OCD symptoms that overlap with Asperger's syndorme: a study
23
Abstract Although obsessional, ritualistic and stereotyped behaviors are a core fea- ture of autistic disorders, substantial data related to those phenomena are lacking. Ritualistic and stereotyped behaviours can be found in almost all autistic patients.Additionally, cognitive able individuals with Asperger’s disorder (AD) and High-Functioning Autism (HFA: defined by the pres- ence of IQ- levels > 70, Howlin, 2004, p. 6) mostly develop circumscribed, often called obsessional interests and preoccupations. Results from recent research indicate that autistic individuals frequently suffer from obses- sions and compulsions according to DSM-IV criteria of Obsessive-Com- pulsive Disorder (OCD), being associated with marked distress and inter- ference with daily life. OCD and autism share several similarities regard- ing symptom profiles and comorbidity. Etiologic overlap between the dis- orders becomes especially evident when focussing cognitive, neurobiolog- ical and genetic aspects. Autism-related obsessive- compulsive phenome- na (AOCP) have generally to be differentiated from OCD-symptoms, al- though there is no sharp borderline. Keywords: Autistic disorders, Obsessive-compulsive phenomena, As- perger’s disorder, High Functioning Autism, Special interests 1 Department of Psychology, University of Hamburg. 2 Department of Psychology, University of Hamburg, e-mail: [email protected] 5 Life Span and Disability / XII, 1 (2009), 5-27 Obsessive-compulsive phenomena and symptoms in Asperger’s disorder and High-functioning Autism: An evaluative literature review Christian Fischer-Terworth 1 & Paul Probst 2
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Transcript of OCD symptoms that overlap with Asperger's syndorme: a study
Abs
trac
t
Alth
ough
obs
essi
onal
,ritu
alis
tic a
nd s
tere
otyp
ed b
ehav
iors
are
a c
ore
fea-
ture
of
autis
tic d
isor
ders
,sub
stan
tial d
ata
rela
ted
to th
ose
phen
omen
a ar
ela
ckin
g.R
itual
istic
and
ste
reot
yped
beh
avio
urs
can
be fo
und
in a
lmos
t all
autis
tic p
atie
nts.
Add
ition
ally
,cog
nitiv
e ab
le i
ndiv
idua
ls w
ith A
sper
ger’s
diso
rder
(A
D)
and
Hig
h-F
unct
ioni
ng A
utis
m (
HFA
:defi
ned
by th
e pr
es-
ence
of I
Q- l
evel
s >
70,
How
lin,2
004,
p.6)
mos
tly d
evel
op c
ircu
msc
ribe
d,of
ten
calle
d ob
sess
iona
lint
eres
ts a
nd p
reoc
cupa
tions
.Res
ults
fro
m r
ecen
tre
sear
ch i
ndic
ate
that
aut
isti
c in
divi
dual
s fr
eque
ntly
suf
fer
from
obs
es-
sion
s an
d co
mpu
lsio
ns a
ccor
ding
to D
SM-I
V c
rite
ria
of O
bses
sive
-Com
-pu
lsiv
e D
isor
der
(OC
D),
bein
g as
soci
ated
with
mar
ked
dist
ress
and
inte
r-fe
renc
e w
ith d
aily
life
.OC
D a
nd a
utis
m s
hare
sev
eral
sim
ilari
ties
rega
rd-
ing
sym
ptom
pro
files
and
com
orbi
dity
.Etio
logi
c ov
erla
p be
twee
n th
e di
s-or
ders
bec
omes
esp
ecia
lly e
vide
nt w
hen
focu
ssin
g co
gniti
ve,n
euro
biol
og-
ical
and
gen
etic
asp
ects
.Aut
ism
-rel
ated
obs
essi
ve-
com
puls
ive
phen
ome-
na (
AO
CP
) ha
ve g
ener
ally
to b
e di
ffer
entia
ted
from
OC
D-s
ympt
oms,
al-
thou
gh th
ere
is n
o sh
arp
bord
erlin
e.
Key
wor
ds:A
utis
tic
diso
rder
s,O
bses
sive
-com
puls
ive
phen
omen
a,A
s-pe
rger
’s d
isor
der,
Hig
h F
unct
ioni
ng A
utis
m,S
peci
al in
tere
sts
1D
epar
tmen
t of P
sych
olog
y,U
nive
rsit
y of
Ham
burg
.2
Dep
artm
ent o
f Psy
chol
ogy,
Uni
vers
ity
of H
ambu
rg,e
-mai
l:pr
obst
@un
i-ha
mbu
rg.d
e
5
Lif
e Sp
an a
nd D
isab
ility
/X
II,1
(20
09),
5-27
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m:
An
eval
uati
ve li
tera
ture
rev
iew
Chr
istia
n F
isch
er-T
erw
orth
1&
Pau
l Pro
bst2
1.In
trod
ucti
on
Obs
essi
onal
,rit
ualis
tic,
ster
eoty
ped
and
repe
titi
ve b
ehav
iour
s ar
e th
eth
ird
core
fea
ture
of
auti
stic
dis
orde
rs,c
o-oc
curr
ing
wit
h co
mm
unic
atio
nal
diff
icul
ties
and
pro
blem
s in
soc
ial
inte
ract
ion
(DSM
-IV
:A
PA,
2000
).A
utis
m-r
elat
ed o
bses
sive
-com
puls
ive
phen
omen
a (A
OC
P)
are
part
of
the
clin
ical
pic
ture
in
all
diso
rder
s of
the
aut
isti
c sp
ectr
um,i
nclu
ding
ear
lych
ildho
od a
utis
m (
Kan
ner,
1943
;Pro
bst
& H
illig
,200
5),h
igh-
func
tion
ing
Aut
ism
(H
owli
n,20
04)
and
Asp
erge
r’s
diso
rder
(A
sper
ger,
1944
;19
44/1
991)
.AO
CP
incl
ude
all k
inds
of
obse
ssio
nal,
com
puls
ive,
ritu
alis
tic,
ster
eoty
ped
and
repe
titi
ve b
ehav
iour
s.A
ccor
ding
to
the
form
al d
iagn
osti
c cr
iter
ia,s
ocia
l pro
blem
s an
d th
e ob
-se
ssiv
e co
mpu
lsiv
e ph
enom
ena
of A
sper
ger’
s di
sord
er (
AD
) do
not
dif
fer
from
tho
se f
ound
in E
arly
Chi
ldho
od A
utis
m (
EC
A)
and
Hig
h-F
unct
ion-
ing-
Aut
ism
(H
FA).
