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651 Final
Brent MacDonald
Amanda Medland
December 4, 2013

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Section 1: Substance Use and Underlying Disorders

1) Gaining further insight into substance use disorders as well as the underlying disorders
that often accompany substance abuse, such as depression, anxiety or other behavioral
disorders was particularly interesting to me this semester. Having a brief and vague
understanding of this prior to participating in the lecture on substance use disorders, I
thought I had a basic concept of these intermingling disorders. During my under graduate
studies I had the opportunity to participate in a practicum in a concurrent disorders
inpatient program, albeit for adults. Throughout the program, many people graduated,
many people relapsed, and one man overdosed and died within days of graduating the
program. This was difficult for me because I felt as if I did not understand why a person
would ruin their relationships, their careers and essentially their lives as a result of
substance use. Not experiencing any overly addictive traits myself, this was difficult
for me to understand. There were successful graduates who made the changes and were
able to participate in sobriety, providing role models for those in treatment, but the
recovery rate within several years of graduating was still less than 35%. Because I did not
understand why so any people were unable to maintain sobriety, I saw the difference
between those who relapsed and those who didnt as a choice, which for many they were
not willing to make. As a result of the learning within this course I have begun to look
more into the reasoning behind the low rates of successful recovery outside of the
concept of the individuals lack of willingness to succeed.
2) Substance use develops into substance abuse and dependence disorders when use
continues over a period of 12 months and is typically linked with numerous harmful or
negative consequences as a result of the repeated substance use. For example, several red

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flags indicating potential substance use disorders may include impact on obligations,
engaging in hazardous activities, increased tolerance and continued use despite being
aware of negative effects (American Psychiatric Association, 2013). Within adolescence,
drug and alcohol experimentation is relatively common, although trends do show both a
general decrease in adolescent use and an increase in knowledge of risk of use over the
past 20 years. As per the Monitoring the Future statistics in the United States, 23% of
12th-graders had used marijuana within the past month and 42% had used alcohol in 2012
(Monitoring the Future, 2013). This supports the fact that adolescent use is common to an
extent, although alcohol and drug use before the age of 14 and 15 respectively have been
highlighted as predictors of later dependency or abuse (Barkley & Mash, 2003).
When investigating substance use disorders, several comorbid disorders can
frequently be identified. Many teens experiencing substance abuse or dependence also
have been diagnosed or meet the diagnosis for attention deficit hyperactivity disorder
(ADHD), depression or oppositional defiant disorder (ODD). Substance use is also
mentioned as co-occurring with anxiety disorders, bipolar disorder, eating disorders, and
Post Traumatic Stress Disorder (PTSD). In addition, children whose parents have past
history of drug or alcohol abuse or dependence show an increased risk for substance use
and potential abuse than do peers without such a family history. These precursors can
influence an individual in progressing from moderate usage to levels that may qualify for
a substance use disorder. Particularly if an individual does not have the skills to deal with
life stressors or maintain stability in mental health problems, using substances can create
temporary relief and can be engaged as a coping strategy, although an ineffective one.
Once identified as having a substance use disorder, looking into recovery can

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become a difficult topic in regards to substance use disorders as slips and relapses can
and do occur. It is improbable to think that adolescents experiencing substance use
disorders will be capable of recovery unless underlying stressors and factors are
addressed. Within treatment centers, a personalized individualistic approach is often used,
acknowledging that each patient is unique and has a complex magnitude of factors that
lead to the substance use. Similarly, if presented with a client through counseling or
psychological services, this same approach should be taken in order to increase likelihood
of success. The concept of slips and temporary relapses is common within addictions
treatment as it is a reality for many who attempt sobriety. A slip does not have to be seen
as a failure, but rather a temporary step back that can be improved upon and learned
from. Engaging in the idea that individuals will be able to stop using and never be
tempted again is unrealistic.
3) Several areas of interest potentially sit within the diagnoses of substance abuse. The
first area of interest looks at a common term used for individuals who engage in
excessive drinking but are able to continue to actively participate within life is a
functional alcoholic. Interpreting where this falls under the Diagnostic and Statistical
Manual of Mental Disorders (DSM) criteria can create potential challenges. A significant
indicator that use has escalated to abuse or dependence is when persons social,
occupational or recreational life is impacted. Denial within these functioning alcoholic
individuals may create a large hurdle as they continue to drink but cannot see the impact
on their lives to an extent that could be deemed problematic. A functional alcoholic may
require increased levels of alcohol to experience the same effects, but may infrequently
experience hang overs, appears capable within his or her work, and typically can control

