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If a child with ASD has OCD, should we leave it alone or try to reduce or eliminate it?

Marta Carulla-Roig
Marta Carulla-Roig
Child and adolescent psychiatrist. Mental Health Area
Hospital Sant Joan de Déu Barcelona

Children with ASD and comorbid OCD should be assessed by a specialized, multidisciplinary unit capable of addressing both conditions. It is crucial to adopt an ASD-focused approach that addresses social communication difficulties, as well as the thought patterns characteristic of individuals with ASD, such as literal thinking, emotional and social cognition challenges, and cognitive inflexibility.

It's important to understand how aware a person is of their own ASD, both for self-knowledge and to begin any psychological therapy, whether for treating OCD or other symptoms. It's crucial to distinguish between the unwanted compulsions of OCD (which are very distressing and should be addressed gradually) and the stereotypical behaviors, routines, and need for predictability that individuals with ASD experience. These latter behaviors are inherent to the neurodevelopmental disorder itself and are not experienced as distressing; rather, they sometimes provide structure and serve as a form of self-regulation.

Cognitive-behavioral therapy can improve the quality of life for people with ASD and OCD , but it is crucial to individualize treatment and carefully prioritize which OCD symptoms should be addressed, their level of interference in daily life, and to distinguish between compulsions and repetitive ASD symptoms characteristic of the disorder. It is important to note that there are few studies on the clinical management of both comorbidities, so clinical trials of the same nature as those conducted with individuals with OCD without ASD are needed.

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Marta Carulla-Roig
Marta Carulla-Roig
Child and adolescent psychiatrist. Mental Health Area
Hospital Sant Joan de Déu Barcelona
María del Pino Alonso Ortega
María del Pino Alonso Ortega
Psychiatrist. Obsessive-Compulsive Disorders Unit. Psychiatry Department
Hospital Universitari de Bellvitge