Common Presentations of OCD & Autism

What does OCD and autism look like? 

Although autism and OCD are separate presentations there are similarities and a significant amount of overlap, this can make it more difficult to diagnose and provide appropriate support.  

Some of the overlapping behaviours and similarities need to be explored fully in order to determine if they are autism characteristics or OCD behaviours. Figuring this out includes understanding the role of the behaviours from the inner perspective from the autistic children and young people. 

Repetitive behaviour is a defining characteristic of both OCD and autism, it refers to a set of behaviours that are performed repetitively. 

Repetitive behaviours

In OCD children often want to carry out behaviours triggered by intrusive thoughts. These compulsions are usually performed in response to intrusive thoughts or images and their function is to relieve anxiety. These may include repeated handwashing, repeating movements or checking behaviours.  

Autistic children and young people may also engage in repetitive behaviours not linked to intrusive thoughts. The repetitive behaviours in autism tend to be self-soothing.  

An autistic children and young people may use stimming such as rocking, pacing, hand movements, spinning and finger flicking. These behaviours are usually for enjoyment, because they feel pleasant or they are self-regulatory. 

Some repetitive behaviours are sensory based and the child or young person engages in the behaviour as it is sensory pleasing or offers sensory feedback which feels good.   

Some repetitive behaviours in autism can be linked to routines and rituals, these offer sameness and predictability for the autistic person. For example, the Child or young person may communicate certain phrases or engage in actions as part of their morning or bedtime routine. They may enjoy re-watching or replaying parts of a video or tv programme over and over. 

Unexpected changes to routine or disruptions to routine can cause anxiety however this is because of the disruption and not because a compulsion couldn’t be carried out to neutralise an intrusive thought. 

Obsessions

A child or young person with OCD may experience obsessive, intrusive thoughts. These obsessions can be on  

• Fear of sickness or contamination 
• Persistent concern about performing something in the right way. 
• Worry about hurting themselves or others.  
• Unwanted sexual thoughts or images 
• Obsessive worry about death 
• Unwanted violent images or fear of hurting themselves or others.  

Autistic children and young people can have special areas of intense interests, these are sometimes referred to as obsessions. However, the neurotypical community prefer terminology such as intense interest, area of special interest. Very often the child or young person attention will be focused on their interest, they may want to talk about or engage in their interest for long periods of time which is known as monotropic attention. 

However, despite these similarities OCD and autism do differ, as mentioned autism is neurodevelopmental which means a person is born autistic. In comparison OCD can develop during a person’s lifetime.  

The main difference is that the repetitive behaviours such as stimming typical in autism are usually to gain sensory input of for the simple enjoyment and pleasure gained from them. In OCD the repetitive behaviours are in response to anxiety and the person feels a strong compulsion to engage in the behaviour.