Phenomenology of Comorbid Autism Spectrum and Obsessive-Compulsive Disorders Among Children

  • Adam B. Lewin
  • Jeffrey J. Wood
  • Sarah Gunderson
  • Tanya K. Murphy
  • Eric A. Storch
Original Article

Abstract

The occurrence of obsessive-compulsive disorder (OCD) in youth with autism spectrum disorders (ASD) is common (37% prevalence or higher) and results in additional distress and impairment. The phenomenology of OCD in youth with ASD is under-researched to date. This study compared the clinical characteristics of youth with comorbid ASD and OCD (ASD + OCD) with age and gender matched controls with OCD in 70 youth (7–13 years old). Youth with both syndromes did not present with more severe OCD symptoms. Obsessive-compulsive symptom severity and total number of obsessions and compulsions between the ASD + OCD group and the OCD group did not differ statistically. However, group differences in reports of specific OCD symptoms as well as patterns of comorbidity were identified. Attention deficit/hyperactivity symptoms, social phobia, and separation anxiety disorder were more common among youth with ASD + OCD. Better understanding of OCD/ASD co-morbidity may facilitate treatment development.

Keywords

Obsessive-compulsive disorder Autism Autism spectrum disorder Comorbidity Children Asperger syndrome OCD 

References

  1. Autism Speaks. (2009, February 19). Autism: fluoxetine not effective in reducing repetitive behaviors, Study Shows. ScienceDaily. Retrieved July 1, 2010, from http://www.sciencedaily.com/releases/2009/02/090218135122.htm.
  2. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autismspectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.Google Scholar
  3. Barrett, P., Healy-Farrell, L., & March, J. S. (2004). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 46–62.PubMedCrossRefGoogle Scholar
  4. Bejerot, S. (2007). An autistic dimension: a proposed subtype of obsessive-compulsive disorder. Autism, 11(2), 101–110.PubMedCrossRefGoogle Scholar
  5. Bejerot, S., Nylander, L., & Lindstrom, E. (2001). Autistic traits in obsessive-compulsive disorder. Nordic Journal of Psychiatry, 55(3), 169–176.PubMedCrossRefGoogle Scholar
  6. Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19(2), 78–86.CrossRefGoogle Scholar
  7. Bellini, S., & Peters, J. K. (2008). Social skills training for youth with autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17(4), 857–873. x.PubMedCrossRefGoogle Scholar
  8. Cath, D. C., Ran, N., Smit, J. H., van Balkom, A. J., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: a preliminary case-controlled study. Psychopathology, 41(2), 101–110.PubMedCrossRefGoogle Scholar
  9. CDC. (2007). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR: Surveillance Summaries, 56(1), 12–28.Google Scholar
  10. Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.PubMedCrossRefGoogle Scholar
  11. de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37(5), 877–886.PubMedCrossRefGoogle Scholar
  12. DeLong, G. R., Teague, L. A., & McSwain Kamran, M. (1998). Effects of fluoxetine treatment in young children with idiopathic autism. Developmental Medicine and Child Neurology, 40(8), 551–562.PubMedCrossRefGoogle Scholar
  13. Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. The Journal of Clinical Psychiatry, 66(Suppl 10), 3–8.PubMedGoogle Scholar
  14. Gallant, J., Storch, E. A., Merlo, L. J., Ricketts, E. D., Geffken, G. R., Goodman, W. K., et al. (2008). Convergent and discriminant validity of the Children’s Yale-Brown Obsessive Compulsive Scale-Symptom Checklist. Journal of Anxiety Disorders, 22(8), 1369–1376.PubMedCrossRefGoogle Scholar
  15. Greenland, S. (1987). Interpretation and choice of effect measures in epidemiologic analyses. American Journal of Epidemiology, 125, 761–767.PubMedGoogle Scholar
  16. Hoekstra, R. A., Bartels, M., Cath, D. C., & Boomsma, D. I. (2008). Factor structure, reliability and criterion validity of the Autism-Spectrum Quotient (AQ): a study in Dutch population and patient groups. Journal of Autism and Developmental Disorders, 38(8), 1555–1566.Google Scholar