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the time intended for use so that it doesnt affect their professional life.
In regards to adolescents, it is common that alcohol and drug experimentation
exists within high schools and most schools have a group of teenagers labeled potheads
or druggies. Despite meeting criteria for substance abuse, does the severity for some
fluctuate as a result of social experimentation? If the substance abuse is merely a part of
teenage rebellion or experimentation and is capable of diminishing with time without any
external help, is this still a risk factor for future drug and alcohol use disorders? My
thoughts question whether the DSM criteria for substance dependence or abuse
adequately depict those who are able to participate in typical lives in addition to meeting
the criteria for substance dependence.
Next, I would like to look at the concept of adolescents adhering to the same
DSM criteria as adults. Barkley & Mash (2003) identify that alcohol dependent teens
present differently than adults with their symptoms, experiencing blackouts and engaging
in risky sexual behaviour as opposed to experiencing withdrawal and medical
complications. It is important to consider as well, the presentation of substance abuse and
dependence symptoms differ between males and females both through adolescents and
adulthood. It appears the differences in adult and adolescent symptomology may not be
accurately accounted for by utilizing the same diagnostic criteria for both age groups. In
addition, as a teenager, expectations and responsibilities are increasing but typically are
only a fraction of those which adults experience. What is the likelihood that adolescents
are able to more effectively mask their substance use or down play it as mild
experimentation rather than a substance abuse disorder? What if there is no social,
occupational, or recreational activities given up, if social and occupational (school)

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activities continue while intoxicated or under the influence. Granted academic

performance would undoubtedly decrease for most using individuals, but concerns arise
with using the same criteria for children and adults to effectively encapsulate all forms of
substance use disorders.
Lastly, I would like to address the concept of potentially effective selfmedication. Personally I have met one adult who smokes marijuana to address his
ADHD, and one who uses 3,4-methylenedioxymethamphetamine (MDMA) for social
anxiety. Not delving too deeply into how this affects their lives, both appear to be
productive, and relatively typically functioning adults. Both have in the past participated
in psychiatrist assigned regimes of prescription drugs in attempts to address their
symptoms, and both claim that their self-medicated regimes were the most effective when
compared to legal pharmacological alternatives. Despite having undetermined medical
consequences as a result of use, due to the lack of additional apparent negative
consequences how do we classify these individuals if they are effectively selfmedicating? Would these people fall into the same category as a functional alcoholic? Or
would there be a different classification for those who appear relatively capable of selfmedicating with illegal substances? Legal pharmacological intervention would not be
considered a substance use disorder as the medication is used to correct mental health
symptoms. Is it fair to say effective self-medication would classify as a substance use
disorder based solely on the fact that their medication is deemed illegal rather than
professionally prescribed?
4. It is common knowledge within the human services and medical fields that teenagers
and adults frequently self medicate the symptoms of the before mentioned mental

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illnesses. Knowing this fact was different than understanding this. As mentioned above, I
saw continued substance use as a choice. I believed that individuals chose to use or chose
to engage in sobriety and that it was as black and white as that. Through this course, my
viewpoint on this has changed. I understand that sobriety is a choice, but when looking at
all of the underlying disorders, it often times is not as simple as just choosing to become
sober. As Ranjenes story illustrated, when she was using there was little insight into how
detrimental the substance use was, and how it affected her life as she claimed that it
became part of her identity (Mazumdar, 2009). Much like other individuals who struggle
with substance use and abuse, I have learned that the use of drugs and alcohol serves a
purpose for them. Whether it is to mask or lessen unpleasant symptoms, to temporarily
increase self-esteem or as Ranjene stated there was no other option at that time
(Mazumdar, 2009). I have also come to learn that even though an individual understands
they are abusing and may truly want to change, realizing this is a frightening experience.
Wanting to change is a start, but many obstacles lay in these individuals way, such as
being required to learn an entirely different mindset and coping strategies for life, and
learning how to resist urges.
Working with adult individuals who struggle with drug and alcohol addictions
that have had their children apprehended as a result, I try to keep an open mind and
reduce the judgment I once felt. Even though many of these parents have shown an
interest in reaching sobriety for their children, I am now very aware of how big of a role
that heredity plays for the children of these adults. As shared in the lecture, despite
having little to no past experience of exposure of trusted adults using, it is common that
the predisposition to use is inherited by children (Chiu & Mitchell-Pellett, 2013). This

