Co-occurring obsessive–compulsive disorder and autism spectrum disorder in young people: prevalence, clinical characteristics and outcomes

Abstract

Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) commonly co-occur and are considered challenging to manage when they co-occur in youth. However, clinical characteristics and prognosis of this group remain poorly understood. This study examined the prevalence, clinical correlates and outcomes of paediatric OCD co-occurring with ASD (OCD + ASD) in a large clinical cohort. Data were extracted from electronic clinical records of young people aged 4-17 years who had attended a mental health trust in South London, United Kingdom. We identified young people with diagnoses of OCD + ASD (n = 335), OCD without ASD (n = 1010), and ASD without OCD (n = 6577). 25% of youth with OCD had a diagnosis of ASD, while 5% of those with ASD had a diagnosis of OCD. At diagnosis, youth with OCD + ASD had lower psychosocial functioning scores on the clinician-rated Child Global Assessment Scale (CGAS) compared to those with either OCD or ASD. Youth with OCD + ASD were equally likely to receive CBT compared to those with OCD but were more likely to be prescribed medication and use services for longer than either comparison group. Youth with OCD + ASD showed significant improvements in functioning (CGAS scores) after service utilisation but their gains were smaller than those with OCD. OCD + ASD commonly co-occur, conferring substantial impairment, although OCD may be underdiagnosed in youth with ASD. Young people with co-occurring OCD + ASD can make significant improvements in functioning with routine clinical care but are likely to remain more impaired than typically developing youth with OCD, indicating a need for longer-term support for these young people.

An Evaluation of a New Autism-Adapted Cognitive Behaviour Therapy Manual for Adolescents with Obsessive–Compulsive Disorder

“…For example, a widely held clinical view is that individuals with co-occurring OCD and ASD tend to require more OCD treatment sessions over a longer period of time to make meaningful gains, compared to those without ASD. Consistent with this, previous research has shown that young people with OCD + ASD are engaged with clinical services for significantly longer than those without ASD [7]. However, to date, there is no empirical data to support this view, and it remains unclear whether extending treatment confers an added benefit.…”

“…OCD is particularly common among young people with autism spectrum disorder (ASD); it is estimated that up to 37% of those with ASD also experience OCD [5,6]. Young people with both OCD and ASD (OCD + ASD) have higher levels of functional impairment, utilise more mental health services, and have poorer outcomes following multimodal treatment for OCD, compared to those with OCD who do not have a diagnosis of ASD [7].…”

Co‑occurring Obsessive‑compulsive Disorder, Autism Spectrum Disorder and Intellectual Disability: A Case Report

“…It is described in the current literature that around 25% of people with OCD are also diagnosed with ASD. 2 Of those with a diagnosis of ASD, approximately 5% also have an OCD diagnosis. 2 It is likely that OCD is underdiagnosed in ASD because ASD associated problems outshine OCD symptoms, or since OCD symptoms overlap with ASD phenomena.…”

“…2 Of those with a diagnosis of ASD, approximately 5% also have an OCD diagnosis. 2 It is likely that OCD is underdiagnosed in ASD because ASD associated problems outshine OCD symptoms, or since OCD symptoms overlap with ASD phenomena. Also, there may be an erroneous over--diagnosis of OCD in individuals with ASD if the nuclear symptoms of the last, such as resistance to change, highly restricted interests/routines and ritualized patterns of behavior, are misunderstood and erroneously considered as obsessions or compulsions.…”

“…Obsessive-compulsive disorder (OCD) is associated with chronic disability and is often reported in individuals with autism spectrum disorder (ASD). 1,2 ASD, besides deficits in social communication and social reciprocity, is characterized by repetitive behavior and restricted interests which may be apparent in OCD as well. 1,3,4 In both disorders, a fixation on routine, ritualized patterns of behavior, resistance to change, and restrictive interests of disproportionate intensity may appear.…”