  17. Hollander, E., Phillips, A., Chaplin, W., Zagursky, K., Novotny, S., Wasserman, S., et al. (2005). A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology, 30(3), 582–589.PubMedCrossRefGoogle Scholar
  18. Ivarsson, T., & Melin, K. (2008). Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD). Journal of Anxiety Disorders, 22(6), 969–978.PubMedCrossRefGoogle Scholar
  19. Jacob, S., Landeros-Weisenberger, A., & Leckman, J. F. (2009). Autism spectrum and obsessive-compulsive disorders: OC behaviors, phenotypes and genetics. Autism Research, 2(6), 293–311.PubMedCrossRefGoogle Scholar
  20. King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregman, J. D., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Archives of General Psychiatry, 66(6), 583–590.PubMedCrossRefGoogle Scholar
  21. Klin, A., Pauls, D., Schultz, R., & Volkmar, F. (2005). Three diagnostic approaches to Asperger syndrome: implications for research. Journal of Autism and Developmental Disorders, 35(2), 221–234.PubMedCrossRefGoogle Scholar
  22. Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395–1403.PubMedCrossRefGoogle Scholar
  23. Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: a systematic review. Developmental Neurorehabilitation, 13(1), 53–63.PubMedCrossRefGoogle Scholar
  24. Lecavalier, L., Aman, M. G., Scahill, L., McDougle, C. J., McCracken, J. T., Vitiello, B., et al. (2006). Validity of the autism diagnostic interview-revised. American Journal of Mental Retardation, 111(3), 199–215.PubMedCrossRefGoogle Scholar
  25. Lewin, A. B., & Piacentini, J. (2009). Obsessive-compulsive disorder in children. In B. J. Sadock, V. A. Sadock, & P. Ruiz (Eds.), Kaplan & Sadock’s comprehensive textbook of psychiatry, Vol 2 (9th ed., pp. 3671–3678). Philadelphia: Lippincott, Williams & Wilkins.Google Scholar
  26. Lewin, A. B., Storch, E. A., Adkins, J., Murphy, T. K., & Geffken, G. R. (2005). Current directions in pediatric obsessive-compulsive disorder. Pediatric Annals, 34(2), 128–134.PubMedGoogle Scholar
  27. Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861.PubMedCrossRefGoogle Scholar
  28. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Schedule. Los Angeles: Western Psychological Services.Google Scholar
  29. Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2008). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics, 121(3), e441–e448.PubMedCrossRefGoogle Scholar
  30. Mandy, W. P., & Skuse, D. H. (2008). Research review: what is the association between the social-communication element of autism and repetitive interests, behaviours and activities? Journal of Child Psychology and Psychiatry, 49(8), 795–808.PubMedCrossRefGoogle Scholar
  31. March, J. S., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York: Guiford Press.Google Scholar
  32. McDougle, C. J., Kresch, L. E., Goodman, W. K., Naylor, S. T., Volkmar, F. R., Cohen, D. J., et al. (1995). A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. The American Journal of Psychiatry, 152(5), 772–777.PubMedGoogle Scholar
  33. Mills, R., & Wing, L. (2005). Researching interventions in ASD and priorities for research: Surveying the membership of the NAS. Paper presented at the National Autistic Society.Google Scholar
  34. Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12(4), 387–393.PubMedCrossRefGoogle Scholar
  35. Piacentini, J. (2008). Optimizing cognitive-behavioral therapy for childhood psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 47(5), 481–482.PubMedCrossRefGoogle Scholar
  36. Piacentini, J., & Chang, S. (2005). Habit reversal training for tic disorders in children and adolescents. Behavior Modification, 29(6), 803–822.PubMedCrossRefGoogle Scholar
  37. Piacentini, J., Langley, A., & Roblek, T. (2007). Overcoming childhood OCD: A therapist’s guide. New York: Oxford University Press.Google Scholar
  38. Rosenberg, R. E., Mandell, D. S., Farmer, J. E., Law, J. K., Marvin, A. R., & Law, P. A. (2010). Psychotropic medication use among children with autism spectrum disorders enrolled in a national registry, 2007–2008. Journal of Autism and Developmental Disorders, 40(3), 342–351.PubMedCrossRefGoogle Scholar
