Autismand obsessive-compulsive disorder (OCD) share notable similarities in repetitive behaviors, presenting challenges for differential diagnosis and treatment planning. Both conditions can involve various types of repetitive behaviors, including:
These behaviors can vary in intensity and presentation between individuals and across the lifespan. Additionally,autism and OCDoften co-occur, with over 17% of autistic individuals also meeting criteria for OCD, further complicating the clinical picture.
Key Points
Rationale
This systematic review aimed to examine similarities and differences in repetitive behaviors between autistic individuals and those with obsessive-compulsive disorder (OCD).
The rationale for this study stems from the diagnostic overlap and high co-occurrence rates between autism and OCD, as well as the phenotypic similarities in repetitive behaviors observed in both conditions (van Steensel et al., 2011).
Previous research has highlighted challenges in differentiating between repetitive behaviors attributable to autism versus those related to OCD, which can impact accurate diagnosis and appropriate treatment planning (Paula-Pérez, 2013; Jiujias et al., 2017).
While previous narrative reviews have begun to explore this topic (Paula-Pérez, 2013; Jiujias et al., 2017), a systematic approach was needed to provide a comprehensive and up-to-date synthesis of the quantitative literature.
Method
The study followed the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines.
A systematic search was conducted across five electronic databases: Science Direct, PsycINFO, Web of Science, Scopus, and CINAHL.
Search strategy and terms
The initial search was conducted on August 18, 2022, with an updated search on June 30, 2023.
Inclusion and exclusion criteria
Inclusion criteria were:
Exclusion criteria included non-human research, participants without formal diagnoses, single clinical population studies, and qualitative studies.
Statistical measures
The review employed both quantitative and narrative synthesis of the data. Categories of behavior were determined based on the measures used to assess repetitive behaviors across studies.
Results
Expression of Repetitive Behaviors:
Content of Repetitive Behaviors:
Factors Associated with Repetitive Behaviors:
Insight
This systematic review provides a comprehensive analysis of the current literature on repetitive behaviors in autism and OCD, highlighting the considerable overlap in behavioral presentations between these conditions.
The findings suggest that while some distinctions can be made at a group level, particularly in terms of overall obsessive-compulsive symptom severity, differentiating between autism and OCD based solely on the expression or content of repetitive behaviors remains challenging.
However, the mixed and often limited findings in these areas underscore the need for further research to better understand the underlying mechanisms driving repetitive behaviors in each condition.
A key insight from this review is the importance of considering the function and experience of repetitive behaviors, rather than just their outward expression, for accurate differential diagnosis and treatment planning.
Future research directions could include:
Strengths
The study had several methodological strengths:
Limitations
This study also had several methodological limitations, including:
These limitations impact the generalizability of the findings and highlight the need for more diverse and inclusive research in this area.
Implications
The findings of this review have significant implications for clinical practice and research:
References
Primary reference
O’Loghlen, J., McKenzie, M., Lang, C., & Paynter, J. (2024). Repetitive behaviors in autism and obsessive-compulsive disorder: A systematic review.Journal of Autism and Developmental Disorders.Advance online publication.https://doi.org/10.1007/s10803-024-06357-8
Other references
Jiujias, M., Kelley, E., & Hall, L. (2017). Restricted, repetitive behaviors in autism spectrum disorder and obsessive–compulsive disorder: A comparative review.Child Psychiatry and Human Development, 48(6), 944–959.https://doi.org/10.1007/s10578-017-0717-0
Paula-Pérez, I. (2013). Differential diagnosis between obsessive compulsive disorder and restrictive and repetitive behavioural patterns, activities and interests in autism spectrum disorders.Revista De Psiquiatría Y Salud Mental (English Edition), 6(4), 178–186.https://doi.org/10.1016/j.rpsmen.2012.07.006
van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis.Clinical Child and Family Psychology Review, 14(3), 302–317.https://doi.org/10.1007/s10567-011-0097-0
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
