Addressing Obsessive-Compulsive Disorder in Pediatric Autism Spectrum Disorder
One of the most common co-occurring mental disorders in children living with Autism Spectrum Disorder (ASD) is Obsessive-Compulsive Disorder. Obsessive-compulsive disorder (OCD) is one of several mental illnesses categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an anxiety disorder.
Studies have shown that up to 43% of pediatric patients with ASD also meet the criteria for at least one other anxiety disorder, including OSD. Oftentimes the cause for an additional diagnosis is unknown, but chemical imbalance, nutritional deficiency, abuse, trauma, or genetics are common origins. Frequently, a young patient's inability to cope with the challenges of living with autism will can the development of an anxiety disorder.
How to Recognize the Symptoms of OCD in Children with Autism
Individuals with obsessive-compulsive disorder tend to suffer from intrusive, repetitive thoughts, ideas, and feelings which compel them to act out seemingly odd or inappropriate compulsive behaviors.
Obsessions frequently experienced by juveniles with obsessive-compulsive disorder include exactness and symmetry, a need for perfection, and a fear of being harmed; typical accompanying compulsions could include repeatedly checking or counting items, rearranging possessions until they are perfectly aligned, and ritualistic thinking. For example, a young boy who holds a persistent fear of being injured in a car accident may have to think to himself “it will be okay, it will be okay, it will be okay” a specific number of times before they are able to get into a vehicle.
The manifestations of obsessive-compulsive disorder in children with autism tend to be much more severe. Moreover, OCD and ASD have many symptoms in common, including extreme inflexibility, temper tantrums, clinging behavior, and ritualistic behavior to induce self-soothing. The intensity of these symptoms often multiplies when children meet the criteria for both diagnoses.
Recognizing the symptoms of OCD in children with ASD can prove to be inordinately challenging for caregivers due to the overlap of so many symptoms; furthermore, children with ASD often lack the verbal skills necessary for communicating certain discomforts. This increases the risk of OCD and anxiety being dismissed as an underlying presentation of autism. Therefore, it is imperative that parents and caregivers of autistic children carefully monitor behavior, and to keep a written journal of their child's day to day actions and conduct so that any new or worsening behaviors can be disclosed to the pediatrician or therapist in charge of the patient.
Is There a Greater Need for Holistic Approaches to Treatment for Children with OCD and ASD?
Medication management in autistic children with OCD is a common approach to treating the disorder; unfortunately, this can often come with a separate set of challenges for some. Treatment of OCD with antidepressant medications carry the risk of causing psychiatric side effects, such as mania, hypomania, and worsening of depression or anxiety. Studies show that up to 10% of children taking these medications will experience some of the side effects. Moreover, SSRI and SNRI medications are not thought to be extremely effective for reducing repetitive behavior.
Some studies show a higher rate of efficacy in antipsychotic medications prescribed to autistic children with OCD; however, side effects such as movement disorders are a risk, as well as juvenile diabetes. Due to the alarming number of risks associated with medication management of co-occurring mental illness in Autism patients, it's worth wondering if there is a greater need for more holistic types of treatment for OCD and ASD.
Vitamin and Mineral Support
In addition to medication and psychotherapy, caregivers should consider vitamin and mineral support for children with both OCD and ASD. A diet high in omega 3 fatty acids can efficiently reduce many symptoms. A patient's pediatrician should be consulted about adding a vitamin B6 and B12 supplement as a complementary form of treatment; additionally, pediatric supplements with folic acid are sometimes recommended for young people with OCD.
It is recommended that caregivers ask a pediatrician about the mitochondrial cocktail for treatment of difficult cases of OCD and autism. Although this “cocktail” of vitamins is generally given to adults and children suffering from various mitochondrial diseases, it is becoming increasingly popular as a supplemental treatment for patients with autism. Ingredients of the mitochondrial cocktail typically consist of Enzyme Q-10, L-Incarnadine, B-Vitamins, and antioxidants.
Holistic Treatment for OCD in ASD Patients
A holistic model of treatment, supplemental to or in place of medication management, is oftentimes one of the best for minimizing symptoms of OCD in ASD patients. This model of treatment usually includes exercise, spending time in nature, getting enough sunlight, and psychotherapy. For children who do not mind being touched, bodywork and massage reduce cortisol; therefore, it decreases symptoms of extreme anxiety and agitation.
Caregivers or parents of autistic children with OCD should always rule out the possibility of physical illness when sudden changes in behavior occur. So many children with autism lack proper verbal skills, making it difficult for them to effectively communicate that they are experiencing physical discomfort. This occasionally will lead to a change in a child's behaviors, leading to confusion in many caregivers.
Coping With A Loved One's Mental Illness is Difficult
Individuals caring for children with obsessive-compulsive disorder and autism are at a much higher risk of suffering from anxiety and depression themselves. It is therefore recommended that all caregivers pay close attention to their personal needs and seek treatment themselves in severe cases. This can help people to better cope with their loved one's symptoms and make them better able to provide solid care in the long run.
Management of obsessive-compulsive disorder in children with ASD is in no way impossible; however, it is irrefutably demanding, and there isn't one individual effective treatment for every child. Therefore, taking careful measures to individually assess each child's mannerisms, behavior, and moods are critical to ensuring higher quality of life and a higher likelihood of successfully treating symptoms.
About the Author:
Today's post is coming to you from Kathrina Jeorgette Flores, who’s currently a 4th-year medical student at Doña Remedios Trinidad Romualdez Medical Foundation in the Philippines and she expects to graduate as an M.D. this May, 2017. Prior to her present-day academic undertaking in medicine, she received a Master's Degree in Nursing Major in Clinical Supervision from the University of San Carlos in 2010. Kathrina is a member of Total Outreach for Community Health Brotherhood and Sisterhood (TORCH), and the Philippine Nurses Association (PNA).
Additional information about Kathrina Jeorgette Flores can be found on her LinkedIn profile (https://ph.linkedin.com/in/kathrinaflores).