How Does Autism Affect OCD Treatment in Young People?

What you need to know

• Young people with both OCD and autism show similar OCD symptom severity but greater functional impairment compared to those with OCD alone
• While both groups benefit from cognitive behavioral therapy (CBT), those with OCD and autism tend to have poorer treatment outcomes
• Greater functional impairment and being on medication partly explain the difference in treatment outcomes between the two groups

Background

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform to reduce anxiety or distress. Autism spectrum disorder (ASD) is a developmental condition that affects social communication and behavior. OCD is more common in people with autism than in the general population, but we know little about how having both conditions affects treatment outcomes.

This study aimed to compare the clinical features and treatment outcomes of young people with both OCD and autism to those with OCD alone. The researchers also wanted to understand what factors might explain any differences in treatment outcomes between the two groups.

How the study was conducted

The study included 619 young people aged 6-18 years who were referred to a specialist OCD clinic in London. Of these, 172 had both OCD and autism, while 447 had OCD alone. The researchers compared various clinical characteristics between the two groups, including OCD symptom severity, insight into their condition, overall functioning, family accommodation (how family members adapt to or help with OCD symptoms), and other mental health difficulties.

A subset of 323 participants (100 with OCD and autism, 223 with OCD alone) received cognitive behavioral therapy (CBT) for their OCD. CBT is a type of talking therapy that helps people change unhelpful thoughts and behaviors. The researchers compared how well each group responded to treatment.

Key findings

Clinical characteristics

Both groups showed similar levels of OCD symptom severity. However, young people with both OCD and autism showed some important differences:

1. Poorer insight: They were less likely to recognize that their obsessions and compulsions were excessive or unreasonable.

2. Greater functional impairment: They had more difficulties in their daily life, including problems with school, social relationships, and family functioning.

3. Higher family accommodation: Their family members were more likely to adapt to or assist with OCD symptoms.

4. More concurrent mental health issues: They showed higher levels of emotional problems, hyperactivity, and peer problems.

5. Lower prosocial behavior: They displayed fewer behaviors that benefit others, such as helping or sharing.

6. More likely to be on medication: A higher proportion were taking medication for their mental health symptoms.

Treatment outcomes

While both groups benefited from CBT, those with OCD and autism showed less improvement overall:

• 53% of young people with OCD and autism responded well to treatment, compared to 76.7% of those with OCD alone.
• 31% of those with OCD and autism reached remission (very low symptom levels), compared to 49.8% of those with OCD alone.

Factors explaining treatment differences

The researchers found that two main factors partly explained why young people with both OCD and autism had poorer treatment outcomes:

1. Greater functional impairment: This accounted for 19% of the difference in treatment outcomes between the groups.

2. Being on medication: This explained 31% of the difference in outcomes.

Other factors, such as family accommodation, insight, and concurrent mental health issues, did not significantly explain the difference in treatment outcomes.

Conclusions

• Young people with both OCD and autism face additional challenges compared to those with OCD alone, including greater functional impairment and higher rates of other mental health issues.
• While CBT is still beneficial for those with both conditions, they tend to show less improvement compared to those with OCD alone.
• Addressing functional impairment and carefully considering medication use may be important for improving treatment outcomes in young people with both OCD and autism.

Implications for patients and families

If you or your child has both OCD and autism, it’s important to:

1. Seek specialized treatment: Look for mental health professionals experienced in treating both conditions.

2. Focus on improving daily functioning: Work on skills that can help in school, social situations, and family life alongside OCD treatment.

3. Discuss medication carefully: Talk with your healthcare provider about the potential benefits and drawbacks of medication as part of treatment.

4. Be patient with treatment progress: Improvement may be slower or less dramatic than for those with OCD alone, but CBT can still be helpful.

5. Address other mental health concerns: Don’t ignore other issues like anxiety or hyperactivity, as these can impact overall well-being and treatment success.

Remember, while having both OCD and autism presents unique challenges, effective treatments are available, and many young people show significant improvement with appropriate care and support.