Obsessive-Compulsive Behaviors (OCBs) are typically associated with Asperger’s syndrome (AS) and are often a major obstacle to making improvements. Whether or not AS will be folded into a new Autistic Spectrum Disorders (ASD) category in the upcoming version of the American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-5, the importance of early identification and finding effective ways to address OCBs in this population will remain undiminished.
Because they inter-mingle and cross boundary markers with rigidities, perfectionisms, perseverations, stereotyped behaviors, habits, impulsivities, and some kinds of tics, arriving at an exact definition of OCBs can challenge even experts in the field. However, sometimes OCBs are so prevalent, systematized, and time consuming that Obsessive-Compulsive Disorder (OCD) is diagnosed as a separate condition co-occurring with AS.
Like Asperger’s and related ASDs, OCD is often associated with problems in social functioning; however, in primary OCD, social deficits tend to be much less severe and pervasive and are not embedded in the context of distinctive autistic spectrum problems like mind-blindness, idiosyncratic mannerisms and communication style, or being extremely literal.
Examples of OCBs common in AS include very excessive washing or checking, repetitive actions, ordering and arranging, and need for symmetry. Other possible OCBs in this population are picking up random items-like hair strands- from the floor, exclusively wearing certain colored clothing, following a very selective diet, turning lights on and off repeatedly, fixating on very restricted subjects, and only sitting in certain places. Providing an exhaustive list would be virtually impossible since almost any behavior potentially be an OCB. OCBs in AS are often not as systematized as well as less associated with specifically feared catastrophic consequences than in those suffering from OCD alone.
The purpose of interventions for OCBs is to reduce their frequency, intensity, duration, and ability to bottleneck further development as well as to decrease the level of distress they- or their caregivers- experience as a result of these symptoms. The scientific evidence indicates Cognitive Behavioral Therapy (CBT) is the psychological treatment of first choice in many cases, particularly a method known as Exposure and Response Prevention (ERP). However, CBT is often used in combination with psychopharmacological approaches in more severe or complex clinical presentations.
In pediatric interventions, CBT may be embedded into a creative, game-like format. For example, a child who insists on wearing a purple colored shirt every day can be introduced to a game that involves a grab bag of differently colored shirts.
Interventions for OCBs (e.g. modifying an established route to school) are often not well received by individuals with AS, to say the least. In fact, various kinds of negative reactions, ranging from silent refusal to tantrums or aggression are to be expected, especially at first. This totally understandable- from the vantage point of the person with AS treatment, even when very gradually implemented, is more likely to feel like an attack rather than help. This can be very uncomfortable for caregivers who often must redefine what being loving and supportive to their child means within the context of treatment.
Despite the obstacles, finding evidence-informed and positive ways to address OCBs is essential in developing a comprehensive intervention plan for Asperger’s syndrome. OCBs, while certainly difficult to treat, should not be thought of as insurmountable. Remember, in the framework of interventions for AS, even small gains can add up to major improvements over time.