Autism symptoms are more common in children and adolescents diagnosed with OCD, and there is a significant relationship between OCD and the severity of autism symptoms. It is called comorbid disorder when autism and OCD are observed at the same time in the same person. Both disorders should be treated together and at the same time. The symptoms of both disorders should be managed at the same time. There are different therapies to be followed according to a person’s needs and the severity of symptoms. These therapies can be modified accordingly.
It is important to investigate the genetic and environmental common risk factors between OCD and autism in more detail. For this reason, studies in different socioeconomic groups, different age ranges, and different demographic groups are needed.
There are 3 basic features that make up autism and the most obvious one is obsessive and ritual behaviors. Both autism spectrum disorder and OCD are in the category of neurological disorders. Although they share many common features, there are also important differences. Fully understanding these disorders and following the right intervention method is based on knowing exactly the differences between these two disorders. In addition, it is necessary to have information about individuals on the autism spectrum with OCD.
OCD is clinically defined as persistent and disturbing thoughts and behaviors. The individual diagnosed with OCD may be using this situation as a coping mechanism. This situation will actually cause them to display behaviors that make their living standards even more challenging. It is common to observe repetitive and ritual behaviors in individuals with autism. Therefore, it is challenging to understand whether individuals on the autism spectrum also have OCD.
Individuals with OCD repeatedly touch certain objects, become obsessed with certain objects, or repeat the same action even when they feel exhausted. The difference between OCD and the autism spectrum is whether the action is done with intention or not. In addition, it is about how they reflect these behaviors in society. While individuals with OCD are ashamed of exhibiting these behaviors in public, individuals on the autism spectrum do not care at all.
At first glance, Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD) may not seem like disorders that are very dissimilar and have little in common, but researchers have stated that they overlap in many ways. These overlaps can lead to misdiagnoses, mistreatments, and wrong interventions. Individuals with autism may not be diagnosed with OCD as soon as they are diagnosed with autism, they may develop OCD over time.
The common features of autism and OCD can make it difficult to distinguish between these two disorders. It can be challenging even for physicians who are experts in this field. The compulsions of an individual with OCD and the stereotypical behaviors of individuals on the autism spectrum may be similar. Therefore, understanding the difference between the two requires seriousness and great importance.
Nevertheless, while individuals with autism have more difficulty in dealing with social situations, individuals with OCD are not in the same position. Due to deficiencies in communication and language problems, individuals on the autism spectrum find it difficult to describe their difficulties and symptoms. Since individuals with autism cannot express their experiences and feel appropriately, treatments and interventions to be followed to them are more difficult.
On the other hand, individuals with OCD are aware of the fact that they have unpleasant thoughts, they develop obsessive behaviors in order to get rid of these thoughts, and these behaviors they develop disrupt their daily functioning. People with OCD are also aware that these behaviors they develop do not make sense at all. But they repeat these rituals because of their stress and anxiety.
Research continues on the environmental factors of OCD. However, the most important thing to remember at this point is that OCD is an anxiety disorder triggered by stress. An increased level of anxiety and stress in a person can lead to OCD and even emotional and physical outbursts.
There are also many differences between OCD and autism. The most important of these differences is that individuals on the autism spectrum consciously exhibit obsessive behaviors, while individuals with OCD use these behaviors consciously and even as a coping mechanism. The functioning and arrangement of the brains of individuals with autism diagnosed with OCD and those diagnosed only with OCD also differ.
Individuals with OCD are unable or have great difficulty in changing their rituals. Even the slightest change can cause them great anxiety or even a panic attack. On the other hand, this is not the case for individuals with autism. Since they have multiple rituals they can choose from. Since the obsessions that individuals with autism have are for comforting themselves, they do not need a specific behavior.
OCD (Obsessive-Compulsive Disorder) In Individuals With Autism Spectrum Disorder
We can express OCD as an obsession in its simplest and non-clinical sense. This allows them to be labeled as irrational, repetitive, routine, and abnormal behavior by society. Obsessions can occur in children with normal development, as well as in special children, between the ages of 2-5.