  39. Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. The Australian and New Zealand Journal of Psychiatry, 39(7), 633–638.PubMedCrossRefGoogle Scholar
  40. Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in Asperger syndrome and high-functioning autism. The British Journal of Psychiatry, 186, 525–528.PubMedCrossRefGoogle Scholar
  41. Ruta, L., Mugno, D., D’Arrigo, V. G., Vitiello, B., & Mazzone, L. (2010). Obsessive-compulsive traits in children and adolescents with Asperger syndrome. European Child & Adolescent Psychiatry, 19(1), 17–24.CrossRefGoogle Scholar
  42. Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., et al. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844–852.PubMedCrossRefGoogle Scholar
  43. Silva, A. P. D., & Stam, A. (Eds.). (1995). Discriminant analysis. Washington, DC: American Psychological Association.Google Scholar
  44. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV-Child and parent versions. San Antonio: Graywinds Publications.Google Scholar
  45. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 937–944.PubMedCrossRefGoogle Scholar
  46. Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160.PubMedCrossRefGoogle Scholar
  47. Steingard, R. J., Zimnitzky, B., DeMaso, D. R., Bauman, M. L., & Bucci, J. P. (1997). Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 7(1), 9–15.PubMedCrossRefGoogle Scholar
  48. Storch, E. A., Murphy, T. K., Geffken, G. R., Soto, O., Sajid, M., Allen, P., et al. (2004). Psychometric evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale. Psychiatry Research, 129(1), 91–98.PubMedCrossRefGoogle Scholar
  49. Storch, E. A., Murphy, T. K., Adkins, J. W., Lewin, A. B., Geffken, G. R., Johns, N. B., et al. (2006). The children’s Yale-Brown obsessive-compulsive scale: psychometric properties of child- and parent-report formats. Journal of Anxiety Disorders, 20(8), 1055–1070.PubMedCrossRefGoogle Scholar
  50. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128.PubMedCrossRefGoogle Scholar
  51. Volkmar, F. R., & Klin, A. (2000). Diagnostic issues in Asperger syndrome. In A. Klin & F. R. Volkmar (Eds.), Asperger Syndrome (Vol. 27, pp. 25–71).Google Scholar
  52. Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753–2766.PubMedCrossRefGoogle Scholar
  53. White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009a). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders.Google Scholar
  54. White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009b). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.CrossRefGoogle Scholar
  55. White, S. W., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A., et al. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77–90.PubMedCrossRefGoogle Scholar
  56. Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice, 17, 281–292.CrossRefGoogle Scholar
  57. Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31(3), 335–342.PubMedGoogle Scholar
  58. Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009a). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.CrossRefGoogle Scholar
  59. Wood, J. J., Drahota, A., Sze, K., Van Dyke, M., Decker, K., Fujii, C., et al. (2009b). Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. Journal of Autism and Developmental Disorders, 39(11), 1608–1612.CrossRefGoogle Scholar
  60. Zandt, F., Prior, M., & Kyrios, M. (2007). Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder. Journal of Autism and Developmental Disorders, 37(2), 251–259.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Adam B. Lewin
    • 1
  • Jeffrey J. Wood
    • 2
  • Sarah Gunderson
    • 1
  • Tanya K. Murphy
    • 1
  • Eric A. Storch
    • 1
  1. 1.Department of PediatricsUniversity of South Florida College of Medicine, Rothman Center for NeuropsychiatrySt. PetersburgUSA
  2. 2.School of Education and Information StudiesUniversity of California Los AngelesLos AngelesUSA

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