Differentiating Autism Spectrum Disorder from Obsessive-Compulsive Disorder

Core Distinguishing Features

The American Academy of Child and Adolescent Psychiatry notes that OCD has a later onset than Autism Spectrum Disorder (ASD), typically emerging in later childhood or adolescence, whereas ASD presents early in development 1, 2
In OCD, repetitive behaviors are ego-dystonic, meaning they are experienced as intrusive, unwanted, and cause marked anxiety or distress, as stated by the American Academy of Child and Adolescent Psychiatry 1, 2
The American Academy of Child and Adolescent Psychiatry recommends assessing for prominent social and communicative impairments, including deficits in nonverbal behaviors and lack of developed social insight, which characterize ASD 1, 2, 5

At 20-42 months, lack of pointing for interest and absence of conventional gestures suggest ASD, according to the American Academy of Child and Adolescent Psychiatry 3, 5
At 24 months, deficits in directing attention and attention to voice indicate ASD, as noted by the American Academy of Child and Adolescent Psychiatry 3, 5

The American Academy of Child and Adolescent Psychiatry suggests using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to quantify OCD symptom severity, with scores ≥14 for obsessions alone indicating clinically significant OCD requiring treatment consideration 4

The American Academy of Child and Adolescent Psychiatry advises against assuming all repetitive behaviors in ASD are simply autistic traits, as individuals with ASD can have comorbid OCD, and failing to diagnose this comorbidity can lead to inadequate treatment 2, 5

If OCD is diagnosed, the American Academy of Child and Adolescent Psychiatry recommends initiating Cognitive Behavioral Therapy with Exposure and Response Prevention (ERP) as first-line treatment, and considering sertraline 50 mg daily as first-line SSRI pharmacotherapy for moderate-to-severe OCD symptoms 4