Published on 12, July, 2020
Hi, our 12 year old son has just been diagnosed as having Aspergers. For some years now he has performed ritual behaviours and had intrusive thoughts which were first diagnosed as OCD. These became more and more distressing for him as every so often he said the thoughts and feelings became so intense they would completely overwhelm him leading to a huge meltdown. At these times he would literally writhe on the floor or sofa sometimes even saying he wished he would die to release him from the mental pain. We had fantastic support from the local CAMHS who put him on sertraline ( it seems to have calmed him down a little) but who also referred him for ASD assessment - the diagnosis came through last week.
From what I understand OCD behaviours can be treated with CBT - ie they can be combatted - whereas stimming is really important for people with Aspergers - ie they shouldn’t be suppressed. At this stage we’re not sure which are OCD if at all and which are stimming. His behaviours involve:
If we talk to him when he’s doing these he gets very upset and has to start all over again. These behaviours start from first thing in the morning and happen every few minutes of the day. We don’t know what happens exactly at school when he is in class but we think he tries to do them in his head so as not to draw attention to himself but occasionally he can’t contain them and this is when he can become overwhelmed and have to leave class..
I’d be grateful for any advice from anyone who knows anything about this behaviour , has experienced it or who does it. Are there ways to control it? Will it change as he gets older? Is this confusion between OCD behaviour and stimming common? He’s starting to go through puberty - to throw something else into the mix!
Sorry about the long post - there’s a lot to say and this is the first time I’ve been able to ask questions to a group who might have some answers!
Thanks very much.
Just for the sake of clarity here is the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders version 5) definition for OCD (Obsessive Compulsive Disorders):
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clinicians with official definitions of and criteria for diagnosing mental disorders and dysfunctions. Although not all experts agree on the definitions and criteria set forth in the DSM-5, it is considered the “gold standard” by most mental health professionals in the United States.
DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
Tic-related: The individual has a current or past history of a tic disorder.
Reprint permission pending from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric Association.
https://beyondocd.org/information-for-individuals/clinical-definition-of-ocd
And for general how to and whats going on information there is a book titled 'The Complete Guide to Asperger's Syndrome' by Tony Attwood which is really worth getting if you have not already, and costs just short of £20 when acquired new, or free as PDF via this link:
http://www.autismforthvalley.co.uk/files/5314/4595/7798/Attwood-Tony-The-Complete-Guide-to-Aspergers-Syndrome.pdf
Thanks very much for this information. It looks to us that these behaviours are both OCD and stimming but he sees them all as what he called his “habits” long before they were diagnosed as OCD. Some of them appear to be comforting to him while others - especially the intrusive thoughts - are things he’d rather not be doing. Because they all have appeared gradually I don’t think he can discriminate between the two and I hope this will be
something the professionals will help him to do. So far they have been looking at OCD but with this new diagnosis I hope they can help him to see the differences.