Teenager with Autism and OCD

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Hi everyone,

I am looking for shared experiences, advice, and tips because I am wondering how to best help my son. He is a teenager, was diagnosed with Autism and ADHD early on, and developed OCD around the age of 12. It can be difficult to distinguish autism from OCD.

My son benefits from SSRIs. Without these, he can engage in hours of ritualistic behaviors and become very distressed by this. On an SSRI, the OCD is much more manageable. The problem is that he does habituate frequently and then we have to up the dose or switch.

Also, even with the SSRI, he still has all these 'rules' about what he can and cannot do, and I wish better for him. His psychiatrist has brought up adding a low dose of an antipsychotic. I am on the fence about this due to the side effects. My son also receives weekly therapy, but his insight is limited, which makes it a slow-moving process. At his specialized private school, he is provided with support and accommodations where needed, but still struggling.

I am ALWAYS wondering if I'm doing enough to help him and if we're seeing the right providers because the OCD seems so impairing.

Does anybody recognize this? I welcome any input, feedback, and advice you may have. Thank you for reading thus far.

There are some actions people take to give them a sense of control. OCD, self harm, even eating disorders such as anorexia can be pursued in an attempt to alleviate anxiety by generating a compensating feeling of control.

It might be helpful to help your son navigate these waters intentionally such as analyzing the effectiveness of various routines to provide relief. Slowly you might also guide him into recognizing sources of anxiety that might be controlled more directly. If he can se pathways to take more direct control, he may lessen in his need to fabricate indirect control.

Timpf, thank you for your reply. It is along the lines of what my son's therapists have been telling me as well. He experiences an underlying feeling of discomfort and utilizes these rules/rituals/compulsions to find relief. According to them, there is not a clearly identifiable source behind his anxiety. Instead, it's this general sense of discomfort/uneasiness that he seeks to reduce. Based on what I'm seeing, I think I agree. The work in therapy (and at home) revolves around using other strategies to ease his discomfort and recognizing when he feels anxious. It's proving difficult to find a strategy as powerful as his 'rituals.' At home, I work on not accommodating his OCD and anxiety. It's a very slow-moving process.

There may also be a nutritional element to consider. If one considers that most of our food is grown on fields that have had most of the micronutrients and minerals depleted years ago and only replace with nitrogen and phosphorous, it would be a good idea to supplement with vitamins with minerals generally.

OCD has been studied with regard to a supplement called Inositol, This was originally called vitamin B8. However, since a vitamin has to be something not made in the body, it was dropped as a vitamin. However, Inositol was made by bacteria in the gut and while technically made "in the body" was not made by the body. You might want to investigate gut health such as probiotics.

There have been NIH studies regarding the efficacy of Inositol supplementation that show an 18 gram daily dose to be effective in helping reduce OCD symptoms. However, I would urge caution in regard to any supplement that required over half an ounce on a daily basis. You may wish to research not only Inositol, but other nutritional supplements.

From a behavior perspective it can be useful to help your son see the management of his condition as something he can control rather than accepting what you are doing for him. If his OCD is giving him the feeling of control, it can lock him into using this as his "go to" management strategy. If he can adopt a strategy that sees OCD as a temporary management coping mechanism, it might help him broaden his perspective to experiment with other or additional coping techniques. It might be possible to ad intense physical activity, such as tennis, as a coping mechanism.