The
occ
urre
nce
of s
ocia
l defi
cits
and
obs
essi
ve c
ompu
l-si
ve p
heno
men
a in
AD
sho
ws
that
typi
cal a
utis
tic
feat
ures
als
o oc
cur
in in
-di
vidu
als
gene
rally
dis
play
ing
high
er c
ogni
tive
abi
litie
s an
d be
tter
lang
uage
skill
s th
an a
utis
tic
indi
vidu
als
(Bar
on- C
ohen
,200
4;W
ing,
2005
).R
ecen
t re-
sear
ch r
esul
ts (
How
lin,2
004)
don
’t p
rovi
de a
bas
is fo
r a
sepa
rate
cla
ssifi
ca-
tion
of A
D a
nd H
FA w
hich
als
o ap
plie
s to
obs
essi
ve c
ompu
lsiv
e ph
enom
e-na
(C
ucca
ro,N
atio
ns,B
rink
ley,
Abr
amso
n,W
righ
t ,H
all e
t al
.,20
07).
Ac-
cord
ing
to th
ese
findi
ngs
only
the
deve
lopm
ent o
f bet
ter
cogn
itiv
e sk
ills
and
the
degr
ee o
f lin
guis
tic-
com
mun
icat
ive
impa
irm
ent
can
serv
e as
a r
elev
ant
mar
ker
for
diff
eren
tiat
ing
AD
/HFA
from
EC
A (
Bar
on-C
ohen
,200
4).
Obs
essi
ons
and
com
puls
ions
in
O
bses
sive
-Com
puls
ive
Dis
orde
rs(O
CD
) an
d A
utis
m-r
elat
ed o
bses
sive
-com
puls
ive
phen
omen
a (A
OC
P)
are
ofte
n re
gard
ed a
s an
ove
rlap
ping
cla
ss o
f be
havi
ors,
shar
ing
a si
mila
r ge
-ne
tic,
biob
ehav
iora
l an
d ne
urob
iolo
gica
l ba
sis.
Cas
e-re
port
s of
OC
D-
sym
ptom
s in
ado
lesc
ents
oft
en c
onta
in d
escr
ipti
ons
of r
itua
lized
beh
av-
iour
s al
so b
eing
com
mon
in a
utis
m (
Win
ter
& S
chre
ibm
an,2
002)
.On
the
othe
r ha
nd A
OC
P o
ften
hav
e di
ffer
ent
func
tion
s fo
r th
e in
divi
dual
(Ken
nedy
,Mey
er,K
now
les,
& S
hukl
a,20
00)
than
the
obs
essi
ons
and
com
-pu
lsio
ns o
f typ
ical
OC
D (
Han
d,19
92).
Alt
houg
h co
gnit
ive
defi
cits
and
lan
guag
e pr
oble
ms
gene
rally
mak
e it
diffi
cult
to s
peci
fy if
aut
isti
c in
divi
dual
s di
spla
y ty
pica
l obs
essi
ons
and
com
-pu
lsio
ns (
Bar
on-C
ohen
,198
9),r
ecen
t st
udie
s sh
ow t
hat
man
y of
the
m,i
n-cl
udin
g th
ose
wit
h A
D a
nd H
FA,h
ave
typi
cal o
bses
sion
s an
d co
mpu
lsio
nsas
soci
ated
wit
h m
arke
d di
stre
ss (
McD
ougl
e,K
resc
h,G
oodm
an,N
aylo
r,V
olkm
ar,C
ohen
,& P
rice
,199
5;R
usse
ll,M
atai
x-C
ols,
Ans
on,&
Mur
phy,
2005
;Zan
dt,P
rior
,& K
yrio
s,20
06;L
eval
lois
,Bér
aud,
& J
alen
ques
,200
7).
Fur
ther
mor
e th
ere
is s
ome
evid
ence
for
the
exi
sten
ce o
f a
dist
inct
OC
Dsu
bcat
egor
y be
ing
typi
cal f
or a
utis
tic
diso
rder
s (M
cDou
gle
et a
l.,19
95).
In-
tere
stin
gly,
rece
nt r
esea
rch
resu
lts
show
tha
t th
ere
is a
sub
grou
p of
OC
Dpa
tien
ts w
ith
auti
stic
feat
ures
(B
ejer
ot,2
007;
Ivar
sson
& M
elin
,200
8) w
hich
6
Lif
e Sp
an a
nd D
isab
ility
Fisc
her-
Terw
orth
C./
Pro
bst P
.
may
pre
sent
wit
h au
tism
- re
late
d so
cial
and
com
mun
icat
ion-
rel
ated
dif
fi-cu
ltie
s (C
ulle
n,Sa
mue
ls,G
rado
s,L
anda
,Bie
nven
u,L
iang
et a
l.,20
08).