This condition, which is called an obsessive-compulsive disorder, causes repetitive thoughts and behaviors that negatively affect the life of the person, can also occur in children with anxiety disorder. In addition to early diagnosis and treatment, the family factor is also very important. The family should receive family behavior training on the subject in question and follow the training with their child without compromise.
Obsessive behaviors persist over the years but often change. As one behavior fades, another behavior often takes its place. Unfortunately, this process is one that these families have difficulty with. Sometimes the behaviors that come to us as obsessions are actually the behaviors that children with autism do to regulate themselves. Obsessions can be made for the purpose of relieving stress, or they can be caused by stress or the effect of environmental factors on the individual.
In children with autism, it is necessary to distinguish between repetitive movements or stereotypical behaviors and obsessions. Repetitive movements may include clapping, rocking back and forth, turning around, making noises, and so on. As in every problematic behavior, it is necessary to understand the cause of the behavior in repetitive movements.
The priority approach should always be: If the child is reacting to something, the stimulus affecting him/her must be analyzed. In addition, we should not ignore that children have individual differences, just like every adult individual. Since not every approach angle can have the same effect on every individual, we need to determine the type of intervention well. Sometimes you may not get any results and the repetitive obsessive behaviors continue to change. In such cases, in addition to behavioral therapies, you should not ignore the support of drug therapy.
OCD in Children With Autism Spectrum Disorder
For children with autism who have OCD, the behavior of parents and other people around them is very important. They need to keep the child safe, or at least make the child feel safe. Reducing potential stressors around them may be the first thing they do.
It is necessary to be aware of what triggers the child. After these are determined, the environment is changed accordingly. Measures can be taken according to the stimuli around. For example, if the problem is sound, headphones can be used; if the light is a problem, dark environments are preferred.
Communication methods are very important. As we mentioned before, it is very difficult to express emotions in children with autism. Therefore, pictures can be used as an alternative communication tool. Or any method that interests your child can be used to understand their needs.
Establishing a structured schedule and routine will be very helpful for children with OCD on the autism spectrum. Knowing what to do and when will reduce the child’s stress level. Creating these programs reduces the level of stress and, accordingly, relieves tantrums. Children with OCD and autism love routine and they are against change. These programs that you will create later can cause stress and create anxiety. Managing these situations is also very important. During these transitions, you should talk to your child often and try to understand what he or she is feeling.
It is important that everyone around the child is involved in the routine and follows the same pattern. Parents, siblings if any, teachers, counselors, therapists, and everyone else must be involved and adapt to this plan. You should not forget that early intervention and treatment are very important. It is of great importance for a better quality of life and high functionality.
OCD in Adults With Autism Spectrum Disorder
Adults with autism are more prone to develop OCD. Their obsessive thoughts and behaviors can complicate their lives. Such behaviors can interfere with their social communication. With various treatment and therapy methods, such behaviors of adults with OCD and autism can be calmed down.
Joining support groups can be the first of these methods. The safe and social environment that support groups provide makes these adults feel more connected to society and less isolated. In addition to these groups, social skill groups can also be preferred. They learn skills that can be used functionally in their daily lives. It is important for them to acquire these skills so that they can live independent life.
The therapy modalities to be followed aim to study the effects of both autism and OCD symptoms. Specific symptoms are focused. It can be group therapy or individual therapy. Coping skills are developed. In addition to all these, drug therapy can be followed. It is a method used to reduce side effects, not symptoms.
Which Methods Can Be Followed in OCD?
- Find the Trigger: Every obsession has a trigger. You may need a suitable observation skill for this. By observing the child, you can find out what triggers this obsession.
- Before and After: There are some questions to be asked before and after obsessions occurrence. What happened before the obsession, what happened during the obsession, what happened after the obsession? By answering these questions, you can find both what triggers the obsession and what reinforces it. For example, the child attends and sits at the table. As soon as he sits down at the table, obsessive behavior occurs. In this case, you will need to make more detailed observations about the behavior of sitting at the table. You may need to answer questions such as how he sits at the table, how he entered the classroom and the features of the table.
- Removing the Trigger: If the child does not see the trigger until the behavior is extinguished, it may prevent them from performing the obsession for a longer period of time.