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idea takes even more credibility away from my preconceived notion of the individuals
choice to use or not use, as many children have to battle against genetics in addition to
any other stressors that may encourage using drugs and alcohol as a coping strategy.
It is also important to understand that tact must be taken when addressing
parents of the adolescents who are using. As heredity plays a factor into likelihood of use
and abuse, it is possible that parents have a history, which may or may not be under
control. Maintaining a non-biased approach is crucial, not only when working with the
adolescents but also with their parents. Typically as children grow into adolescence and
closer to adulthood, parental roles serve to foster independence and guidance into
creating a functional adult life. This means that choices these adolescents make are often
outside of parental control, regardless of the parents view of alcohol and drug use.
Engagement in this course has allowed me to consider other factors outside of
the alcohol and drug use, such as underlying illnesses or stressors and biological factors.
Many of these concepts were all things I knew but I feel now that I didnt previously
understand. I believe that I have a greater understanding about substance use disorder but
I know that I will have to continue to learn and try to create a better understanding as I
progress through my professional life. I also know that deep down that I may never
completely understand unless I happen to find myself in the same situation.
5) In order to continue to professionally improve myself, and to continue to reduce any
preconceived judgments around substance use disorders it is critical that I continue to
seek out education around this topic, particularly if I find myself working with
individuals experiencing substance use disorders. At a very basic level, I could ensure

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that I attend any seminars offered by Calgary Educational Services in regards to

substance use in children and adolescents. Although none are offered presently, it is a
topic that has been covered in the past, and would give a short brief insight into the latest
research and information.
The next step that could be taken would be to research additional scholarly
articles to delve deeper into the role of substance use within particular mental disorders.
Any information gained within this course does not begin to penetrate into the mass
amounts of research in regards to this. As I typically do not work with individuals who
are experiencing substance use disorders, professional plans to effectively conceptualize
substance use disorders can be pursued over the next several years along with other areas
of interest that may arise. That said, acknowledging that this is an area of weakness for
me creates an ethical responsibility to pursue further professional development.
Thirdly, creating contact with recovery centers such as Alberta Alcohol and
Drug Abuse Commission (AADAC) Youth Services, Alberta Adolescent Recover Centre,
Community Health Region Addiction Centre Foothills, and Addiction services through
Woods Homes would be of benefit. Gaining knowledge and awareness of specific
services, understanding where teenagers can go for support groups, or outpatient
treatment would be crucial if I find my future leads me towards working with individuals
who are experiencing substance use disorders.
Lastly, I also am aware that if presented with a case of substance use, that I will
need to spend time and effort ensuring that I rationally detach from the situation. This
will be something that will become easier over time I believe, but as an eager new

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professional I still find myself having the utmost hopes for success in clients. This trait
can be a positive one, but has the potential to result in personal disappointment if goals
arent met. If presented with a client struggling with substance use, it will be important to
make sure to make extended efforts to separate work from other areas of my life. As
experienced before within my practicum where a graduate overdosed within days of
discharge, I had great hopes of success for this man. He was very convincingly dedicated
to his sobriety, so I had no reason to believe that things would end so badly. This affected
me more than it should have because I had no doubts that he would be successful.
Rationally detaching from work is a part of myself that I will need to continue to work on
regardless if I work with substance users, behaviorally disordered clients or
developmentally disabled individuals.
6) As a result, I now know that when addressing individuals with a substance use
disorder, it is just as important to work with any underlying disorders or mental illnesses
that may be impacting the substance use. This means that when I am presented with a
child who experiences substance use or abuse, there will need to be attention paid to the
function of the substance use. Applying Ross Greenes concept of lagging skills could
very easily be adapted to working with children who experience substance use disorders
(Green, 2010). If one was to replace explosive behaviours with substance use, addressing
the lagging skills can create an alternative to engaging in unproductive behaviours
(Green, 2010). Lagging skills in this case may be unstable mental health, lack of coping
abilities, feelings of inadequacy, and many more, but without addressing the underlying
concerns, there is little reason to believe that a person will stop engaging in their
behaviours of substance use. Having a more in depth understanding of substance use

