OCD or ASD? Therapy?

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OCD or ASD?

So, I know people with ASD often have OCD behaviors. My son is currently doing Speech/Occupational Therapy. Does he need some kind of separate therapy for OCD? He is only 5 by the way. It’s so hard dissecting what might just be his ASD, or what might be OCD. Does it matter? (I have a brother diagnosed OCD who has REALLY struggled in life.)

So, what does my son do? Right now he is obsessed with counting and numbers. He mumbles numbers to himself quite a bit, has to count the lines on the paper, counts all kinds of things, everywhere, quite often. We live on the 14th floor—so he is obsessed with ALL number things being 14—as in, he must have 14 crackers, wants to park in spot 14, order #14 on the menu, etc.
He also has asked me EVERY day for probably the past three weeks the question: What is 4 + 4? He knows the answer (he can count to 130), but he STILL asks me every day: ‘Mom, what is four plus four?’ He also asks a lot of other number addition questions of me: ‘Mom, what is 100+100+100+100+100+5?’ He does this a lot every day, but that four plus four question is the one he always starts with. I feel like it is his ‘variable’—like, if my answer to that is still true, he can trust the rest of my answers! I don’t mind his questions, but I do wonder how much to encourage the counting and how much to redirect him when it’s keeping him from doing what he is maybe supposed to be doing (putting on pajamas, etc.)

He lines up toys, categorizes toys, which I’ve read is both OCD or ASD. He doesn’t seem to be obsessive about order in his room or about cleanliness though.
He does do things like having to only step on certain squares on the brick sidewalk, having to exit the car a certain way—comfortable rituals, but I know those are common with ASD too. I read that with OCD you have to enroll them in special behavior therapy . . . and if you wait too long, it can be incredibly difficult for them to manage their compulsions. Is this (needing specific therapy) true, even if he doesn’t have true OCD, but just has perseverative/ritualistic ASD behavior? Just wondering the experience of those of you who have been through this yourself or with your child . . .

He’s already diagnosed ASD and SPD . . . Do I need to go have him re-evaluated at some point for OCD?

I'm searching and finding a little on some old WP chats, but would still love to hear wise thoughts from those who feel inclined to share . . .

Sounds like OCD to me. I would suggest seeking out treatment. I'm can't imagine speech therapy covering OCD.

I don't know, obviously I am no medical professional but it sounds to me like the counting, stepping on certain bricks, wanting 14 crackers, etc. are rituals that help him cope and give him some sense that the world has order. For ex. maybe he asks you what is 4 + 4 every day because the answer is always the same and its not so much that he can trust YOU because the answer is always the same but that he can trust that there is order to his whole world because the answer is always the same. I found an old calculator a couple months back and without even really thinking about it, I handed it to DS (6 yo ASD). He started adding, multiplying numbers, etc and was getting a big kick out of it (who knew, right?). Well he happened to multiply something like 8 times 1 and he laughed out loud that the answer was 8. I told him that any number multiplied by 1 was itself. He could scarcely believe me. He spent several minutes using the calculator to multiply every number he could think of by 1. He was thrilled about this simple rule of mathematics and was stuck on it for weeks! Every day he would ask me What''s 10 X1, whats 1003 X 1? He would usually just answer himself and then he would LAUGH! He would tell everyone he met about this rule that he had learned. It seemed to give him great comfort that there was this rule about numbers that was ALWAYS to same.

I don't know if any of that applies to your little guy or not. I do think you have to interrupt the number train once in a while in order to get things done but IMHO I don't know that you need to start treating him for OCD.

I don't think the source of your son's behaviors matters. It is more important to get him into treatment while he is young. The right kind of treatment is more effective when started young.

I am an adult in my early 50s and often count things to myself. I also look for and at patterns in things. I don't do this to the exclusion of other things that I should be doing, though. I do have some weird habits. With the scroll bar on the PC I will often click up or down in sets of four or five, mostly fours. If I miss click I will often move it back to the top or bottom and start over. There are a few other little nutty things like this that I do. It doesn't do any harm, so there is no reason to stress out over this. You should realize that your son will always have his own little quirks, and you should apply the same rule for him. If it doesn't do any harm, let it ride. It's not worth getting both of you stressed out over it. He will need treatment to handle the ones that do interfere with his life, and that will cause him enough stress.

