Here’s What You Need To Know About the Connection Between Autism and OCD

Autism and obsessive-compulsive disorder (OCD) have enough in common that it can sometimes be hard to tell them apart.

Developmental pediatrician Carrie Cuffman, MD, explains the differences, why they matter and what to do if you think that you or your child is living with both.

Are autism and OCD connected?

Autism and OCD are comorbidities, which means it’s common for people to have both. A 2022 review found that 11.6% of autistic children and teens are also diagnosed with OCD.

That percentage is likely higher for adults because only about 50% of people diagnosed with OCD begin showing symptoms in their childhood or teenage years. The average age of onset is 19.

It’s worth noting that OCD is just one of many mental health and neurodevelopmental conditions that autistic people are more likely to have. And those conditions can also cause behaviors you might assume to be related to autism. That’s why it’s so important to work with a trained professional to figure out what individual behaviors actually mean. (More on that in a bit.)

Similarities

“Autism and OCD are often confused for each other because the traits can overlap,” Dr. Cuffman notes. People with both conditions may experience:

• Repetitive thoughts and behaviors
• Strong reactions to sensory input
• Difficulty adapting to change

What makes autism and OCD different is what’s causing these traits — and how the traits impact you.

Differences

There are a few key differences between autism and OCD, but the most important one is how your repetitive thoughts and behaviors make you feel.

“OCD traits are unwanted, disturbing and disruptive,” Dr. Cuffman explains. “The obsessions are intrusive and upsetting. In some cases, they’re even violent or sexual. You perform the compulsive behavior to address those obsessions.”

Let’s say, for example, you’re obsessed with germs. This leads you to wash your hands over and over again. But you’re not doing it because it feels good. You’re doing it because you’re afraid of what could happen if you don’t.

“Autistic repetitive behaviors can look like OCD from the outside, but those actions are often soothing, not disturbing,” Dr. Cuffman continues. Examples include stimming or following strict routines.

It’s also common in autism to have interests that, at first, might seem like obsessions. But for a thought or topic to be obsessive, it needs to be unwanted or intrusive. And in most cases, if you’re autistic, you hyperfixate (and hyperfocus) on things you enjoy.

So, what does it look like when autism and OCD coexist? Usually, there’s a mix of positive and negative repetitive thoughts and behaviors. Some make you feel calm or happy, and others make you uncomfortable or make it harder to function.

Of course, some people, including young children, may have a hard time expressing this difference. That’s one of the many reasons it’s so important to seek out the support of a trained healthcare professional.

What to do if you’re concerned about yourself or your child

If you or your child is autistic and you’re noticing signs of OCD, your first step should be talking to your specialist. For children, that’s usually a developmental pediatrician. For autistic adults, it could be a psychiatrist, a psychologist or even a neurologist.

Adults who are concerned about OCD but don’t have a formal autism diagnosis should speak to their primary care provider about those concerns.

“OCD is closely related to anxiety, so we can often treat it with anxiety medication — typically selective serotonin reuptake inhibitors (SSRIs),” Dr. Cuffman says. “Otherwise, the treatment is a specific type of behavioral therapy called exposure and response prevention.”

If your child is autistic but doesn’t have OCD, applied behavioral analysis (ABA) is the most recommended therapy, particularly for younger kids. Just keep in mind that most repetitive behaviors don’t require treatment.

“We don’t usually want to get rid of repetitive behaviors because those actions are coping mechanisms,” Dr. Cuffman further explains. “The only reason we’d try to change them is if they’re harmful or incredibly inappropriate — something like head-banging or another form of self-injury. In those instances, we may use ABA therapy to try to reduce or replace those destructive traits.”

One more thing: Understanding the relationship between neurodevelopmental and mental health conditions requires extensive training. And there’s a lot of misinformation out there about both topics. So, don’t rely on online quizzes or settle for a self-diagnosis.

Final thoughts

With both autism and OCD, early detection and early intervention can make a big difference.

The right resources and support can improve your (or your child’s) quality of life in a big way. So, don’t hesitate to share any worries you may have with your provider. Your questions are worth answering.