Does My Child Have OCD, Autism, or Both?
May 05, 2026
Since Jade was a young child, she appeared to be hitting milestones like speech and walking. earlier than her peers. While she was a joy to be around, she often struggled with sleep and experienced temper tantrums that could last longer than half an hour. Her parents felt at a loss. They noticed a persistent rigidity in her behavior, which they hoped she would eventually outgrow.
By the time Jade reached preschool, the morning routine became a significant challenge. She often had meltdowns and refused to go. Her teachers reported that while she would eventually calm down, they also noticed her rigidity. Her pediatrician wasn’t initially concerned; because Jade was meeting or exceeding her developmental milestones, nothing seemed “wrong” in a traditional sense.
However, as Jade grew older, her anxiety intensified. By third grade, homework became a source of distress; she would erase numbers and redo them repeatedly. Getting ready for school became an ordeal as she struggled to choose socks, tops, or pants, frequently changing her mind. Frustrated, her parents would urge her to just get dressed, which often led to aggressive outbursts—especially if her younger siblings entered her room and touched her belongings.
Observations from school added more pieces to the puzzle. Her teacher noticed Jade speaking slower than usual, as if she were searching for “just the right” thing to say. She also began tapping her pencil repeatedly when anxious, unable to stop even when asked kindly. Socially, Jade had only a few friends. Her mother noticed that Jade always insisted on being in charge and only wanted to play “fairies”—a subject she was deeply passionate about and collected extensively.
After a school psychologist diagnosed Jade with severe anxiety, she began weekly therapy, but it didn’t seem to help. As the struggles continued, her parents sought a thorough psychological evaluation. It was then they discovered Jade was autistic and also struggling with Obsessive-Compulsive Disorder (OCD). Fortunately, they were able to find specialized clinicians who understood the intricate overlap between the two.
How Do You Differentiate OCD and Autism in Children?
Autism can be missed by parents and professionals alike, especially when a child is “Level 1” (requiring support). For context, the clinical scales range from Level 1 to Level 3 (requiring very substantial support).
Jade was diagnosed as Level 1. She possessed average to above-average cognitive and verbal skills, yet she struggled with social interactions, sensory overload, and self-regulation when triggered by her environment.
Previously, her stimming—repetitive behaviors used to regulate emotions, focus, or cope with sensory input—had been misunderstood as OCD. While she did have OCD, the functions of her behaviors were different.
The “Why” Behind the Behavior
In Jade’s case, her stimming (tapping, rocking, pacing, and humming) helped her soothe herself. However, she also struggled with “Just Right” OCD and Harm OCD.
- “Just Right” OCD: Changing her socks or clothes wasn’t a preference; it was a necessity because they “felt wrong.” She would cycle through items until her body felt “just right,” believing she couldn’t tolerate the physical discomfort otherwise.
- Harm OCD: If she had a “bad” or “scary” thought while walking through a doorway, she felt a frantic urge to walk back through it while thinking a “good” thought to undo the “harmful” one.
The primary difference is the driver: Jade’s stimming was for regulation and comfort, while her OCD was driven by fear and the urge to prevent a perceived catastrophe.
Autism Routines vs. OCD Compulsions
| Autism | OCD |
| Routines create comfort and predictability. | Repetitive behaviors are used to reduce anxiety. |
| Repetition may be enjoyable or self-regulating. | Behaviors are a response to distressing, intrusive thoughts. |
| Activities usually relate to specific interests. | Rituals are an attempt to prevent a feared outcome. |
How OCD May Look in Autistic Children
Because both conditions involve repetitive patterns, OCD is frequently overlooked in autistic children. Signs that OCD may be present include:
- Intense distress if specific rituals cannot be completed.
- Repeatedly seeking reassurance or checking things.
- Intrusive thoughts that feel upsetting, “scary,” or unwanted.
- Strong fears regarding contamination, making mistakes, or causing harm.
- An extreme difficulty in tolerating uncertainty.
Finding the Right Path
Many parents hope their child’s behaviors are just a “phase.” While hope is a powerful mindset, waiting can allow these patterns to become more ingrained. Understanding the difference between these two conditions is vital.
If your child’s anxiety or repetitive behaviors are interfering with their daily life, consult with a clinician trained in both OCD and neurodiversity. Clarity is the first step toward effective treatment.
Take the Next Step Toward Clarity
Don’t wait for the “phase” to pass. If you see your child in Jade’s story, the most powerful thing you can do is seek specialized support. Our team understands the unique intersection of OCD and Autism, and we are here to help your family find a path forward.
Contact us to schedule an appointment with a specialist who understands the unique intersection of OCD and Autism.
There is hope, and you don’t have to navigate this alone!
By Annabella Hagen, LCSW