Be-
jero
t and
Mör
tber
g (2
009)
sho
wed
and
an
incr
easi
ng r
isk
of b
eing
bul
lied
atsc
hool
for
chi
ldre
n an
d ad
oles
cent
s w
ith
OC
D a
ssoc
iate
d w
ith
auti
stic
fea
-tu
res
like
low
soc
ial c
ompe
tenc
e.Sy
mpt
oms
of o
bses
sive
-com
puls
ive
diso
rder
s ar
e ti
me-
cons
umin
g ob
-se
ssio
ns a
nd c
ompu
lsio
ns w
hich
cau
se m
arke
d di
stre
ss a
nd s
igni
fica
nt in
-te
rfer
ence
wit
h da
ily li
fe.O
bses
sion
s ar
e re
curr
ent
thou
ghts
,im
puls
es o
rim
ages
intr
udin
g re
peti
tive
ly in
to c
onsc
ious
ness
,oft
en r
elat
ed to
the
fear
of
a th
reat
enin
g ev
ent
for
whi
ch t
he p
atie
nt f
eels
res
pons
ible
(A
PA,2
000)
.C
omm
on o
bses
sion
s ar
e as
soci
ated
wit
h fe
ar o
f con
tam
inat
ion,
deat
h or
ill-
ness
,oth
er th
ough
ts o
r im
puls
es h
ave
an a
ggre
ssiv
e,se
xual
or
blas
phem
ous
cont
ent.
Com
puls
ions
are
irre
sist
ible
rit
uals
the
indi
vidu
al h
as t
o ca
rry
out
over
and
ove
r to
red
uce
the
anxi
ety
or d
isco
mfo
rt g
ener
ated
by
the
obse
s-si
ons. Freq
uent
com
puls
ions
are
rit
ualiz
ed w
ashi
ng,c
heck
ing
(e.g
.sto
ves
orli
ght
swit
ches
),re
peat
ing
(rep
eati
ng w
ords
or
sent
ence
s,re
read
ing
orre
wri
ting
sen
tenc
es),
orde
ring
,cou
ntin
g,qu
esti
onin
g an
d ho
ardi
ng (
Ras
-m
usse
n &
Eis
en,1
992)
.A d
iagn
osis
of a
utis
m w
ith
com
orbi
d O
CD
req
uire
ssp
ecif
ic c
ogni
tive
-beh
avio
ural
(L
ehm
kuhl
,Sto
rch,
Bod
fish
,& G
effk
en,
2008
) an
d ph
arm
acol
ogic
al in
terv
enti
ons
(Lev
allo
is,B
erau
d,&
Jal
enqu
es,
2007
) ef
fect
ivel
y ta
rget
ing
obse
ssio
ns a
nd c
ompu
lsio
ns,t
he c
ore
sym
ptom
sof
OC
D.T
hese
spe
cial
OC
D in
terv
enti
ons
shou
ld b
e an
inte
gral
par
t of
atr
eatm
ent p
lan
incl
udin
g in
terv
enti
ons
for
the
auti
stic
dis
orde
r an
d co
mor
-bi
d co
ndit
ions
.
2.M
etho
d
To r
evie
w t
he r
esea
rch
liter
atur
e ab
out A
OC
P a
nd O
CD
-sym
ptom
s in
auti
sm,t
he o
nlin
e da
ta b
ases
“M
edlin
e”,“
Psy
ndex
”an
d “P
sycI
nfo”
wer
esc
reen
ed f
or a
rtic
les
from
197
7 to
200
9.R
elev
ant
info
rmat
ion
was
als
ofo
und
in r
elev
ant
psyc
hiat
ric,
psyc
holo
gica
l an
d ed
ucat
iona
l ha
ndbo
oks
and
sing
le p
ublic
atio
ns a
bout
Aut
ism
,Asp
erge
r’s
diso
rder
and
Obs
essi
ve-
com
puls
ive
diso
rder
s.W
hen
scre
enin
g th
e on
line
dat
a ba
ses,
the
sear
chte
rms
“aut
ism
”an
d “A
sper
ger”
wer
e co
mbi
ned
eith
er w
ith
“OC
D”,
“com
-pu
lsio
ns”,
“obs
essi
ons”
,“ob
sess
ive
com
puls
ive”
,“ri
tual
s”,“
ster
eoty
pies
”an
d “r
epet
itiv
e”.I
n th
e on
line
rese
arch
the
rel
evan
t ar
ticl
es c
onta
inin
g de
-sc
ript
ions
,ana
lyse
s an
d cl
assi
ficat
ion
of o
bses
sive
-com
puls
ive
sym
ptom
s in
auti
stic
dis
orde
rs w
ere
foun
d.T
he s
elec
ted
liter
atur
e co
nsis
ts o
f re
view
san
d st
udie
s ab
out p
heno
men
olog
ical
,gen
etic
and
eti
olog
ic o
verl
ap a
reas
of
OC
D a
nd a
utis
m,a
naly
ses
of s
tere
otyp
ed b
ehav
iour
and
the
rapy
stu
dies
and
thre
e st
udie
s es
peci
ally
foc
usin
g on
obs
essi
ons
and
com
puls
ions
in
auti
stic
dis
orde
rs.
