Autism And OCD Comorbidity

Although this doesn’t happen all the time, many parents report OCD behaviors to their children’s teachers, doctors, and therapists. It’s fairly common for children with autism to become hyper-fixated on a topic and memorize absolutely everything there is to know about that one topic. They will talk non-stop about that topic even when that topic is not part of the discussion other people in the room are having. It may seem like OCD, but it’s really just another symptom of the autism.

The difference between just plain autism fixation and autism with OCD comorbidity is that obsessive-compulsive disorder completely takes over the life of the person that has it. It essentially takes the fixation autism children already have and multiplies it by a factor of about ten. The kids, adults and teens who really, truly have autism and OCD together are completely paralyzed from doing anything else because they have routines that are strictly followed or they have a panic attack. A typical day for these poor kids usually starts a few hours earlier than anyone else’s because they have to comb each side of their head twenty times with the same comb at the same angle, they have to tie their shoelaces five times, they have to drink fifty sips of milk, etc. Really the only thing that can help is lots of therapy and medication, although it has to be pretty severe for level 2 antipsychotics to be served up to anyone under the age of thirteen.

Really, there are no simple behavior modifications to be made if a child or teen has both autism and OCD. The direct result of trying to change the “routines” in even the smallest of ways usually results in a total meltdown, a panic attack and/ or absolutely everything in a room of the house destroyed and scattered about, with absolutely no progress made toward the goal that was originally intended. This is perhaps one of the hardest comorbid diagnoses of all for parents with autistic children because nothing can really be done that doesn’t disrupt the child’s growth until a certain age.

Parents who are faced with the challenges of a child with both autism and OCD need a lot o support. If they are getting several supports from the county agencies where they live, they can also request that they receive some respite time. This is a service that takes the child to a group home for a weekend so the parents can get a break. It helps both the parents and the child get a break from each other and prevents unintended child abuse when the parents’ nerves are pushed too far. The other option is having an autism therapist come in a couple of times a week for therapy, and they take care of the child and the parents get a couple of hours to go shopping, go to the movies, relax, etc. Given the nature of the dual diagnosis, you can imagine what it’s like for parents to get the simplest tasks done, such as going to get milk from the corner store or washing dishes. These extra services really help the whole family, which might otherwise be in crisis without them.

Once the child has hit puberty, the doctors and psychiatrists may decide that it’s time for some serious medication to help everyone cope and make behavioral therapy that much more effective. The antipsychotic medications help keep patients with OCD from a meltdown and help them walk away from a repetitive behavior with the understanding that the whole world isn’t going to nuke itself if they don’t count the exact number of cereal O’s into their bowls every morning. It might even lessen the true autism fixations just a little, which definitely isn’t a bad side effect to say the least. The down side is that it will slow them down and make them very tired all the time, so parents have to weigh the side effects against the benefits to see if it’s something they really feel strong enough about doing.

When the adult with OCD and autism has been left untreated or treated inconsistently for the paralyzing effects of OCD, the OCD gets significantly worse. This is why it’s so important to start treatment in puberty; parents avoid harming a growing child but give the teen the right medication and effective behavioral tools to cope as an adult. The window is quite narrow, and it doesn’t open enough for adults in this situation to be treated as successfully. In very rare instances the OCD tapers down before puberty with behavioral and cognitive therapies, but surging hormones in teens can cause it to re-emerge. Parents need to be very cautious and monitor their child’s behavior for any upticks in OCD behaviors their children exhibited before.

As is the case with any child with autism, careful and observant parents who keep a detailed record in any of their child’s unusual behaviors can help the psychiatrist figure out if it’s just autism fixation or true OCD. An autism fixation might even develop into the level of OCD, but only if it lasts longer than a year and completely interferes with other areas of the child’s daily life. An example of this might be skin that peels and flakes from excema or psoriasis. The child might talk about it or pick at it, but once it reaches the level where they have to pick at it for a specific length of time and specific times of the day for months on end, it enters into the realm of OCD. Again, careful observation and documentation makes all the difference because doctors don’t see the child every day; the parents do.

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