OCD and Autism Therapy

OCD and Autism: Quick Overview

Some individuals experience both Obsessive-Compulsive Disorder (OCD) and Autism, which can sometimes make symptoms more difficult to recognize. While autism may involve routines or repetitive behaviors that are comforting, OCD behaviors are typically driven by intrusive thoughts, doubts, intensive distress and anxiety.

At Mindset Family Therapy, we specialize in treating individuals experiencing OCD, including those who are autistic or otherwise neurodivergent.

Our approach focuses on understanding the function of behaviors and adapting evidence-based treatments—such as Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Inference-Based Cognitive Behavioral Therapy (I-CBT)—to support each person's unique needs.

With the right understanding and treatment approach, many individuals are able to respond to unpleasant emotions differently, decrease compulsive behaviors, and improve daily functioning. support each person's unique needs.

Who we Help

At Mindset Family Therapy, we work with:

• •Children experiencing OCD and anxiety
• •Autistic children and teens who may also struggle with OCD
• •Adults who may be discovering autism later in life and are struggling with OCD
• •Parents seeking guidance on how to support a child with OCD
• •Individuals struggling with intrusive doubts and compulsive behaviors

What Makes Our Approach Different

At Mindset Family Therapy, we understand that OCD and autism can interact in complex ways. Our treatment approach is:

• •Individualized — therapy is tailored to each person's needs and strengths
• •Neurodivergent-affirming — we respect and support neurodiversity
• •Evidence-based — we use treatments supported by research, including ERP, ACT, and I-CBT
• •Collaborative — we work closely with families and loved ones when appropriate

Our goal is to help individuals develop practical skills while feeling understood and supported.

Key Points

• •OCD and autism can occur together, and symptoms may sometimes appear similar on the surface.
• •Autistic routines are often comforting, while OCD compulsions are usually performed to reduce anxiety caused by doubts and unwanted thoughts.
• •Exposure and Response Prevention (ERP) is the most effective evidence-based treatment for OCD, and can be adapted for autistic individuals.
• •Family involvement can support treatment success, particularly when parents learn how to respond to OCD behaviors in supportive ways.

On This Page

• •Understanding OCD and Autism
• •Why Accurate Understanding Matters
• •Is It OCD, Autism, or Both?
• •Signs OCD May Be Present in Someone with Autism
• •Common OCD Themes in Autistic Individuals
• •Undiagnosed Autism in Children and Adolescents
• •Undiagnosed Autism in Adults
• •Why OCD Treatment May Need to Be Adapted
• •What Treatment May Look Like
• •Treatment Approaches
• •Factors We Consider During Treatment
• •The Role of Loved Ones in Treatment
• •How Families Can Support Someone with OCD
• •Why Early OCD Treatment Matters
• •You Are Not Alone
• •Getting Started

Understanding OCD and Autism

At Mindset Family Therapy, we provide personalized treatment for individuals experiencing OCD, including autistic children, teens, and adults. While people may experience similar levels of distress, the underlying factors driving their experiences can be different. Effective treatment therefore requires an individualized approach rather than a one-size-fits-all model.

In our clinical work, we have observed that many individuals seeking treatment for Obsessive-Compulsive Disorder (OCD) also experience other forms of neurodivergence, including Autism. Research supports this overlap. A systematic review found that approximately 1 in 8 individuals with autism also experience OCD (Aymerich et al., 2024).

Despite this connection, awareness remains limited. Many individuals and families may not recognize when OCD and autism occur together.

Many families come to us feeling unsure whether certain behaviors are related to autism, OCD, or both. With careful assessment and individualized treatment, it is possible to better understand these experiences and provide effective support.

Why Accurate Understanding Matters

OCD and autism can sometimes look similar on the surface because both may involve repetitive behaviors or routines. However, the reasons behind these behaviors are often very different.

Some families are told that certain behaviors are simply part of autism, when in reality OCD may also be present and contributing to someone's distress. When OCD is recognized and treated appropriately, individuals experience meaningful relief and improvement in daily functioning.

Is It OCD, Autism, or Both?

Although the behaviors may look similar, the motivation behind them is often different.

A careful evaluation can help determine whether behaviors are related to autism, OCD, or both.

Signs OCD May Be Present in Someone with Autism

OCD symptoms can sometimes be difficult to distinguish from autistic traits. However, certain signs may suggest OCD is also present.

These may include:

• •Intense distress when rituals cannot be completed
• •Repetitive checking, cleaning, or reassurance seeking
• •Intrusive thoughts that feel unwanted or upsetting
• •Strong fear of making mistakes or causing harm
• •Difficulty tolerating uncertainty

Common OCD Themes in Autistic Individuals

While OCD symptoms can vary, certain themes may appear more frequently in autistic individuals.

• •Fear of Making Mistakes
• •Contamination Concerns
• •Harm or Responsibility Fears
• •"Just Right" Feelings
• •Intolerance of Uncertainty
• •Scrupulosity

Undiagnosed Autism in Children and Adolescents

Research suggests that many young people with autism may not receive a diagnosis until later in childhood or adolescence.