7
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
3 A
utis
m a
nd O
bses
sive
-com
puls
ive
Dis
orde
r:ph
enom
enol
ogic
alan
d et
iolo
gica
l ove
rlap
3.1
Sym
ptom
sL
ess
exce
ssiv
e va
rian
ts o
f rep
etit
ive
beha
viou
rs in
OC
D a
nd a
utis
m c
anal
so b
e fo
und
in t
ypic
ally
dev
elop
ing
child
ren
(Mili
tern
i,B
rava
ccio
,Fal
co,
Fico
,& P
aler
mo,
2002
;Gre
aves
,Pri
nce,
Eva
ns,&
Cha
rman
,200
6).R
itua
l-iz
ed b
ehav
iour
s lik
e be
dtim
e ri
tual
s,in
sist
ence
on
sam
enes
s or
rit
ualiz
edpl
ay m
ostl
y pe
ak a
t the
age
bet
wee
n 2
and
4 an
d de
crea
se w
ith
grow
ing
age
(Eva
ns,L
eckm
an,C
arte
r,R
ezni
ck ,
Hen
shaw
,Kin
g,&
Pau
ls,1
997)
.Mot
orst
ereo
typi
es li
ke n
ail b
itin
g or
roc
king
oft
en o
ccur
in p
erio
ds o
f co
ncen
tra-
tion
,exc
item
ent o
r bo
redo
m (
Trös
ter,
1994
).In
typi
cal d
evel
opm
ent r
itua
l-iz
ed b
ehav
iors
ten
d to
cha
nge
over
tim
e w
hich
is
the
case
in
OC
D a
ndau
tism
as
wel
l (W
inte
r &
Sch
reib
man
,200
2).R
apop
ort
(198
9) a
sks
if t
heri
tual
ized
pla
y of
a f
our-
yea
r- o
ld w
ith
e.g.
a st
ring
cou
ld b
e hi
s in
divi
dual
vari
ant o
f a w
ashi
ng o
r ch
ecki
ng c
ompu
lsio
n (W
inte
r &
Sch
reib
man
,200
2).
Peo
ple
wit
h O
CD
and
aut
isti
c in
divi
dual
s di
spla
y co
mpu
lsiv
e be
havi
our,
obse
ssiv
e in
sist
ence
on
sam
enes
s,re
peti
tive
mov
emen
ts,a
str
ong
need
for
sym
met
ry a
nd c
erta
in p
rinc
iple
s of
ord
erin
g (W
inte
r &
Sch
reib
man
n,20
02;
Zan
dtet
al.,
2006
).E
go-d
ysto
nic
OC
D-s
ympt
oms
have
gen
eral
ly to
be
sep-
arat
ed fr
om a
utis
m-r
elat
ed e
njoy
able
“ob
sess
iona
l”in
tere
sts
(Rus
sell
et a
l.20
05;S
outh
,Ozo
noff
,& M
cMah
on,2
005)
,alt
houg
h th
e di
stin
ctio
n re
mai
nsun
clea
r (C
ath,
Ran
,Sm
it,v
an B
alko
m,&
Com
ijs,2
008)
.
3.2
Pat
tern
s of
Com
orbi
dity
OC
D a
nd a
utis
tic
diso
rder
s sh
are
a si
mila
r pa
tter
n of
com
orbi
d co
ndi-
tion
s lik
e an
xiet
y di
sord
ers,
affe
ctiv
e di
sord
ers,
tic
diso
rder
s (R
asm
usse
n &
Eis
en,1
992;
How
lin,2
004)
or
pers
onal
ity
diso
rder
s (B
ejer
ot,N
ylan
der,
&L
inds
tröm
,200
1).A
nxie
ty in
aut
ism
(G
illot
t,F
urni
ss,&
Wal
ter,
2001
) is
of-
ten
trig
gere
d by
typ
ical
aut
ism
–rel
ated
pro
blem
s lik
e se
nsor
y ov
erlo
ad o
rth
e in
terr
upti
on o
f rit
uals
(Sa
met
,200
6).S
enso
ry o
verl
oad
can
be v
iew
ed a
sa
typi
cal a
utis
m-
rela
ted
trig
ger
for
anxi
ety,
whe
reas
the
fun
ctio
n of
rit
uals
to r
educ
e an
xiet
y is
sim
ilar
but n
ot id
enti
cal i
n O
CD
(D
SM-I
V:A
PA,2
000)
.C
onco
mit
ant
spec
ific
pho
bias
(R
asm
usse
n &
Eis
en,1
992;
Ley
fert
et
al.,
2006
) so
cial
pho
bia
(Cat
h et
al.,
2008
) an
d se
para
tion
anx
iety
(B
hard
waj
,A
garv
al &
Sit
hole
y,20
05;N
esta
dt e
t al
.,20
03)
are
com
mon
in
OC
D a
ndA
SD.I
n co
ntra
st t
o ea
rlie
r fi
ndin
gs,c
omor
bidi
ty w
ith
schi
zoph
reni
a an
dot
her
psyc
hoti
c co
ndit
ions
is
rare
in
Aut
ism
(H
owli
n,20
04)
and
OC
D(F
rom
mho
ld,2
006)
.Int
eres
ting
ly,h
owev
er,t
here
is o
verl
ap b
etw
een
both
AD
/HFA
and
OC
D w
ith
schi
zoty
pica
l sym
ptom
s an
d pe
rson
alit
y fe
atur
es(B
ejer
ot,2
007)
.The
per
sona
lity
sty
le o
f m
any
AD
/HFA
ind
ivid
uals
has
muc
h in
com
mon
wit
h sc
hizo
typi
cal p
erso
nalit
y fe
atur
es (
revi
ewed
by
An-
dres
en &
Maß
,200
1),e
spec
ially
reg
ardi
ng b
izar
re f
anta
sies
and
inte
rest
s,ec
cent
ric
beha
viou
r,m
etap
hori
c an
d st
ereo
typa
l use
of l
angu
age,
soci
al a
nd
8
Lif
e Sp
an a
nd D
isab
ility
Fisc
her-
Terw
orth
C./
Pro
bst P
.
com
mun
icat
iona
l de
fici
ts (
Est
erbe
rg,T
rotm
an,
Bra
sfie
ld,
Com
pton
,&
Wal
ker,
2008
).A
lso
cert
ain
subc
ateg
orie
s of
OC
D a
re m
ore
stro
ngly
rel
at-
ed to
sch
izot
ypic
al s
ympt
oms
than
to o
ther
anx
iety
dis
orde
rs (
Sobi
n,B
lun-
dell,
Wei
ller,
Gav
igan
,Hai
man
,& K
aray
iorg
ou,2
000)
.Lik
e in
tic
-rel
ated
OC
D,a
bro
ad s
pect
rum
of c
linic
al m
anif
esta
tion
s of
com
orbi
d ti
c di
sord
ers
can
also
be
foun
d in
aut
ism
(R
ingm
an &
Jan
kovi
c,20
00).
