Autism and OCD

One of the first red flags I witnessed for my eldest boy on the autism spectrum, was when he was two years old and started lining up his cars. He loved cars, we bought him set after set and he began to line them up in the living room. They would stretch from one end of the room to the other and god help anyone who would interfere with his planning or broke his line.

What we thought was an obsession was the flag that started us on our journey to get him support and ultimately a diagnosis of Autism. He dropped the cars and moved on to Thomas the tank engine and trains and as he grew geography, and the worlds countries became his obsession.

As followers of mine on social media and regular blog readers will know he has developed a social anxiety problem as he has entered his teens and this anxiety has become more extreme as he has displayed symptoms of obsessive-compulsive disorder, (OCD).

These included continually washing his hands, believing he was cursed and that this could only be washed away with excessive showering.

After a long struggle we now have a dual diagnosis of Autism and OCD and are on the road to helping him overcome his obsessions, which are what he uses to sooth his anxiety.

Autism and OCD are of course different, but clinicians have now identified an overlap between the two in an increasing number of children and young adults.

Whilst studies have now identified that up to 84% of those on the autism spectrum are living with some form of anxiety, they have also found that around 20% may have a form of OCD. Conversely a significant proportion of those living with OCD may be undiagnosed with autism!

So, what is OCD?

OCD is a condition that characterises intrusive and often distressing thoughts that lead to anxiety and compulsions, which are repetitive behaviours or mental acts that the person feels compelled to perform to relieve the anxiety.  

Obsessions and these intrusive thoughts tend to cluster around similar themes and common obsessions which include:

• Fear of germs and contamination
• Hypochondria and health worries
• Fear of acting silly or inappropriately
• Worries of leaving doors open
• Fear of harm/change
• Excessive thoughts of religion, guilt and shame.

These lead to compulsions of which the most common are:

• Excessive cleaning, showering and hand washing
• Rituals to ward of contact with objects or people
• Using prayers or chants to prevent bad things happening
• Arranging and rearranging objects
• Checking doors locks and appliances.

People with OCD often have difficulty with daily activities and functioning due to the time they spend on their compulsions.

I can testify to this, as we have enormous trouble getting our boy out of the electric shower and if we turn of the shower before his rituals are finished, the cycle begins again from scratch!

The difference between Autism and OCD

As a parent of children on the autism spectrum I was used to repetitive behaviour such as lining up the cars or movement or vocal tics. What I was not used to was the behaviour my eldest displayed as his anxiety increased. I understood that the autism repetition was a display of anxiety or excitement, but it took me time and support from professionals to identify that the source of obsessive habits of OCD are very different.

When my child feels driven to fill their life with repetitive patterns such as excessive showering, handwashing or warding off what they perceive are curses this is part of a mental process. Their compulsive behaviours have complicated motives which are not reasonable and which, in themselves, are part of the diagnosis.

My child has explained to me and to professionals that the rituals they carry out have to be done exactly as they demand as he cannot yet move from this ridged behaviour despite knowing it is irrational and something he should move away from. A key factor which took us time to adjust to is that no amount of coaxing or patient reasoning from us will make any difference or be able to reduce my child’s anxiety. They have to complete the ritual.

Another difference between OCD and autism lies in how the individual reacts to these actions and tendencies in public. Typically, someone diagnosed with OCD will be ashamed or embarrassed of their actions, while someone on the spectrum is not as affected by what other people think.

Do you think your child may have OCD?

Is your child:

• Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.
• Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)
• Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)
• Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.

If so, and I speak from experience seek professional help now, waiting lists are long so the sooner you begin the better. Without specialised knowledge of OCD, the typical parent is not equipped to intervene. Whilst we may believe we are helping our child sometimes our intervention can exacerbate the problem and the compulsions and behaviours get worse.

What support is available?

Treatments can include behaviour therapy and medication. Behaviour therapy, specifically cognitive-behavioural therapy, helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behaviour.

Behaviour therapy for OCD can involve gradually exposing children to their fears in a safe setting; this helps them learn that bad things do not really occur when they don’t do the behaviour, which eventually decreases their anxiety.

Behaviour therapy alone can be effective, but some children are treated with a combination of behaviour therapy and medication. Families and schools can help children manage stress by being part of the therapy process and learning how to respond supportively without accidentally making obsessions or compulsions more likely to happen again.

I hope you found this useful, and I’d repeat that if you have any concerns that your child may have OCD the sooner you seek professional help and advice the better.

Until we speak again, keep fighting for our children and campaigning for autism awareness and acceptance and remember to follow me on twitter @Autismdad67 and on Facebook at www.facebook.com/autismdadireland