OCD and Autism: Similarities and Differences

When it comes to their features, obsessive-compulsive disorder (OCD) and autism can look similar. In fact, they’re sometimes even misdiagnosed for each other. But there are distinct underlying differences between them.  

To learn more about OCD vs. autism, we sat down with Abigail Ackourey, the assistant clinical director of Embark Behavioral Health in Berwyn, Pennsylvania. She shared what you need to know and how you can support your teenager if they have symptoms of these conditions.

Autism vs. OCD

When it comes to autism vs. OCD, autism spectrum disorder (ASD), as defined by the National Institute of Mental Health, is a developmental and neurological disorder. OCD is a mental health disorder. At their root, the diagnoses of these conditions are fundamentally different. However, there are similarities between OCD and autism.   

If you’re wondering if your teenager has autism, OCD, or both, here are some key facts to know.  

Similarities between autism and OCD

On the surface, OCD and autism can look the same in four key areas of your teenager’s behaviors and personality: intrusive thoughts, obsessions, stimming, and difficulty with social interaction.  

Intrusive thoughts

Intrusive thoughts are unwanted and usually disturbing thoughts that happen on their own. Ackourey noted that they’re linked with anxiety, which teenagers with OCD or autism commonly experience. 

“Intrusive thoughts are more symptomatic of OCD, but intrusive thoughts in autism can occur as well,” she said.  

Examples of intrusive thoughts your teen may experience include: 

• Recurring fears that they’ll do or say something embarrassing or inappropriate. 
• Thoughts about distressing or violent scenarios. 
• Worries about something harmful happening to their loved ones or themselves. 

Another type of repetitive thinking associated with anxiety and OCD is rumination. With ruminating thoughts, teens obsessively think about their thoughts over and over.  

Obsessions

Ackourey said autism and obsessions are often connected. OCD and obsessions are linked together too, but the obsessions don’t show up in the same way. 

“For teens with autism, it’s a hyperfocus on a very specific interest or passion, which often serves them well with career goals,” Ackourey said. “I worked with one young man with autism who was very passionate about insects. He could identify all of them and wanted to be an entomologist one day.” 

In contrast, Ackourey said, OCD obsessions tend to be more about fears and worries, such as a teen overfocusing on harmful events that could befall their friends and family. These thoughts hold them back, which is not the case with autism obsessions.  

“For teens with autism, these obsessions are usually an interest and a joy,” Ackourey said. 

Stimming

Stimming, also known as self-stimulating behaviors, can happen with OCD and autism. Autism stimming refers to repetitive behaviors, such as tapping a foot or rocking back and forth. OCD stimming involves ritualistic behaviors, such as a teen flicking a light switch every time they enter a room or washing their hands every hour. While OCD stimming can often be confused with the repetitive behavior associated with autism, the difference between the two is why your teenager is doing what they’re doing.  

“With autism, the function is more self-soothing,” Ackourey said. “It helps relieve anxiety. It can be a grounding technique that they aren’t even conscious they’re doing. With OCD, they’re having these anxious thoughts like, ‘If I don’t tap my pencil exactly 10 times, something bad will happen.’ Teens with OCD are aware of the connection between their behavior and their anxious thoughts. It’s done out of discomfort, and it’s quite the opposite of the self-soothing function of autism stimming.”  

Difficulty with social interaction

Social interactions can be tough for teens with OCD and autism. For those with autism, Ackourey said their passion for a specific topic often alienates others who don’t share the same interests. These teens may also have trouble reading social cues, such as a friend’s facial expressions, which makes relationships difficult.  

“Meanwhile, with OCD and the intrusive thoughts and the compulsive behaviors that follow, the teen’s anxiety and compulsions can be a significant issue,” Ackourey said. “They’re aware of their anxiety. They know these actions are not ‘normal,’ so to speak, which reinforces their anxiety and makes social interactions hard.”  

Differences between OCD and autism

In the end, the differences between OCD and autism are about why your teen has repetitive behaviors and compulsions. For a teen with OCD, Ackourey said much of what they’re doing comes from a place of fear and anxiety, which leads to difficulty navigating the world around them. For a teen with autism, she said their actions and obsessions arise from a place of passionate interest. And when it comes to their repetitive behaviors and social interactions, they often aren’t even self-aware of what’s occurring.  