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creates the ability to analyze an individual with a less biased approach than when seeing
substance use strictly as a choice.
Deep down, I know that this area is one that is difficult for me to understand and a
small part of me still wonders how a person can let alcohol and drugs take over their
lives. For this reason, I believe the concept that counselors of substance use and abuse are
best fitted if they themselves have overcome an addiction, because they have a greater
ability to understand how much of a struggle the concept of sobriety may be. I believe
that these counselors would be of greatest importance to collaborate with when I am
presented with a child experiencing substance abuse. As a result of this class, one
professional contact that fits these criteria has been made, and as professional contacts
grow, the potential to develop additional contacts would be a helpful and valuable
resource.

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References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: APA.
Barkley, R. A. & Mash, E. J. (2003). Child psychopathology (2nd ed.). New York:
Guilford Press.
Greene, R. W. (2010). The explosive child. New York: HarperCollins Publishers.
Mazumdar, R. (Producer). (2009). Ranjenes story: from darkness to light. Available from
http://www.youtube.com/watch?v=HETivtrJqcQ
Monitoring the Future. (2013). Institute for Social Research. Retrieved from:
http://www.monitoringthefuture.org/data/12data.html#2012data-drugs
Chiu, K., & Mitchell-Pellett, M. (November 6, 2013). Adolescent substance use
disorders. Disorders of Learning and Behaviour. Lecture conducted from Calgary,
AB.

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Section 2: Autism Spectrum Disorder and Obsessive Compulsive Disorder

Working with individuals who have been diagnosed on the autism spectrum,
one of the most prominent atypical behaviours presents in the form of rigidities or
repetitive behaviours. Particular repetitive behaviours such as hand flapping are common
within those with autism, and are not of much interest to me. Of higher concern were the
similarities of more generic repetitive behaviours such as touching objects, lining things
up or repetitive sayings or words. These I felt could in some children be easily explained
by identifying obsessions and compulsions. As well, in reverse, the potential for children
who have been identified as having obsessive and compulsive tendencies to be diagnosed
within the autism spectrum may be a more effective categorization. My curiosity was
peaked in regards to similarities, differences and diagnostic considerations when looking
at these disorders both separately and the potential for both to exist within one individual.

Identification of the Areas

Autism Spectrum Disorder (ASD) is a diagnosis that is becoming more frequent

over the years, affecting approximately 1% of the population (APA, 2013) A
developmental disorder, typically autism is identified in children around two years of age
and is based on the absence or delay in developmental milestones. These delays and
deficits persist across social communication and interactions as well as displaying
restricted or repetitive behaviours. Despite being identified after the first several years of
life, symptoms can be present within early development, and parents can often look back
and see atypical behaviours in their children that could be categorized as autism
symptoms before the diagnosis. For children who display less severe symptoms,

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identification may not occur until later when they are not able to adapt to demands. As a
result of the social and language deficits and the repetitive or restricted behaviours, the
childs everyday life is affected or limited by autism. These effects vary, as does the
severity within the autism spectrum, ranging from utter impairment paired with severe
cognitive delay, to average or above average cognition with minor social deficits and
ridged or repetitive behaviors. It is not uncommon to see individuals with autism display
motor deficits and exhibit disruptive behaviours and self-injury. Although it is possible
that adults may progress through life without a diagnosis for many years, the
symptomology must date back to early years. For example, Judy Endow, MSW, author,
and mother of three boys, received a diagnosis of ASD on the same day her son received
his, but her symptoms had been misdiagnosed in earlier years (Endow, 2013). Autism is a
lifelong disorder, although as children grow they show developmental gains. However
deficits can still typically be seen in these individuals despite intervention or
compensatory strategies.

