Supporting OCD

Given the overlap particularly in the presence of repetitive behaviours, it is important practitioners carefully assess which behaviours are autism characteristics and which reflect OCD presentation co-occuring with autism.

The use of sensitive and reliable measures of assessment are important. The CYBOCS-ASD (Children’s Yale-Brown Obsessive Compulsive Scales for ASD) is shown to be a reliable measure to evaluate repetitive behaviours in autistic children and young people.  

Providing support for autistic children and young people with OCD requires an adapted or modified approach. Traditional cognitive behavioural therapy approaches and/or OCD approaches such as exposure response prevention (ERP) need to be adapted taking into consideration the individual learning style and profile of the autistic person.  

Modifications to CBT may include: 

• Use of special interest to enhance child engagement. 
• Use of visual supports to aid communication, transitions and processing. 
• More cognitively concrete and structured approach. 
• Additional support for generalisation.  
• Increased parental involvement. 
• Interactive and multimodal teaching approaches. 
• More regular breaks. 

There is robust evidence from the National Institute of Clinical Excellence to support the efficacy of CBT for supporting OCD in children.

Modifications to ERP include: 

• Understanding and safety in recognising sensory processing differences 
• Coping tools which consider the child or young persons individual strengths 
• Incorporating special interests when developing concrete visual supports such as anxiety thermometers and fear hierarchies. 
• Consideration of alexithymia and interoception before initiating any exposure based work 
• Slower approach at person’s own pace