Research from Rutgers University indicates that approximately 25% of 16-year-olds with autism have not yet received a formal diagnosis.

National data also show that for every 10 children diagnosed by age four, there may be one additional child suspected of autism but still waiting for evaluation.

Undiagnosed Autism in Adults

Undiagnosed autism is common among adults who grew up before modern diagnostic criteria and awareness became widespread.

Estimates suggest that 89-90% of autistic adults between ages 40-59 and up to 97% of adults over age 60 may remain undiagnosed. Many individuals first recognize autistic traits in themselves after their child receives an autism diagnosis.

Some autistic adults may initially be misdiagnosed with conditions such as anxiety disorders before receiving a more accurate understanding of their experiences.

Why OCD Treatment May Need to Be Adapted

Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD. However, autistic individuals may benefit from adaptations that account for differences in communication style, sensory sensitivities, and learning preferences.

Therapy may include:

• •Predictable and structured sessions
• •Visual supports or written exposure plans
• •Clear explanations of treatment goals
• •Flexible pacing during exposure exercises
• •Attention to sensory sensitivities

These adaptations help ensure treatment is both effective and supportive of neurodivergent needs.

What Treatment May Look Like

Treatment at Mindset Family Therapy is individualized, process-focused, and informed by each client's unique profile.

When OCD occurs alongside autism, treatment may take longer than typical OCD treatment in order to move at a pace that supports learning and confidence.

Treating OCD in autistic children often requires adapting therapy to the child's communication style, sensory needs, and developmental level.

For children on the autism spectrum, therapy may include:

• •Visual supports
• •Structured routines
• •Gradual exposure exercises
• •Parent involvement

Over time, therapy can help individuals learn how to respond to anxiety differently and improve daily functioning.

Treatment Approaches

Evidence-based treatment for OCD typically includes:

• •Exposure and Response Prevention (ERP)
• •Medication, when appropriate
• •A combination of therapy and medication
• •Acceptance and Commitment Therapy (ACT)
• •Inference-Based Cognitive Behavioral Therapy (I-CBT)

More information about evidence-based OCD treatment can be found through the International OCD Foundation.

At Mindset Family Therapy, we are trained in ERP, ACT, and I-CBT and may incorporate additional strategies to support each client's success.

Factors We Consider During Treatment

During treatment, therapists pay attention to factors that may affect progress, including:

• •Intolerance of uncertainty
• •Difficulty identifying emotions
• •Emotional regulation challenges
• •Sleep difficulties
• •Stress or burnout
• •Resilience and coping resources

Therapy may include strategies to strengthen coping skills, build resilience, support wellbeing, and help prevent relapse.

The Role of Loved Ones in Treatment

Family members can play an important role in supporting treatment. Research shows that family members sometimes unintentionally reinforce OCD behaviors through family accommodation, such as participating in rituals or providing reassurance.

Studies show family involvement can help:

• •Reduce family accommodation (Lebowitz et al., 2013)
• •Support therapy skills at home (Thompson-Hollands et al., 2015)
• •Improve treatment adherence and functioning (Van Noppen & Steketee, 2009)

How Families Can Support Someone with OCD

Helpful ways to support a loved one include:

• •Learning about OCD
• •Reducing reassurance and ritual participation
• •Encouraging use of therapy skills outside sessions
• •Offering patience and encouragement
• •Collaborating with the therapist when appropriate

Download The OCD Family Toolkit

Why Early OCD Treatment Matters

OCD symptoms can strengthen over time when compulsions and avoidance behaviors reinforce anxiety.

Evidence-based treatments such as ERP and ACT can help individuals choose to do what matters most to them, reduce compulsions, and improve daily functioning.

When OCD occurs alongside autism, thoughtful adaptations can help ensure treatment is both effective and supportive.

You Are Not Alone

Many individuals and families feel confused or overwhelmed when trying to understand behaviors related to OCD, autism, or both.

If this experience feels familiar, you are not alone. Many families find that once these challenges are better understood, effective treatment can significantly help their loved one with skills to improve daily functioning.

References

Aymerich, C., et al. (2024). Prevalence and correlates of the concurrence of autism spectrum disorder and obsessive-compulsive disorder in children and adolescents. Brain Sciences.

Lebowitz, E. R., Panza, K. E., & Bloch, M. H. (2013). Family accommodation in obsessive-compulsive disorder. Expert Review of Neurotherapeutics.

Thompson-Hollands, J., Abramovitch, A., Tompson, M. C., & Barlow, D. H. (2015). A randomized clinical trial of a brief family intervention to reduce accommodation in OCD. Behavior Therapy.

Van Noppen, B., & Steketee, G. (2009). Testing a conceptual model of patient and family predictors of OCD symptoms. Behaviour Research and Therapy.