- Keeping Busy: If the obsession is triggered by a situation that you cannot find a solution for, try keeping the child busy. For example, preoccupying the fingers with obsessions with the hands will prevent the behavior from occurring.
- Sensory Stimulus: Lack of stimuli is a frequently observed condition in individuals with autism. This is why most obsessions with fingers and hands arise. Hand massages, stimuli given to the fingers, dealing with different sensory environments, and allowing the child to touch different tissues reduce such obsessions.
- Ignoring: Some obsessions are made for attention. In this case, it may be necessary not to deal with the child immediately after the emergence of the behavior, but to be busy with something related to the child. For example, while the child is performing the obsessive behavior, it can be played with a play dough that the child likes. Dealing with the child as soon as he or she stops the behavior helps reinforce ‘non-repetition of the obsession’.
- Not Reinforcing the Behavior: One of the main reasons for the establishment of obsessive behaviors is the reinforcement of the obsession. Behaviors such as paying extra attention to the child, shouting at the child, and talking to the child more during obsession are coded in the child’s brain as “I get more attention when I do this”. For this reason, the child’s obsession should not be talked about during the repetition of the obsession.
- Short Commands: Commands should always be precise, clear, and short. Giving abstract commands is perceived as incomprehensible, a long speech, and extra attention. For example, let’s say the mother says to her obsessed child with autism: “Son, don’t do that for God’s sake.” The child will have a hard time understanding this. Son: Abstract. God: Abstract. For someone’s sake: Abstract. Don’t: Negative. Under these conditions, the command becomes unintelligible. Therefore, there is no subject for this sentence that the child can understand.
- Slight Flaring: During an activity or situation, if the child has an obsession with the hand, the caregiver gently lowers the hand without interrupting the activity, if he or she does this obsession. For example, if the child is playing with her hair, it is the case of pulling the hand slightly from the hair without interrupting the activity.
- Not interfering if it is not harmful: If an obsession or repetitive behavior does not harm or disturb your child or their environment, you need to ignore the behavior and your child.
You can follow one or more of the above solution methods for your child. You should decide which one and how you will implement it as a result of your and the psychiatrist’s observations.
- My child has an obsession with order, what can I do about it?
Excessive order obsession is evaluated within the obsessive-compulsive disorder group. In children with this type of obsession, the fact that the objects around them do not stand in a certain symmetry can be a source of stress for them. Symmetry can also be a result of intelligence or pervasive developmental disorders. Routines put these kids at ease. These routines are that sometimes everything is in the same place, sometimes they always wear the same clothes, and sometimes they want to go from one place to another in the same way. Even if the child is agitated, it is very important to break this routine. Family members should not act out of fear of the child being agitated. Obsession with order can be overcome with applied behavior analysis methods that can be effective in all obsessive behaviors. In addition, it should not be forgotten that statements such as “no”, “don’t”, and “please” do not work. Before obsessions turn into behaviors, precautions can be taken by immediately attracting attention to a different direction.
- What can be done about object obsession in children?
In children with autism who have object obsession, this situation can be overcome with play therapy. Whatever objects the child is obsessed with, you can make games with those objects and make the objects meaningful by removing the event from meaninglessness. When you leave the child alone in an environment, of course, due to distraction reasons, he can plunge into his own world and connect the objects he has determined to his routine. Unless this situation is taken under control and meaningful games are not established with the child, these obsessions will continue. The “removing method” can also be used in such obsessions. For example, removing obsessed objects from the environment.
- How can flapping behaviors be prevented?
Flapping can be observed in many children on the autism spectrum and is a very difficult behavior to extinguish. First of all, you can try to ignore it. Of course, when the timing of the flapping is also an important parameter. It should be noted whether it is a behavior that is done when excited or worried or constantly. If the child does this behavior when excited, it is important that we understand the child’s emotions. “Yes, you are excited, or you are very happy right now”, can be tried to understand by saying sentences. Of course, in these cases, the cognitive capacity of the child is also very valuable. Sometimes this method may not be functional. Then we can try to give the child self-control by warning and providing awareness.
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