Do OCD (Obsessive Compulsive Disorder) and Autism Go Together?
Monday June 15, 2009
Earlier today, I blogged about a young boy with autism who has an intense interest in trains. I suggested that his parents find ways to build on that interest through social, academic and hands-on activities related to trains. Jonathan, an adult with autism, responded:
Have you heard of Darius McCollum whose obsession with trains was quite similar to this boy’s and he learned everything about the New York transit system. His obsession with trains has gotten him arrested multiple times for joyriding and he has spent a fair amount of time in prison and no time at all working in a train related occupation. You are quite wrong that these obsessions are not harmful and your neurodiversity perspective totally trivializes these problems. Darius has taken various medications to try to treat his obsessions with no effect. It is likely that he will continue to do this activity and be arrested and in and out of prisons for the rest of his life.Jonathan is correct that Obsessive Compulsive Disorder can be comorbid with (that is, can occur along with) autism. But OCD and autism are not always linked, and often people with autism have intense interests that are not compulsive. Over the years, for example, our son has gone through phases of intense interest in trains, certain television shows, certain books and authors, and so forth. Now that he is older, he's able to take those interests and build on them -- creating stories based on favorite characters, building models of his favorite robots, and even putting together presentations based on favorite animals.
The difficulty, of course, lies in a parent's ability to distinguish between interest and obsession. When a person must engage in his interest in the same way over and over again or experience great anxiety, there is cause for concern. When a person can engage in true conversation about the topic of interest, can share his belongings or interests easily, or can build on his area of interest, then it makes sense to encourage the interest with the expectation of positive outcomes.
Sometimes, special interests are a great source of opportunity. Sometimes they're a serious problem. What's your experience with autism and special interests?
Darius McCollum has been diagnosed with Asperger’s in addition to having OCD. His defense attornies during at least one of his arrests attempted to use Asperger’s as the defense unsuccessfully. I don’t know if McCollum was in fact on the spectrum or just had serious OCD issues, but the point is apparently an ASD played a role in his behavior.
While special interests for autistic people may not always be harmful, with the possible exception of Temple Grandin, I know of no examples of special interests that have benefitted an autistic person in any way (except for maybe giving them enjoyment in some cases) occupationally or in improving the quality of life. However, the case of McCollum does prove to me that at times they can be quite harmful and I do not believe your trivialization of a very serious disability is warranted.
I’m on the spectrum and ever since I first got my hands on a computer (when I was around 7) I have loved to code software. The logic of it appeals to be me and I find if I go too long without it (i.e. over the course of a holiday) my mind becomes too busy and I can no longer function as ‘normally’ as I usually manage. I have, fortunately, turned this into a successful career.
Bram Cohen (of BitTorrent fame) doesn’t seem to be doing too badly out of being on the spectrum either!
I would suggest that the parents of the boy sit him down in front of Transport Tycoon and see what happens!
Any number of us have chosen to follow careers or take jobs in our area of interest, whether that interest is in academic subjects such as mathematics or biology (I know several professors and researchers w/ASD in each field), or the pizza-obsessed kid I used to work with who now works at a pizza restaurant. We could even use my own special interests in education and autism to explain in part why I am pursuing a special ed teaching degree.
It is common when working with children w/ASD to use special interests as a tool to interest and involve the student in the learning activity. More than one child has been brought to reading, or even verbal communication, through this approach. This lets them have greater opportunity to participate in and enjoy what is going on around them–isn’t that one of the definitions of “quality of life?”
Great topic Lisa. Interesting. But I don’t think OCD and ASD have any relationship, other than coincidence.
My 3-1/2 yo son did a lot of stimming (spinning ANYTHING and EVERYTHING he could get his hands on). But I don’t think Stimming has a darn thing to do with OCD.
OCD doesn’t run in my family, but I have known people who are OCD. The only resemblance between Stimming and OCD behaviors is the fact that they are REPETITIOUS.
REPETITION is only a very superficial similarity, and tells us nothing about the neurological origins of OCD vs. Stimming. I’m pretty sure they have NOTHING to do with each other. A digital clock and a wind-up clock both tell the time — a superficial similarity — but their inner workings bear little resemblance to each other.
I say “did” (stimming) in reference to my son because he has improved a lot in the “stimming” department. And, in watching his improvement, I am even more convinced that STIMMING has NOTHING to do with OCD. I think a great number of people in life have OCD and are just able to mask it well. For example, I know several doctors who are OCD about hand-washing and are germ-phobic. They are actually on anti-anxiety drugs to control their OCD! But they mask it well. And being concerned about “germs” is a socially acceptable excuse for a doctor to wash his hands a lot. So they have a good “cover story”.
I think OCD probably occurs at the same exact rate in ASD folks as anyone else. It’s just that those with ASD don’t give a rip what others think. So they make no effort to mask their OCD. Thus, OCD is probably just DETECTED at a higher rate among those with ASD; but probably is no more prevalent among them.
