Routines

This can minimise anxiety for both autism and OCD behaviours and characteristics.

Using visual support, such as use of calendars or ‘To Do’ lists can help with this and help your child to understand what is going to happen.

Be Aware of Your Child’s Triggers

Observing and remembering triggers will allow you to alter your child’s environment when needed.

For example if you know that responsibility is an area that triggers OCD rituals, you may decide to temporarily remove some of your child’s responsibilities. This will reduce their stress.

If your child worries about locking the front door when they go to school, you may find a way to adjust your working hours so that you can assist with this on some weekdays.

Provide Sensory Objects for Self-Calming

Sensory objects such as chewy bracelets can help even if your child does not have OCD. Autistic children can use sensory objects or stim toys as a calming and soothing technique to help manage the stresses of everyday life. Sensory objects can also help to distract from the intrusive and obsessive thoughts as well as calming the nervous system.

Be Careful Not to Collude With OCD

It can be tempting to join in with the OCD rituals to soothe your child’s distress.

For example, if your child asks you to turn their light switch on and off 5 times before you say goodnight at bedtime, you may be tempted to do this.

However, try to remain firm. “Colluding” with OCD can cause it to escalate. You could find yourself having to engage in increasingly lengthy and complex rituals to soothe your child.

Know When to Seek Professional Help

Many mental health professionals, including clinical psychologists, are experts in both OCD and autism. They can provide therapy which is adapted for autistic children.

If your child’s everyday life has become negatively impacted by their OCD, it’s time to seek professional help.

If you want to better understand and support your autistic child, take a look at our online course for parents, Embracing Autism.

Autism vs OCD: Summary

Autism and OCD are separate conditions that can sometimes occur simultaneously within an individual. They both affect daily life but can be managed.

It is important to remember that whilst an autistic person may also have OCD, autism exists independently of OCD.

Similarly, OCD exists independently of autism.

As the symptoms, behaviours and characteristics look similar on the surface, incorrect diagnoses are quite common.

It’s vital to look at beneath-the-surface behaviours and understand the motivation behind them. That helps us distinguish between OCD and autism-driven behaviour. We can then develop an action plan or treatment plan that meets the child’s specific needs.

If your child has OCD and it is negatively impacting on their daily life, it is important to seek professional help. There are effective therapeutic treatments including CBT/ERP.

Related Articles

Autism And Relationships: Supporting Young People

Autism Assessments: Information For Parents

ASD: Thriving In The Teenage Years

Autism And Anxiety: Supporting Children In An Imperfect World

Autism Stim Toys: 30 Awesome Sensory Ideas

The Crucial Impact of Interoception For Your Autistic Child

About the Author: Stephanie Soza has an MSc in Theory and Practice in Clinical Psychology from the University of Reading. She hopes to become a Clinical Psychologist in the future.

She undertook a clinical placement at Everlief with Dr Lucy Russell (Founder of They Are The Future). Stephanie has a specialist interest in the mental health and well-being of teenagers, particularly surrounding negative body image and eating disorders.  

UK parents, looking for expert parenting advice?

Dr. Lucy Russell’s Everlief Parent Club offers a clear path towards a calmer, happier family life. This monthly membership includes exclusive workshops, direct support from child psychologists, and access to our private Facebook community.

Together, we can move towards a calm, happy family life and boost your child’s wellbeing. Become a member today!