Obsessive Compulsive Disorder (OCD), on the other hand, can be described

more as a mental illness. One can be identified as having OCD if they engage in
obsessions or compulsions, which are time consuming and cause impairment within their
every day lives. It is important that these symptoms are not a result of any identifiable
medication or adverse reactions to drugs or medication. Frequency and severity can vary,
with OCD symptoms occupying only short intervals of time to occurring almost
constantly and impacting every action taken. Although obsessions and compulsions are
unique to each individual, common patterns are seen, such as emphasis on hygiene,
creating symmetry and restricting forbidden thoughts. It is common for individuals with

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OCD to have dysfunctional beliefs and insight into these can range from good insight to
poor and to absent insight. A child may have good insight, and know that the likelihood
of their parents being murdered while they are at school is low, as well as identify that if
they fail to engage in their compulsions that this will have little to no effect on that
likelihood. On the opposite end, a child may have no awareness that their parents being
murdered is not directly linked to the compulsions, and feel that the lives of their family
lies on successful completion of the compulsions. OCD occurs is roughly 1% of the
population, with increased rates of males affected during childhood (APA, 2013).
Although the average onset of OCD is seen in early adulthood, approximately one quarter
of cases start in the teenage years, and the earlier onset can result in OCD that persists
throughout the childs lifetime. If left unaddressed, obsessions and compulsions will
typically result in a chronic lifelong debilitation, but with treatment many can find
remission where symptoms can subside or lessen allowing the individual to return to
more typical levels of functioning.

Critical Issues for ASD

Social Functioning. Symptoms of autism are often noticed before a general global
concern for development. Parents may report oddness in their childs play routines, or
interactions with others. Children who have later been diagnosed may not engage in eye
contact as infants, may have little interest in engaging with adults outside of basic needs,
and typically have difficulty with the concept of joint attention with another individual.
Typically developing children tend to share attention through eye shifting around six to
nine months, and then through using gestures around nine to twelve months, while

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children with autism may show impairments in both of these areas.

Language. Language is a second indicator that children may fit the diagnostic criteria for
Autism. Most children are starting to develop basic verbal skills such as babbling, word
approximations and short one-syllable words between the ages of six months to a year.
Between the first and second year, most typically developing children should be able to
speak several short word sentences. For children with autism, commonly seen is a lack of
engagement in verbal skills for communication. For those who do develop language, a
frequent symptom experienced is echolalia, or engagement in repetitive speech after is
considered developmentally typical. Also problematic is the inability to engage in a
functionally reciprocal conversation, as focused interests and misunderstanding of social
cues can hinder a fluent conversation.

Stereotypic behaviour. The last and most important topic for the intent of this paper is the
distinguishing factor for ASD of stereotypic behaviours. Commonly seen in youth and
adults with ASD is a range of abnormal behaviours, which can consist of motor
movements, or higher-level behaviours such as focused interests or adherence to routines.
Repetitive motor movements can be seen more frequently in younger children, while
higher-level behaviours are typically seen in individuals who are affected less cognitively.
Although stereotyped, restricted or repetitive behaviours are essential for diagnostic
criteria of ASD to be met, little research has been done delving deeper into the
uniqueness of stereotypic behaviours in autism.

Critical Issues for OCD

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Obsessions. Obsessions consist of unwanted thoughts, urges or images that are persistent
and typically cause some sort of distress to the individuals experiencing them. As a result
of these recurrent thoughts, typically the affected individual tries to relieve the thoughts
by whatever means possible, often by engaging in another thought or behaviour in order
to overpower the negative thought. This results many times in performance of a
compulsion.

Compulsions. Compulsions are acts that are completed in order to relieve some of the
negative feelings associated with the obsessive thoughts noted above. These behaviours
are typically not related to the thought in a realistic way that would change the outcome
of the thought. For example, reciting a poem and having it feel right has no impact on the
well being of a family member. Despite the lack of connection between the compulsion
and the obsession, accurate completion of the compulsions must occur in hopes to
neutralize the obsessions, even if temporarily. These compulsions can be seen in the
forms of repetitive behaviours or mental acts such as counting or repeating words. For
many, not engaging in the compulsions is near impossible as their belief, even if they are
aware of its absurdity, is that the obsessions are directly impacted by the compulsions.

