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.

Timpf, thank you again for your valuable advice. I had never heard of inositol before. I googled it, and it looks promising. It makes me wonder if other nutritional elements may be beneficial. I will consult with my son's psychiatrist regarding the inositol to see if we can add it and if so, what dose.

We started him on a low dose of an antipsychotic yesterday. We bit the bullet because he has been restricting his food intake and has lost weight.

I like the idea of working towards increased agency for my son and less reliance on me 'fixing' his OCD. The only coping strategies I've found that work for him are distraction and massages, which we arrange for him. I did buy him a trampoline, maybe it's time to build it and give that a go.

Thank you again for thinking along with me.

The addition of anorexia contributes another control issue. I heard a Catholic priest once comment about the administration of his order that he had observed that it was important for men to have responsibility to control something or have something they were personally responsible for before the age of 30.

Living in a rural area we had many things our son was responsible for that I think contributed to his growing with a good work ethic and sense of control. When we lived in suburbia I was uncertain how this aspect could be provided for. It might be that for your son having a pet like a dog that was his responsibility might both draw him out a little as well as provide an opportunity to have control. - Just a thought

Timf, thank you again for your insightful reply. Everything you're saying is in line with what we're pursuing in therapy. I take it you have a child with autism?

I am racking my brain to come up with something my son could be responsible for. I think his current level of impairment makes it difficult for him to carry responsibility for anything, particularly the well-being of an animal. I briefly tried having him be responsible for feeding the cat but he never remembered. Poor cat .

I am working really hard on letting him be (and having him keep things under his control). For instance, while I want him to eat and drink much more than he is, I stopped prompting him. I now simply place the items in front of him and walk away. He will leave half the drink/meal and look at me somewhat suspiciously , as if it is a trap. He also has a social story around eating that emphasizes the power he has over his OCD brain.

I also emailed his psychiatrist about the Inositol and ordered 500 MG in the meantime.

Thank you again for reading my ramblings and replying.

When I was teaching my youngest daughter to drive I would exhort her to scan her peripheral vision every 15-20 seconds as situational awareness is beneficial in traffic. You might want to try some memory aids for your son like writing on his hand what is supposed to do or tying a string (loosely) around his finger. After a while when he has forgotten what it was he was supposed to do, you can ask him what is written on his hand or why he has the sting on a finger.

In the movie The Zero Effect a statement was made that passion was the enemy of precision. In a similar way the focus of attention can allow one to forget that which is important. You might want to make a game out of setting a timer to ring in an hour and use the interruption to ask him if there was anything he was going to do. This might help hi develop a habit of periodically rousing himself from focus to consider what may seem to him as peripheral matters.

I had a partner who took SSRIs for anxiety but I don't think they did anything for OCD.