Co-Occurring Autism and OCD

Teens can have autism and OCD at the same time. Among children ages 4-17 who received mental health services, 25% of youths with OCD were also diagnosed with autism spectrum disorder, according to research published in the journal European Child & Adolescent Psychiatry.  

OCD and Autism: When One Is Misdiagnosed as the Other

Because of the significant overlapping symptoms between autism and OCD, teens can receive an autism misdiagnosis or OCD misdiagnosis, with one disorder incorrectly diagnosed as the other.  

“My experience is it’s really challenging to decipher between OCD vs. autism,” Ackourey said. “What I’ve found when I work with teens on the spectrum who exhibit OCD-like behaviors is that it’s difficult for them to express what’s happening internally. So, when I’m assessing them to determine if they have autism or OCD, if they can’t identify if they’re having intrusive thoughts leading to a certain compulsion, it’s challenging from a diagnostic perspective.”  

Ackourey added that standardized screening tools for OCD and autism can support or lead to a more accurate diagnosis of these disorders. 

How Parents Can Help

1. Be empathetic

“When we talk about OCD and autism and any sort of diagnosis, it can be a really scary and uncomfortable place for teens,” Ackourey said.  

She noted that your teen needs to feel supported and heard. For example, if your teenager has symptoms that could indicate they have autism, and they’re passionate about a specific topic, research that interest and engage with them in conversation. The same goes for a teen showing signs of OCD. Talk to them about their intrusive thoughts and worries.   

“Aim to be patient,” Ackourey said. “Interrupting their repetitive behaviors or trying to make them stop can create a lot of anxiety, leading to emotional dysregulation and a meltdown. If they need to flip the light switch 10 times before leaving the house, let them do that.” 

2. Find a therapist for OCD and autism treatment

“If you’re noticing your teen is struggling, reach out to a therapist,” Ackourey said regarding OCD and autism treatment. “The earlier that teens have access to professional treatment, the better. They’re in their prime developmental stage of life, and now’s the time for them to build skills to manage the challenges that would otherwise be detrimental in adulthood.”  

Ackourey said teens with OCD can benefit from developmental and relational approaches to therapy to set a safe and secure base and then add cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy, which is a type of CBT. CBT helps teenagers replace harmful thought patterns with positive ones. ERP puts teens in stressful situations where they experience intrusive thoughts related to their obsessions so they can learn to avoid using compulsions to alleviate their stress.  

For teens with autism, Ackourey suggested wraparound services that help them succeed at work, home, and school. These services can include counseling, social skills training, vocational training, and academic accommodations. 

Ackourey encouraged parental involvement during treatment. 

“If teens are in therapy or a skills group, reinforce the tools and strategies they’re being taught,” she said. “Be engaged with their treatment. Learning what your child is learning can be really helpful for parents to meet their teen’s needs.”  

3. Encourage healthy nutrition as self-care

Self-care is important to your teenager as they work toward a diagnosis and receive treatment. 

“When your teen’s body is nourished and functioning, it improves that mind-body wellness,” Ackourey said.  

Healthy nutrition should include plenty of fresh fruits, vegetables, and whole foods. That said, Ackourey noted that certain foods can be challenging for teens with OCD, autism, or both if they have sensory issues.  

“Be patient, and be open to trial and error during family mealtimes,” she said. 

4. Provide structure around daily activities

“Generally speaking, whether it’s OCD or autism, all teens benefit from having a routine,” Ackourey said.  

She explained that teens with these disorders often struggle with transitioning to different activities or tasks.  

“It’s really helpful to structure their day so they know what’s expected of them,” Ackourey said. 

Autism and OCD: Wrapup

Autism and OCD share symptoms, so it may be difficult to determine which disorder your teen has. The underlying factors of their experiences are important. Namely, is your teen having repetitive behaviors and obsessions from a place of passion and self-soothing or from a place of fear and anxiety?  

Whatever your teen’s diagnosis, which could be OCD and autism rather than OCD vs. autism (or vice versa), you can help them heal and thrive.  

“The support and treatment are there, and there’s a community of parents and teens going through similar experiences,” Ackourey said. “Your teen can live a full life, and there’s a place for them in the world. Work together as a family, and be kind to yourselves. It sometimes gets overwhelming with some of these challenges, but there’s certainly hope, and you’re not alone.”  

Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!