Critical Comparison of ASD and OCD.

The co-occurrence of child and adolescent OCD in children with ASD is

relatively common, occurring at approximately 37%. (Lewin, Wood, Gunderson, Murphy,
& Storch, 2011). One area of interest between ASD and OCD lies within repetitive
behaviours, which in general refers to a behaviour that is engaged in often that appear as
inappropriate, strange, or impractical. Within ASD these behaviours are frequently

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referred to as stereotypic behaviours or sometimes as self-stimulation. For individuals

with OCD these repetitive behaviours are referred to as compulsions. As both of these
behaviours fall under the umbrella term of repetitive behaviours, research into if and
where an overlap falls between these and how it affects the individuals diagnosis and
outcome is needed.

General Comparison. The concept of repetitive behaviours is not specific to ASD as it

occurs in other disorders including OCD as well as other disorders. Although repetitive
behaviours occur across both diagnoses, some differences can be seen in their
presentation.
Within individuals with ASD, the repetitive behaviours can frequently be
observed in elevated frequency and patterns of occurrence when compared to typically
developing children. Repetitive behaviours seen in children with ASD include resistance
to change, desire for sameness, repetitive motor movements and a narrow range of
interest (Zandt, Prior, & Kyrios, 2007). For example, these can be seen in the form of
lining up objects, experiencing distress or behaviours when a favorite toy has been
moved, or moving their bodies back and forth. When compared to behaviours of OCD
individuals, the repetitive behaviours of ASD tend to be less complex and less elaborate
(Lewin, et al., 2011). In several studies, specific repetitive behaviours such as hoarding,
touching, tapping, rubbing, ordering, creating symmetry or self abuse can be seen at
increased rates with individuals with ASD and mental retardation when compared
individuals with OCD (Berjerot, 2001; Lewin et al., 2011). To an untrained eye,
confusion can occur, as behaviours such as touching, tapping, and ordering are generally

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classic symptoms of OCD.

In the case of individuals with OCD, repetitive behaviours occur in approximately
one third, and of these children repetitive behaviours most frequently consist of rituals
and routines (Zandt, Prior, & Kyrios, 2007). Symptoms of repetitive behaviours in
individuals with OCD typically occur as obsessions and checking, symmetry, cleanliness
and hoarding (Berjerot, 2007). As mentioned prior, youth with OCD reported more
sophisticated obsessions and compulsions when compared to not only youth with ASD,
but as well with co-occurring ASD and OCD (Lewin et al., 2011). In addition, youth who
experienced both ASD and OCD also showed increased rates of other anxiety disorders
such as separation anxiety and social phobia than did those with ASD alone. Pertaining to
OCD alone, younger children experienced more focus on creating sameness while as
children age, reports increase regarding obsessions as well as the compulsions. This
creates difficulty as younger children with OCD may engage in the behaviours but be
unable to understand or find a route cause for engaging in it. As well, without personal
insight into why behaviour is occurring, it runs the risk of presenting similar to the
repetitive behaviours seen in children with ASD.
In regards to general comparison, repetitive routines seen in autism can often
appear almost identical to those seen in youth with OCD. Both may show repetitive
behaviours consisting of touching, counting, creating routine and symmetry. This creates
difficulty when determining diagnosis, particularly if faced with a child who shows less
of the severe symptoms of ASD. Particularly for those individuals who experience OCD
with limited insight, it has the potential to look very similar to repetitive behaviours in
those with ASD. In order to assist with a differential diagnosis, looking into the function

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of the behaviour may provide clues in order to best diagnose.