Ano
ther
con
di-
tion
fre
quen
tly
co-o
ccur
ring
wit
h bo
th O
CD
(M
asi,
Mil
lepi
edi,
Muc
ci,
Ber
tini
,Pfa
nner
,& A
rcan
geli,
2006
) an
d au
tism
(L
eyfe
rt,F
olst
ein,
Bac
al-
man
,Dav
is ,
Din
h,M
orga
n et
al.,
2006
) is
Att
enti
on d
efic
it H
yper
acti
vity
Dis
orde
r (A
DH
D),
espe
cial
ly b
eing
pre
vale
nt in
chi
ldre
n an
d ad
oles
cent
s.E
atin
g di
sord
ers
like
anor
exia
ner
vosa
are
a f
requ
ent
com
orbi
d co
ndit
ion
of O
CD
(K
aye,
Bul
ik,T
horn
ton,
Bar
bari
ch,&
Mas
ters
,200
4) a
lso
bein
g as
-so
ciat
ed w
ith
auti
stic
dis
orde
rs,e
spec
ially
wit
h A
D/H
FA (
Jörg
ense
n,19
94;
Fism
an,S
teel
e,Sh
ort,
Byr
ne,&
Lav
alle
e,19
96).
3.3
Etio
logi
cal o
verl
apO
CD
and
aut
ism
bot
h ha
ve a
neu
robi
olog
ical
bas
is (
Win
ter
& S
chre
ib-
man
,200
2).N
euro
imag
ing
stud
ies
show
vol
umin
etri
c an
d st
ruct
ural
abn
or-
mit
ies
in t
he c
ereb
ellu
m,t
he f
ront
al lo
be,t
he h
ippo
cam
pus,
the
amyg
dala
and
the
corp
us c
allo
sum
of
auti
stic
indi
vidu
als
(Her
bert
,Zie
gler
,Deu
tsch
,O
’Bri
en,L
ange
,Bak
ardj
iev
et a
l.,20
03;B
aron
-Coh
en,2
004;
Bou
cher
,Cow
-el
l,H
owar
d,B
roks
,Far
rant
,Rob
erts
,& M
ayes
,200
5;B
oger
-Meg
gido
,Sha
w,
Frie
dman
,Spa
rks,
Art
ru,G
iedd
et
al.,
2006
).R
epor
ts o
f a
sudd
en o
nset
of
OC
D s
ympt
oms
follo
win
g br
ain
inju
ry a
nd in
fect
ions
sho
w th
at O
CD
has
ane
urol
ogic
al b
asis
(St
eket
ee &
Pig
ott,
2006
,p.5
3).E
spec
ially
the
effe
ctiv
e-ne
ss o
f se
roto
nerg
ic a
ntid
epre
ssan
ts a
nd c
ogni
tive
-beh
avio
ural
tre
atm
ent
bein
g vi
sibl
e in
PE
T (
Schw
artz
,Mar
tin,
& B
axte
r,19
92),
SPE
CT
and
MR
Isc
ans
stro
ngly
con
trib
uted
to
the
conc
epti
on o
f ne
urob
iolo
gica
l di
seas
em
odel
s (S
teke
tee
& P
igot
t,20
06).
Neu
robi
olog
ical
fin
ding
s in
OC
D a
nd a
utis
m s
how
sim
ilari
ties
whi
chm
ight
be
rele
vant
reg
ardi
ng o
bses
sive
com
puls
ive
phen
omen
a (W
inte
r &
Schr
eibm
an,2
002)
.Pat
tern
s of
fam
iliar
int
erac
tion
,edu
cati
onal
sty
les
orot
her
exte
rnal
str
esso
rs c
an c
ontr
ibut
e to
exa
rcer
bati
ons,
impr
ovem
ents
or
chan
ges
in b
oth
AO
CP
(H
owlin
,200
4) a
nd O
CD
-sym
ptom
s (P
robs
t,A
sam
,&
Ott
o,19
79).
A s
olid
soc
ial b
ackg
roun
d an
d th
e in
volv
emen
t in
prod
ucti
veac
tivi
ties
dim
inis
hes
the
depe
nden
ce o
n st
ereo
type
d an
d ri
tual
ized
beh
av-
iors
in
OC
D (
Schw
artz
& B
eyet
te,1
997)
and
aut
isti
c di
sord
ers
as w
ell
(How
lin,2
004,
p.13
7).
3.3.
1 C
ogni
tive
asp
ects
Sim
ilar
def
icit
s in
inf
orm
atio
n pr
oces
sing
mig
ht u
nder
lie
OC
D a
ndau
tism
(W
inte
r &
Sch
reib
man
,200
2).A
ccor
ding
to s
ever
al a
utho
rs lo
cal i
n-fo
rmat
ion
proc
essi
ng is
pre
ferr
ed to
glo
bal p
roce
ssin
g in
aut
ism
and
OC
D.
Add
itio
nall
y,im
pair
men
t in
the
exe
cuti
ve f
unct
ions
has
bee
n no
ted
in
9
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
OC
D a
nd d
iffe
rent
dis
orde
rs o
f th
e au
tist
ic s
pect
rum
(F
rith
,198
9,19
92;
Rus
sell
et a
l.,20
05).
The
pre
fere
nce
of lo
cal i
nfor
mat
ion
proc
essi
ng c
ause
sth
e in
divi
dual
to
focu
s at
tent
ion
on s
ingl
e el
emen
ts o
f th
e en
viro
nmen
tw
hich
can
lea
d to
ste
reot
ypy,
ritu
als
and
narr
ow i
nter
ests
(F
rith
,198
9,19
92).
