Children and adolescents with autism are significantly more likely to experience obsessive-compulsive disorder (OCD) than the general population, according to new research and clinical observations. Although OCD affects an estimated 2% of people studies indicate that 10% or more of individuals with autism also have OCD. This connection highlights the need for increased awareness and tailored treatment approaches for this vulnerable population.
Clinicians are reporting even higher rates of co-occurring OCD in young people with autism. “Based on clinical experience, for example from our specialist OCD clinic, the proportion in child and adolescent psychiatry may be as high as 20%,” says Helene Ringberg, a psychologist and doctoral student at Karolinska Institutet in Stockholm.
Shared Characteristics
OCD is characterized by intrusive, anxiety-provoking thoughts—obsessions—and repetitive behaviors—compulsions—performed to try to relieve that anxiety. Common compulsions include excessive handwashing or repeatedly checking things like whether a stove is turned off. These compulsions can lead to anxiety and depression, and often consume so much time and energy that they interfere with daily life, including school, perform, social activities, and hobbies.
The exact reasons why autism and OCD frequently occur together are not fully understood, but both conditions share common features. Ringberg points to rule-governed thinking as one such similarity. The repetitive behaviors and need for routine often seen in autism can resemble compulsive actions—and may potentially develop into full-blown OCD.
“There are many hypotheses, and research suggests there may be a common genetic basis, but we don’t know why both children and adults with autism are at higher risk of developing OCD—only that they are,” Ringberg explains.
Limited Research on Effective Treatments
Currently, there is limited research on which treatments are most effective for individuals with both autism and OCD. To address this gap, Ringberg and her colleagues are now evaluating two different treatments using internet-based cognitive behavioral therapy (CBT) for children between the ages of seven and 17 who have both conditions.
“There’s a perception in some places that it’s impossible to treat OCD if the patient has autism, partly due to the overlap and the difficulty in determining what is what. This is likely not due to an attitudinal issue within healthcare, but rather to the fact that there hasn’t been enough research and knowledge produced about autism-adapted treatments,” she says.
The Key: Autism-Specific Adaptations
The study will randomly assign participants to one of two online treatments, both three months long and based on cognitive behavioral therapy. Both the child and caregiver will participate and receive regular guidance from a therapist.
Ringberg cannot detail the specific content of the treatments due to the study’s randomized, controlled design, but she says the autism adaptations may include everything from support with emotional regulation to presenting information in different ways, such as visually. She also emphasizes that when treating OCD in individuals with autism, it’s particularly important to consider the child’s overall life situation, such as reviewing daily routines.
“It’s often a bit more challenging, takes longer, and requires different forms of adaptation, but we know clinically that it’s possible to treat OCD if the patient also has autism, and we hope to prove that in our study,” she says, adding: “One reason there’s a lack of evidence for treatments for both autism and OCD is that people with autism are often excluded from treatment studies. CBT via the internet has proven effective for children and young people with OCD alone, and we’ve now taken the step to investigate how it works for patients who also have autism.”
Less Common Use of CBT
Another reason for the study is that previous research indicates a higher use of psychotropic medications, such as SSRI antidepressants, within the group with both OCD and autism—which may be a consequence of the knowledge gap.
“Previous studies show that children with both autism and OCD are more often prescribed medication for their symptoms compared to children with OCD alone. Medication is certainly not wrong, and SSRIs have good evidence for OCD, preferably in combination with CBT. What we aim for to do is increase the availability of CBT in the care of OCD in autistic children,” Ringberg explains.
Recruiting Participants Nationwide
The study aims to recruit over 200 participants from across the country and is expected to enroll participants throughout 2026 and 2027. The decision to study CBT in an internet-delivered format was deliberate, Ringberg says. It’s likely to be a good fit for many individuals with autism, and an online-based treatment could potentially reach more patients in the long run.
“My impression is that there’s a lot of variation between regions in access to specialist care for OCD, especially when autism is also present. Not all regions have the resources to provide such treatment in person, but if it’s delivered online, there’s a good chance that regions can implement it and thus increase access to evidence-based care for this group.”