Function of the Repetitive Behaviour. One major area where differences can be seen
within the repetitive behaviours of ASD and OCD is in the function. As is well known,
compulsions are engaged in typically to relieve stress or anxiety about an obsession. This
means that the function of the behaviour is to relieve a negative feeling, and is done so by
engaging in the repetition. This contrasts what is believed about repetitive behaviours in
children and adults with ASD. Some believe that rituals and stereotypic behaviours result
in a feeling or pleasure for children on the autism spectrum (Zandt, Prior, & Kyrios,
2007). The result is experiencing positive reinforcement for individuals with ASD and
negative reinforcement for individuals with OCD. Despite the difference in function,
individuals or caregivers of individuals with both diagnosis may try to limit or stop the
repetitive behaviours due to impact on daily living or because the behaviours are not
socially acceptable (Berjerot, 2007).
Brain functions and Genetics. Interesting comparisons exist around genetics and brain
functions in regards to OCD and ASD. The concept of a broader autism phenotype lies in
the belief that relatives of individuals with ASD may present with some autistic
symptoms as a result of genetics, although not significant enough to warrant a diagnosis.
This idea of genetics poses interesting connections between ASD and OCD. One study
found that first-degree relatives of children with autism were significantly more likely to
have a diagnosis of OCD than relatives of children with Down syndrome (Barkley &
Mash, 2003). In regards to brain functions, researchers have started to look into repetitive
behaviours and what this looks like biologically. Although only just beginning, research
into neurotransmitters such as serotonin and dopamine have started to pique interest in

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their role in such behaviours (Zandt, Prior, & Kyrios, 2007). Research is starting to
suggest that there may be similarities biologically between a variety of disorders, which
show repetitive behaviours, ASD and OCD included. Although research is still in infancy
in regards to brain functions and biology, there is evidence of similarities between ASD
and OCD, and future research has the to potential to guide effective diagnosis or
categorization of these disorders.

Differential Diagnosis. A question of concern arises when looking into diagnosis of ASD
and OCD and whether a dual diagnosis is beneficial or even prohibited by the confines of
the Diagnostic and Statistical Manual of Mental Disorders. In higher functioning
individuals with ASD, determining the diagnostic explanation for repetitive behaviours
can present as problematic as the other diagnostic criteria of communication and social
deficits may be less noticeable. For individuals who are already diagnosed as having
ASD, addition of a secondary diagnosis would require an expertise to determine whether
the levels of repetitive behaviour fall outside of what is typical for those with ASD. This
is difficult as there is no set definition on what is considered over and above ASD
repetitive behaviours (Zandt, Prior, & Kyrios, 2007). Of importance is the fact that in
order to receive a diagnosis of OCD, the symptoms must not be better explained by
another mental disorder (APA, 2013), so the diagnosing psychologist must feel as if the
repetitive behaviours of OCD are different from those one would experience within their
diagnosis of ASD. It is also important to consider that characteristics of ASD may occur
in those with OCD, even if they do not meet the criteria for ASD. OCD appears on a
continuum of severity, ranging from an observably typical appearance to an impact so
great that the individual may appear to have autistic tendencies (Lewin, et al., 2007;

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Berjerot, 2007). The lines may become easily blurred around where ASD stops and OCD
begins. Although it is difficult to differentiate, identifying those who experience OCD
symptoms on top of ASD may be of benefit as the OCD obsessions and compulsions may
respond to treatment and have potential to improve functioning of the ASD individual.
Summary
In finality, even though OCD is most commonly identified in adolescence and
adulthood, childhood diagnoses do occur, particularly for those who may appear to have
OCD tendencies. Great investigation must be taken for these children, as the similarities
between stereotypic or repetitive behaviours seen in ASD versus the compulsions
belonging to those with OCD can be very similar in presentation. This is not to say that
benefit cannot be gained by such identifications, but more so the emphasis must be
placed on accurate diagnosis. If only considering the repetitive behaviours in solitary, it
creates difficulties in determining accurate diagnosis, as both have the ability to present
similarly. For those who appear to present with social and language difficulties of ASD
as well as the obsessions of OCD it creates complexity. With current research indicating
commonalities with biological factors, this has the potential to guide or alter future
considerations of diagnoses. Regardless of the commonalities of OCD and ASD
behaviours, importance is placed on differentiating the repetitive behaviours in hopes that
providing a more accurate and tailored treatment outcome can help to decrease the
repetitive behaviours, and improve child functioning as a result.

Running head: MEDLAND, AMANDA 651 FINAL

23

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