Anyway, good luck with your son!

My son is borderline with some of these behaviors, and we were helped a lot by the book What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD http://www.amazon.com/What-When-Brain-S ... 1591478057

We aren't sure that DS ACTUALLY has OCD (he obsesses and he has compulsions, but the two things are not related) so we spent a lot of time explaining that while he does NOT have OCD, the techniques would be helpful to him. In a 5-year-old, you might want to buy the book for yourself and use the language and techniques, but hang onto it in case the behaviors persist.

DS's behaviors seemed to be an expression of autistic rigidity, driven to extremes by anxiety - so ultimately, the speech therapy (which is what he was most anxious about) helped him most. Understanding that he wasn't crazy, though - the book helped with that.

I think the distinction is whether how he feels about his obsessions.

If he seems to enjoy the repetitive things he does, that's an autistic thing. A lot of autistic kids do repetitive actions for the same reason that most children play. I've seen many autistic kids, for example, line up toys and smile and make happy little sounds, maybe doing a bit of happy flapping as well. This is something the kid enjoys, and can sometimes be used to the kid's advantage by turning it into an interactive game or by getting him to do it to calm down when stressed. The only problem with this kind of obsession is if he does it when he should be doing something else, such as getting ready to go.

If he seems not to enjoy it much, but gets extremely upset when he's stopped from doing it, that's more OCD-ish. But it could be an autistic stress-management thing too. The difference is whether he still needs to do it when there are no stressful things going on, and whether he seems to want to stop the thing but can't. (Autistic obsessive stuff, the kid only wants to stop if he's been shamed or teased for it.)

If his obsessions are causing him distress, get him checked out for OCD. At the very least, if OCD is ruled out, you may get some advice on how to manage the obsessive behavior a bit better. For example, there are strategies to lessen an autistic kid's need for routine.

Also, with repetitive questions, one thing I've found that can work is to turn the question back on the kid and make him answer it.

That strategy doesnt work with my son, in fact it INFURIATES him and it is a guarantee meltdown if I place the question back to him. I used to LOVVE the phrase , "Why not?" You know when kids go thru WHY phase, this stumped them ALL. WELL, not my son. When he goes thru his WHY questioning only an answer will do. Why not makes him yell and scream!! ! And asking him to answer the question is just as bad!

While ASD's can involve obsessive or compulsive behavior, and a person with an ASD can also have OCD, ASD and OCD are two entirely different things, and ASD related obsessive and compulsive behaviors are different from OCD obsessions and compulsions. OCD obsessions are more appropriately understood as intrusive thoughts, tactile sensations, and magical thinking that produce anxiety. OCD compulsions are better understood as rituals one does to rid themselves of that anxiety.



The question to ask him is why does he do this? If this is ASD related then his motivation is that he derives some sort of pleasure or fascination from it. If it's OCD related then in his mind he is attempting to "balance the universe" and the whole thing has rather negative undertones about it.



Categorizing, while an obsessive compulsive trait, is not usually a true OCD compulsion because. It can be if the person has a fear such that something bad will happen to a loved one if there is a yellow bead in with the blue beads, or if the person feels a sense of unbalance, but this usually isn't the case with compulsive categorizers/organizers. In most instances, these people are just more at peace or can think more clearly when their environment is organized. Being a "neat freak" is not really a trait of OCD either, people only misunderstand it to be. A person with OCD who has cleanliness issues will usually have this manifest in a narrow, illogical manner. The vast majority are hand washers. They wash their hands because they get the sense that their hands are dirty, and they cannot rid themselves of it. This same person, however, could be the biggest slob in the world, and have moldy food strewn about their room and have no problem with it. Or they might wash their hands 50 times per day but rarely shower. Unlike "neat freaks" those who OCD based contamination fears usually do not have uniformity to their preferences.



Again, whether he has OCD or not depends entirely on the reasoning behind his behavior. The vast majority of the time a person with OCD has to step on the sidewalk in a certain way, it is because they get the overwhelming sensation that something bad will happen to someone they love if they don't. Or they get a very ominous feeling of something being unbalanced.

