Autism Awareness with Dr. Hoffman - Revisiting Stuck

By Jonathan Hoffman, PhD

This edition of NBI Exposure features a conversation with Dr. Jonathan Hoffman, Chief Clinical Officer at NBI and author of Stuck: Asperger’s Syndrome and Obsessive-Compulsive Behaviors. 

Originally published in 2012, Stuck offered practical tools and insights for families, educators, and professionals working with children on the autism spectrum - especially those dealing with obsessive-compulsive behaviors. 

Over a decade later, we revisit the book with Dr. Hoffman to reflect on what has changed, what has endured, and how clinical understanding has evolved when it comes to the intersection of autism and OCD. 

What initially motivated you to write Stuck?   

What really motivated me was that, at the time I was writing this book, there were still so many questions about how OCD and autism really related. Were the behaviors obsessive-compulsive traits that were part of autism? Or was it a whole other condition – OCD - that autistic people were also dealing with? What was the prevalence rate? How common was this? How could families deal with it? 

So what motivated me was being asked so many questions and really wanting to provide as much information as we knew at the time - not only to help families, but also patients who were interested in reading it, and professionals. 

Looking back, what was the biggest challenge you faced when trying to explain the overlap between autism and obsessive-compulsive behaviors? 

I think at the time there was less clarity about all these different factors - how to modify treatment for obsessive-compulsive behaviors or obsessions and compulsions, and how to communicate the most effective treatment methods. 

Those were real challenges. Also, at the time when I wrote the book, Asperger's was still a DSM diagnosis, which has changed now - at least in the United States. 

The book came out in 2012. Since then, what do you think has been the most significant shift in how we understand or treat OCD in individuals on the spectrum?

I think people have started looking at things in a different way, especially regarding levels of functionality and support needs, rather than categorizing people under one label like Asperger's or autism. These have now been grouped together under the same umbrella, and there’s more clarity. 

Some people think that was a good change. Others feel that the term “Asperger’s” had a particular flavor that helped people understand the diagnosis, and now that nuance is lost. There’s been some reevaluation of the original research that led to that term. So, it’s been a moving target, and like anything else, there will be more changes as new information emerges. 

What’s really changed is the number of people interested in the subject - many more professionals are involved. And while there's still a need for more training, there is more understanding now. When someone is autistic, one of the things professionals are more likely to assess now is whether they also have obsessive-compulsive issues. 

Initially, OCD was thought to be uncommon among autistic people. Many of those behaviors were considered simply features of autism. But with more clarity—and a better job separating restrictive and repetitive behaviors from obsessions and compulsions - it seems that around 10% of autistic individuals also meet criteria for OCD. 

Another change has been in our understanding of how effective OCD treatment can be for autistic individuals. Most people will need treatment modifications, but not all. It's very individual, because autistic people vary so much. You can’t apply a one-size-fits-all approach. Each person has their own situation and may need different modifications—or none at all. 

Have your views on anything in the book changed over time? Or is there something you would add if you were writing it today? 

If I were writing the book today, I’d have more than ten additional years of experience to draw on. I think I’d be even more focused on behavioral change and family accommodation. 

I would also talk more about the amazing support and advocacy efforts that are helping to make this a better-known issue and reducing stigma. And there’s so much more research available now that supports the effective treatment of OCD among autistic individuals - and how to support families through that process. 

What’s one key message from Stuck that you think is still just as important—if not more—in 2025? 

I think I might even change the title. Stuck sounded catchier than my original idea, Getting Unstuck, but it does carry a negative connotation - even though it was accurate at the time. A lot of people were stuck—unsure of where to turn or what to do. 

Today, we have a lot more resources. Of course, we still need more, but I’d want to focus on the more optimistic insights we’ve gained from research—about how much help is available, how people can overcome OCD, and how truly life-changing that can be. 

What would you say to caregivers or clinicians who are just beginning to understand this overlap between autism and OCD? 

I think it’s important to really understand where the person you're working with is coming from. Some people may be confused about what's being asked. Others are not confused at all, they’ve just had negative experiences with past providers. 

It's crucial to take the time to get to know someone, understand what their particular obsessions or compulsions are about, and provide information in a clear and comprehensible way. 

Also, gather information from as many sources as possible. Of course, from the individual if they’re able to communicate, but also from family members, teachers, doctors, community workers, or other professionals involved in their life. 

What are the main clinical challenges when treating individuals who are on the autism spectrum and also have OCD?

The biggest challenge is actually getting started - engaging people and giving them hope. Often, it’s not about the technical aspects of treatment, but about helping people understand how transformative effective OCD treatment can be. 

Sometimes, it’s hard because OCD treatment requires doing things that feel uncomfortable or wrong. People can feel overwhelmed, so we need to be sensitive to that. But if we communicate openly, and partner with the person and their family, in many cases it’s absolutely worth it. 

What recent developments in psychology or neuroscience do you think have most improved care for individuals with this dual diagnosis? 

One major improvement is that so many more professionals are now trained to work with OCD in autistic people. That’s been a big step forward. 

In addition, there are promising developments in neuroscience and behavioral science that allow us to tailor treatment to the individual. As I said earlier, one size does not fit all. The more we understand the nuances of each case, the more effectively we can target treatment. 

What was a formative moment in your career that influences your work to this day?

A formative moment for me was when I was working at a hospital and two renowned OCD specialists began seeing patients there. I’d heard of them through someone else, and they asked me if I wanted to get involved in treating their patients while they were in the hospital. I said yes - fortunately - because it changed my life. 

Until that point, I knew a little about OCD treatment, but I hadn’t realized how life-changing it could be when delivered by experts. I worked and learned alongside them for years, and I also became more aware of just how many people suffer from OCD, and how devastating it can be. 

What inspires you in your work?

I feel inspired when I see what a difference it makes to help someone through a difficult time - to help a person or a family navigate through a tough situation. That’s always been inspiring. 

I’m also constantly inspired by the courage of the people I work with, and by the lengths families go to in order to support their loved ones. And what continues to inspire me—even after decades in this field—is how many people stay in touch after they finish treatment. Hearing how well they’re doing really reinforces the importance of this work, and of partnering with families and patients through such a challenging time. 

With so much work, what do you do to unwind in your free time?  

I like to unwind by reading, writing, exercising, and staying active. I enjoy spending time with family and friends. 

And honestly, it doesn’t feel like “work” in the usual sense when you truly love what you do. Of course, it is work, but having a great team and supportive colleagues really helps. It puts you in a position where your work doesn’t feel like a chore you need to recover from. You see your life as a whole, and I feel privileged to live this life in this field.