How do we interpret obsession in children with autism?.”

The term “obsession” is used to describe a behavioral pattern, such as sticking to a particular path or having to have a specific item. Unfortunately, it can lead parents and therapists to take a very misguided approach to get rid of this pattern as soon as possible because it looks different.

What is OCD in the dictionary? It’s a form of depression and anxiety, a form of mental illness in which a person wants to stop having specific thoughts, but can’t stop having them, so they keep repeating them repeatedly. The biggest thing about OCD is that it’s a vicious cycle in which the person tries to eliminate their anxiety through compulsive behaviors. They get rid of their stress at the moment, but their obsessive tendencies get stronger.

The repetitive behaviors seen in children with autism spectrum disorder are slightly different.  It’s very similar in that they’re stubborn and repeat specific patterns, but I’ve never seen some of these patterns that we talk about as obsessive-compulsive behaviors last for a long, long, long time. They almost fade away over time. 

Two patterns of behavior are often mistaken for OCD.

The first is “Resistance to Change.” For example, only going down a particular path, doing things in a specific order, or acting in a certain pattern. These behaviors are driven by comfort. There are no variables when we follow a set routine, so we react according to what we have already prepared and feel comfortable repeating it. However, when faced with a new path or a new choice, our sensory system has to undergo an agitated process of preparing a response, comparing and analyzing information, and making a choice. For a child with autism, whose sensory response system is challenged, the choices that make these changes feel difficult. So instead, they’d make life easier for themselves by repeating patterned routines.  This patterned behavior in mild autism never lasts long.  As they repeat the pattern, they gradually modify the experience of the way, and then they introduce another pattern.  And then they introduce one another pattern, and then another pattern, and then another pattern; by doing this, they can eventually operate in a diversified way to make choices.  We don’t have to try to correct this pattern. Still, it needs to be supported in a way that prepares and helps children make change less painful by diversifying and differentiating their approach to change. Hence, they are comfortable with it themselves.

Secondly, behaviors often mistaken for compulsions express a preoccupation or attachment with a particular object, such as holding a specific thing in one’s hand or insisting on wearing only certain clothes. The purpose of pursuing these obsessive behaviors is to gain psychological comfort through the use of familiar sensory organs. For example, typical children grow up with stuffed animals and feel comfortable with them, and this is not so different from the obsessive behavior of children with autism.

The only difference is that it’s more intense and lasts longer. Just as typical children would naturally let go of a clingy doll as they move on to other behaviors and objects that are more fun and that they are more attached to, children with autism never have prolonged periods of clingy behavior. So, instead of trying to change or eliminate this clingy or over-attachment behavior, we must help children with autism find relief by expanding their play to other things that are much more fun.

There is no such thing as obsessive-compulsive behavior in children with autism. It’s just a resistant and preoccupied attachment behavior repeated over a very long period. Therefore, it is crucial to help them transition to a range of pretty natural behaviors while understanding that they may inevitably go through a process that looks “Obsessive,” which is quite natural and part of the developmental process.

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