The therapy you are speaking of is cognitive behavioral therapy. People with OCD have white matter abnormalities in their brain. White matter is the tissue that comprises the neural pathways through which different parts of the brain communicate. The more certain pathways are used, the stronger the connection becomes. The less they are used, the weaker it becomes. The goal of CBT is to indirectly weaken the errant pathways. When OCD becomes bad enough, it might be difficult to implement CBT without first using medications, because the pathways have become so well formed. However, most people can get to a point where they can use CBT to control their OCD to some extent, and starting later rather than sooner does not necessarily affect the outcome in the long run.

I would just ask your son why he likes the number 14...why not the number 15, and why he steps on the sidewalk in the manner that he does.

Thanks for the explaination, Chronos. My son is very similar and I was wondering about OCD as well.

I also want to point out that certain meds can worsen or bring on OCD-like behavior. Just FYI.

Thanks for all the feedback. And Chronos, thanks for the thorough details.
He seems to just enjoy counting, enjoy numbers. It seems to calm him and perhaps give him some sense of order and control. Most of his obsessions/compulsions don't seem to cause him frustration--they 'zone' him out if anything. I don't know if he thinks anything terrible will happen if he doesn't 'complete' his counting or get to find his number '14' . . . I only know he has had a mini-meltdown because we haven't allowed him to finish counting or to have '14' M&M's. It seems to be more about his love for what he is doing/likes, rather than some fear that something bad will happen. I'll have to ask him more questions about his favorite number and his need for counting. I have been positive not annoyed with it. Typically, if we have to interrupt him when he is counting, he is frustrated and annoyed, but we can 'bring him around' with reason and explanations as to why he has to take a break. With 'some' angst and frustration from him, but not a full tantrum. I know it may seem silly I haven't delved into the 'why' with him, but he doesn't exactly like answering my questions and it can be hard to break through at times!
Honestly, when he sits there staring out the window counting and when he asks me his crazy addition questions, I just want to give him the biggest hug and kiss because he is so stinking adorable in his quirky cuteness. Just want to make sure I'm not looking at him as 'cute' when really it is something that needs more guidance or limiting. Because it isn't so cute when we have a schedule to keep or a task to get done and it gets in the way.

You know, my son is pretty much the same with the counting. And similarly he seems to use it for calming, because it's safe for him. I've noticed that sometimes if you ask him a question he cannot answer he will start counting.

My son doesn't like to be interrupted while counting either. I think it's because he wants to finish what he's doing.

I am not good at figuring out what is ASD and what is a co-morbid, but obsession with numbers sounds like it could be under hyperlexia which is in the ASD family, (depending on who you ask.) Hyperlexia manifests in different ways but it involves obsession with letters, numbers, symbols and logos. The usual ASD social issues are involved and it often includes precocious reading, where fluency skill exceeds comprehension skill.

Exactly. So hard to know what is just ASD and what is co-morbid. Not to stress over it . . . but seems it will be more helpful to him to figure it out.
Interesting you mentioned hyperlexia. I thought it was only defined as children who start reading very young? He learned all of his alphabet by the time he was 2. However, he has been very slow to read (not focused or interested enough). However, from 12-18 months he recognized the logos of EVERY store--he could identify them verbally. And he--quite strangely--could identify ANY bank as a 'bank' verbally. We did not teach him that . . . we were just driving and every time he saw any bank (not just the one we bank at), he would say 'bank'. So, we started asking him, pointing to schools or stores and asking if they were banks, he'd always say 'no'. But the moment he saw ANY bank/bank logo, he would identify it as a bank. I would guess hyperlexia requires is always defined though by early reading, and that he has not done. Quite the opposite, it has been a bit of a struggle. But we were approaching it via phonics, whereas he just wants to memorize all the words.

My son is definitely hyperlexic. He knew the alphabet and could read before age 2. Around his fourth birthday he started to read single words. I think part of it is sight reading and the rest is reading phonetically. He leared this through watching Hooked on Phonics, the Electric Company, etc on Youtube.

From what I understand hyperlexia is generally recognized as the ability to read single words before age five and fascination with letters and numbers. Does this sound like your son at all?