Also, it’s easy to confuse stimming with OCD habits because, to the untrained eye, they seem to be one and the same, in that they are REPETITIVE. But they almost certainly come from totally different “places”, neurologically speaking.
OCD is linked to anxiety disorders and phobias. It is usually manifested in things like repetitive hand-washing; checking door locks; etc.
Those on the ASD spectrum stim because of the sensory input it gives them, NOT because of a phobia. Sure, when they are “anxious” they may stim to calm down and to center themselves. But the stimming is basically just a source of sensory input, and does not actually arise out of some underlying anxiety or phobia issue.
It’s also important to notice that most stimming involves playing with a certain toy, or spinning objects, or rocking, etc. Whereas most OCD involves behaviors linked directly to the object of the anxiety / phobia — like hand-washing because of fear of germs, or checking door locks because of a fear of someone breaking in, etc.
As my son’s stimming has gradually decreased over time, I have seen NO indications that he has any OCD tendencies. He is not substituting hand-washing or lock-checking for spinning. Actually, he plays with a lock on our patio door because he likes the “click” sound it makes, and he closely observes how the turning of the lock makes the “catch” extend out of the door. But he has ZERO anxiety about someone breaking in.
Likewise, he likes playing in water, and can do so for hours if you let him. But he loves to get dirty and play in the rocks and mud. He is not obsessively washing his hands due to some phobia about germs. He just likes the sensory input from the water.
I bet 99% of parents of ASD kids will tell you the same thing. ONe has nothing to do with the other. A child may be unlucky enough to have ASD and OCD, but a lot of ASD kids have brown eyes; and one has nothing to do with the other.
ASD kids just don’t try to mask their OCD because they don’t care what others think. That’s the difference.
Thanks!
Dear Lisa,
Upon re-reading your column, THIS jumped out at me:
“Darius has taken various medications to try to treat his obsessions with no effect.”
That makes my point perfectly — and I think yours as well. Namely, the “intense interests” that many on the ASD spectrum have are not expressions of OCD!!! Thus, OCD medications will have no effect on them.
All humans need a certain amount of activity and stimulation. Extraverts have too little internal stim, so they seek it through external sources. Introverts are the opposite. Those on the ASD spectrum probably find a lot of enjoyment in memorizing trian schedules or painting the same scene over and over.
BUT THAT IS NOT OCD! OCD is quite different — it is an anxiety disorder.
Here’s a web resource that makes the point better than I could…
Most people with obsessive-compulsive disorder fall into one of the following categories:
(1) Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
(2) Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
(3) Doubters and (4) sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
(5) Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
[NOTE: this one -- counters and arrangers -- seems to be the closest to ASD, but note that the motivation with OCD is anxiety and "superstition". Those do not apply with ASD].
(6) Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.
You’re certainly right, Bob, that stimming, perseveration and OCD are not the same thing. It does seem to be the case, however, that there is a correlation between Asperger syndrome and mood/anxiety disorders such as OCD, social anxiety and depression.
At this point, it’s not completely clear whether that correlation is caused by the AS or vice versa, though researcher Tony Attwood suggests that the correlation may be genetically based.
I’m not aware of research that correlates ASDs other than Asperger syndrome with mood disorders. Certainly there are plenty of people on the spectrum who do NOT have mood disorders, OCD, etc.
Lisa
Jonathan wrote: “I know of no examples of special interests that have benefited an autistic person in any way (except for maybe giving them enjoyment in some cases) occupationally or in improving the quality of life.”
Jonathan, I am sorry you have not made the acquaintance of any of the incredibly gifted people on the spectrum whose special interests have led them to excellence and mastery of particular subjects. They far too numerous to list. Stephen Shore is just one example. Most writers who are on the spectrum show this kind of passion for what they are writing about. I wish for you the ability to see and encourage the capabilities of the persons on the spectrum who are part of your life. –Christine
Bob,
Hate to inform you, but stimming and OCD are completely unrelated. Where did the stimming/OCD argument come from? My son is 18 and has Autism. About 2 years ago he was diagnosed with OCD and Tourette’s Syndrome. (another compulsive disorder). This came on when he was 16 and continues to this day. I totally disagree with you and have done research on the subject. Actually, OCD quite often accompanies Autism. I am also a special ed teacher and many of the children I have taught over the years have both. My son has no stimming behaviors (his autism is moderate) but he has involuntary tics and always wants broken or damaged things to be fixed or replaced immediately. He wants everything to be in its place (including people at prescribed times). I have learned that this OCD and Tourettes often subsides after adolescence but not always. Before the OCD he was a much less stressful person. We are trying to help him with medication and stress-management techniques but his symptoms ebb and flow. Please don’t tell the public that these diagnoses are unrelated because this simply isn’t true.