In O
CD
indi
vidu
als
are
ofte
n in
tern
ally
forc
ed to
gai
n co
ntro
l ove
r a
smal
l par
t of t
heir
env
iron
men
t wit
h th
e at
tent
ion
focu
ssed
on
dysf
unct
ion-
al t
houg
hts
and
urge
s (S
chw
artz
et
al.,
1992
).A
n in
tern
al s
igna
l aut
omat
i-ca
lly te
rmin
atin
g re
peti
tive
beh
avio
ur fr
om a
cen
tral
pro
cess
ing
unit
see
ms
to b
e la
ckin
g in
OC
D (
Hof
fman
n &
Hof
man
n,20
04)
and
ASD
(Fr
ith,
1989
,19
92).
Del
orm
e,G
ouss
e,R
oy,T
rand
afir
,Mat
hieu
,Mou
ren-
Sim
eoni
et
al.
(200
6) d
iscu
ss a
pos
sibl
e co
mm
on e
ndop
heno
type
rel
ated
to e
xecu
tive
dys
-fu
ncti
ons
com
mon
ly a
ssoc
iate
d w
ith
OC
D a
nd a
utis
m w
hich
may
eve
n be
rela
ted
to r
epet
itiv
e be
havi
or (
Zan
dt,P
rior
,& K
yrio
s,20
09).
Acc
ordi
ng t
oth
e co
gnit
ive-
beha
viou
ral
mod
el
of
OC
D
(Sal
kovs
kis,
Forr
este
r,&
Ric
hard
s,19
97)
prim
ary
neut
ral t
houg
hts
get fi
lled
wit
h fe
elin
gs o
f anx
iety
,di
sgus
t an
d/or
gui
lt w
hich
inc
reas
es t
heir
int
rusi
vene
ss.C
ompu
lsio
ns a
reca
rrie
d ou
t to
red
uce
thes
e em
otio
ns f
or a
sho
rt p
erio
d of
tim
e w
hich
rei
n-fo
rces
the
intr
usiv
enes
s of
the
thou
ght.
As
Rus
sell
et a
l.(2
005)
sta
te,c
ogni
-ti
ve s
tyle
s be
ing
typi
cal f
or a
utis
tic
indi
vidu
als
can
also
con
trib
ute
to a
spe
-ci
fic w
ay o
f giv
ing
valu
e to
thos
e th
ough
ts.
Defi
cits
in a
uton
omou
s ha
bitu
atio
n pr
oces
ses,
poss
ibly
bei
ng a
ssoc
iate
dw
ith
amyg
dala
dys
func
tion
(A
mar
al &
Cor
bett
,200
2;St
eket
ee &
Pig
ott,
2006
),co
uld
serv
e as
an
expl
anat
ion
for
the
obse
ssiv
e re
sist
ance
aga
inst
chan
ge i
n au
tism
and
OC
D.I
n au
tist
ic p
erso
ns m
inim
al e
nvir
onm
enta
lch
ange
s ca
n tr
igge
r st
rong
anx
iety
and
pan
ic a
ttac
ks (
Sam
et,2
006)
,whe
re-
as O
CD
-pat
ient
s of
ten
pani
c w
hen
thei
r ri
tual
s ar
e no
t car
ried
out
“ap
pro-
pria
tely
”(R
asm
usse
n &
Eis
en,1
992)
.The
per
sist
ent
enga
gem
ent
in r
igid
obse
ssiv
e-co
mpu
lsiv
e be
havi
ours
mig
ht s
erve
as
a pr
otec
tion
aga
inst
new
stim
uli b
eing
exp
erie
nced
as
thre
aten
ing.
3.3.
2 N
euro
anat
omic
al a
nd n
euro
bioc
hem
ical
ove
rlap
Seve
ral a
utho
rs s
tate
that
dys
func
tion
s in
cor
tico
-str
iata
l-th
alam
ic p
ath-
way
s ar
e in
volv
ed in
the
path
ogen
esis
of a
utis
m (
Dam
asio
& M
aure
r,19
78)
and
are
a cr
ucia
l el
emen
t of
the
neu
rona
l ci
rcui
try
unde
rlyi
ng O
CD
(Sch
war
tzet
al.,
1992
).A
bnor
mit
ies
in s
peci
fic a
reas
of
the
fron
to-s
tria
tal
syst
em c
ause
cha
nges
of a
dapt
ive
resp
onse
s to
env
iron
men
tal s
tim
uli,
espe
-ci
ally
bas
al g
angl
ia d
ysfu
ncti
ons
lead
to
repe
titi
ve a
nd r
igid
beh
avio
urs
(Bra
dsha
w &
She
ppar
d,20
00).
MR
I-sc
ans
of t
he b
asal
gan
glia
in
auti
sman
d O
CD
pat
ient
s sh
ow e
nlar
ged
volu
min
a of
the
nuc
leus
cau
datu
s be
ing
asso
ciat
ed w
ith
com
puls
ive
ritu
als
and
mot
or m
anne
rism
s (S
ears
,Ves
t,M
o-ha
med
,Bai
ley,
Ram
son,
& P
iven
,199
9;H
olla
nder
,Ana
gnos
tou,
Cha
plin
,E
spos
ito,
Haz
neda
r,L
ical
zi,W
asse
rman
n et
al.,
2005
).A
lack
of
basa
l-ga
n-gl
ia-m
odul
ated
cor
tica
l inh
ibit
ion
can
lead
to
hype
ract
ivit
y in
the
orb
ito-
fron
tal
cort
ex.A
s th
e or
bito
-fro
ntal
cor
tex
is o
vera
ctiv
e,fl
exib
le b
ehav
-
10
Lif
e Sp
an a
nd D
isab
ility
Fisc
her-
Terw
orth
C./
Pro
bst P
.
