Felt but not seen: Observed restricted repetitive behaviors are associated with self-report-but not parent-report-obsessive-compulsive disorder symptoms in youth with autism spectrum disorder

Abstract

Youth with autism spectrum disorder often exhibit symptoms of obsessive-compulsive disorder; however, it can be difficult for parents and clinicians to tell the difference between the restricted and repetitive behaviors often seen in autism spectrum disorder and symptoms of obsessive-compulsive disorder. This difficulty in distinguishing symptoms may arise from the fact that these symptoms appear the same to observers but are typically differentiated based on whether the motivation for the behavior is to reduce stress (restricted and repetitive behaviors) or whether the behavior itself is stressful (obsessive-compulsive disorder). It is important to know the difference between these two symptoms as it may impact the treatment prescribed. The goal of this study was to better determine the difference between restricted and repetitive behaviors and symptoms of obsessive-compulsive disorder in youth with autism spectrum disorder. It was found that although parents and clinicians had trouble differentiating between the two, the children were able to provide insight as to their own motivations for behavior, and thus whether they were restricted and repetitive behaviors or symptoms of obsessive-compulsive disorder. It was also found that children may actually have subjective negative experiences when engaging in restricted and repetitive behaviors, which complicates their classification. These results provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder.

Keywords: autism spectrum disorder; comorbidity; obsessive-compulsive disorder; restricted and repetitive behaviors; school-age children.

Figure 1.

Parent-reported mean-centered OCD symptoms as a predictor of (A) clinician-observed and (B) parent-report RRBs, and self-report mean-centered OCD symptoms as a predictor of (C) clinician-observed and (D) parent-report RRBs

Figure 2.

Unique (red bars) and common regression effects of SRS-2 SCI, parent-report MASC-2 OCD symptoms, and self-report MASC-2 OCD symptoms on (a) clinician-observed ADOS-2 RRBs and (b) parent-report CASI-5 RRBs.