iour
al r
espo
nses
to
thou
ghts
and
urg
es a
re im
pair
ed (
Schw
artz
et a
l.,19
92;
Schw
artz
& B
eyet
te,1
997)
.As
the
amyg
dala
pla
ys a
cru
cial
rol
e in
the
mod
-ul
atio
n of
anx
iety
and
fea
r (W
and,
2005
),m
etab
olic
cha
nges
in t
he a
myg
-da
lae
of a
utis
tic
indi
vidu
als
can
lead
to
phob
ias
and
anxi
ety
(Am
aral
&C
orbe
tt,2
002)
.Als
o in
OC
D th
e am
ygda
la h
as b
een
foun
d to
be
over
acti
ve(S
teke
tee
& P
igot
t,20
06,p
.55)
.Red
uced
am
ygda
la v
olum
es h
ave
alre
ady
been
ass
ocia
ted
wit
h ri
gid
and
com
puls
ive
beha
viou
rs a
nd n
arro
w in
tere
sts
(Dzi
obek
,Fle
ck,R
oger
s,W
olf,
& C
onvi
t,20
06).
Imba
lanc
es o
f se
vera
l neu
rotr
ansm
itte
rs li
ke s
erot
onin
and
dop
amin
ear
e m
ore
or le
ss in
volv
ed in
the
pat
hoge
nesi
s of
aut
ism
and
OC
D (
Gro
ss-
Isse
roff
,Her
mes
h,&
Wei
zman
,200
1;St
eket
ee &
Pig
ott,
2006
,p.5
9).
Sero
tone
rgic
dys
func
tion
is
a cr
ucia
l el
emen
t in
the
eti
olog
y of
OC
D(B
aum
gart
en &
Gro
zdan
ovic
,199
8) a
nd h
as a
lso
been
rep
orte
d in
the
liter
-at
ure
abou
t au
tism
(W
inte
r &
Sch
reib
man
,200
2).S
erot
onin
re-
upta
ke in
-hi
bito
rs (
SSR
I) h
ave
not
only
bee
n sh
own
to b
e ef
fect
ive
in O
CD
(G
reis
t,Je
ffer
son,
& K
obak
,199
5),i
n so
me
case
s th
ey c
an a
lso
impr
ove
AO
CP
(Lev
allo
iset
al.,
2007
) an
d ot
her
auti
sm-r
elat
ed s
ympt
oms
like
soc
ial
defic
its
and
aggr
essi
on (
How
lin,2
004,
p.29
0).A
ddit
iona
lly,f
amily
stu
dies
have
sho
wn
mut
atio
ns o
f th
e se
roto
nin
tran
spor
ter
gene
in b
oth
diso
rder
s(O
zaki
et a
l.,20
03;W
endl
and,
DeG
uzm
an,M
cMah
on,R
udni
ck,D
eter
a-W
adle
igh,
& M
urph
y,20
08).
The
pro
pert
y of
the
dop
amin
e-ag
onis
ts L
-D
opa
and
amph
etam
ines
of
indu
cing
ste
reot
yped
beh
avio
ur (
Ric
ciar
di &
Hur
ley,
1990
) im
plie
s th
e in
volv
emen
t of d
opam
iner
gic
path
way
s in
ste
reo-
typa
l beh
avio
ur.A
lso
the
effic
acy
of d
opam
ine-
anta
goni
st a
ntip
sych
otic
s in
redu
cing
tic
-lik
e co
mpu
lsio
ns a
nd s
ome
clas
ses
of s
tere
otyp
al b
ehav
iour
,ca
n se
rve
as e
vide
nce
for
the
invo
lvem
ent o
f the
dop
amin
ergi
c sy
stem
into
auti
sm (
How
lin,
2004
;Lev
allo
is e
t al
.,20
07)
and
tic-
rela
ted
OC
D (
Mc-
Dou
gle,
1992
),al
so t
he r
ole
of n
icot
inic
ace
tylc
holi
ne-r
ecep
tors
bot
h in
OC
D (
Pas
quin
i,G
arav
ini,
& B
iond
i,20
05)
and
auti
sm (
Lip
iello
,200
6) is
be-
ing
inve
stig
ated
.
3.3.
3 G
enet
ic s
imila
riti
esT
he o
ccur
renc
e of
OC
D in
fam
ilies
can
pre
dict
a g
enet
ic v
ulne
rabi
lity
for
auti
sm.I
n co
mpa
riso
n w
ith
norm
al c
ontr
ols
mot
or ti
cs,O
CD
sym
ptom
s,an
xiet
y di
sord
ers
and
depr
essi
on r
un s
igni
fican
tly
mor
e of
ten
in fa
mili
es o
fau
tist
ic p
atie
nts,
whi
le th
ere
is e
vide
nce
for
the
tran
smis
sion
of a
bro
ad p
he-
noty
pe (
Bol
ton,
Pic
kles
,Mur
phy,
& R
utte
r,19
98;W
endl
and
et a
l.,20
08).
OC
D s
ympt
oms
in p
aren
ts a
re o
ften
pos
itiv
ely
corr
elat
ed w
ith
stro
ngre
peti
tive
beh
avio
urs
in a
utis
tic
child
ren
(Hol
land
er,K
ing,
Del
aney
,Sm
ith,
& S
ilver
man
,200
3),e
.g.t
he o
bses
sive
insi
sten
ce in
sam
enes
s (A
bram
son,
Rav
an,W
righ
t,W
iedu
wilt
,Wol
pert
,Don
nelly
et
al.,
2005
).F
urth
erm
ore,
OC
D-p
atie
nts
disp
lay
auti
sm-l
ike
com
mun
icat
ive
impa
irm
ent
mor
e of
ten
than
indi
vidu
als
wit
h de
pres
sive
dis
orde
rs (
Bol
ton
et a
l.,19
98)
and
tend
to
have
aut
ism
- re
late
d pe
rson
alit
y fe
atur
es i
n se
vera
l ca
ses
(Bej
erot
et
al.,
11
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
2001
).R
esea
rch
resu
lts
from
mol
ecul
ar g
enet
ics
indi
cate
gen
etic
link
s be
-tw
een
OC
D a
nd a
utis
m a
s w
ell (
Hol
land
er e
t al
.,19
99;O
zaki
et
al.,
2003
;Fo
nten
elle
,M
endl
ovic
z,B
ezer
ra d
e M
enez
es,
dos
Sant
os M
arti
ns,
&V
eris
ano,
2004
).
4.O
bses
sive
-com
puls
ive
phen
omen
a in
aut
ism
4.1
Cla
ssifi
catio
nA
ccor
ding
to
DSM
-IV
-cri
teri
a (A
PA,2
000)
Aut
ism
- re
late
d ob
sess
ive-
com
puls
ive
phen
omen
a (A
OC
P)
com
pris
e (a
) th
e ex
cess
ive
invo
lvem
ent
into
one
or
mor
e ci
rcum
scri
bed
spec
ial i
nter
ests
(b)
the
enga
gem
ent i
n dy
s-fu
ncti
onal
,com
puls
ive
ritu
als
trig
geri
ng a
nxie
ty o
f ch
ange
whe
n be
ing
in-
terr
upte
d (c
) st
ereo
type
d an
d re
peti
tive
mot
or m
anne
rism
s (d
) an
xiou
s in
-si
sten
ce in
sam
enes
s.O
CD
is c
hara
cter
ized
by
the
follo
win
g fe
atur
es:(
a) T
he o
ccur
renc
e of
repe
titi
ve a
nd in
trus
ive
obse
ssio
ns a
nd c
ompu
lsio
ns c
ausi
ng a
nxie
ty a
nd/o
rdi
scom
fort
.(b)
The
thou
ghts
and
beh
avio
urs
are
gene
rally
rec
ogni
zed
as in
-ap
prop
riat
e (i
n th
e ca
tego
ry O
CD
with
poo
r in
sigh
tsym
ptom
s ha
ven’
t nec
-es
sari
ly t
o be
exp
erie
nced
as
ego-
dyst
onic
) (c
) In
divi
dual
s m
ake
an e
ffor
tto
res
ist
the
obse
ssio
ns a
nd c
ompu
lsio
ns.(
d) T
he o
bses
sion
s an
d co
mpu
l-si
ons
mus
t cau
se s
ubst
anti
al fu
ncti
onal
impa
irm
ent.
Rit
uals
are
car
ried
out
to r
educ
e an
xiet
y an
d/or
dis
com
fort
or
to p
reve
nt a
pot
enti
ally
thre
aten
ing
even
t (A
PA,2
000)
.B
etw
een
AO
CP
and
OC
D-S
ympt
oms
ther
e ar
e si
mila
riti
es a
nd d
iffe
r-en
ces
as w
ell
(Has
him
oto,
2007
).Tu
rner
(19
97)
clas
sifi
esob
sess
ions
and
com
puls
ions
as b
elon
ging
to
AO
CP.
Alt
houg
h th
e in
volv
emen
t in
spe
cial
inte
rest
s of
ten
has
an o
bses
sion
alch
arac
ter,
AO
CP
- rel
ated
pre
occu
pati
ons
are
not t
he s
ame
as th
e ob
sess
ions
of O
CD
.Bar
on-C
ohen
and
Whe
elw
righ
t(1
999)
reg
ard
thos
e ob
sess
ions
as a
n eg
o- s
ynto
nic
subt
ype
of O
CD
(al
sose
e Fo
nten
elle
et
al.,
2004
).A
OC
P a
re g
ener
ally
ego
- sy
nton
ic a
s th
ey a
reno
t ex
peri
ence
d as
ina
ppro
pria
te (
Bar
on-
Coh
en &
Whe
elw
righ
t,19
99).
Obs
essi
onal
inte
rest
s no
rmal
ly d
o no
t tri
gger
anx
iety
or
guilt
,as
they
are
of-
ten
acco
mpa
nied
by
feel
ings
of e
upho
ria
(Jör
gens
en,1
994,
p.55
).O
ther
rit
uals
in a
utis
m,h
owev
er,c
an r
esem
ble
the
com
puls
ions
of
OC
D,
as th
ey a
re c
arri
ed o
ut to
redu
ce a
nxie
ty o
r to
prev
ent t
hrea
teni
ng e
vent
s.A
c-co
rdin
g to
Jol
iffe
et a
l.(1
992)
rit
uals
in a
utis
m s
erve
as
a st
ruct
urin
g el
emen
tin
a w
orld
exp
erie
nced
as
chao
tic.
Rou
tine
,the
rec
ogni
tion
of
regu
lar
pat-
tern
s,te
mpo
ral s
truc
turi
ng a
nd ri
tual
s can
hel
p to
redu
ce a
nxie
ty a
nd fe
elin
gsof
con
fusi
on tr
igge
red
by s
enso
ry o
verl
oad
(see
How
lin,2
004,
p.13
7).
The
idi
osyn
crat
ic s
tere
otyp
ies
of a
utis
m,r
each
ing
from
sim
ple
refl
ex-
like
acti
ons
to c
ompl
ex m
ovem
ent
patt
erns
som
etim
es r
esem
ble
tic-
rel
at-
ed O
CD
sym
ptom
s (R
asm
usse
n &
Eis
en,1
992)
.Ste
reot
ypie
s ar
e of
ten
trig
-ge
red
by c
erta
in s
tim
uli
(Gri
tti,
Bov
e,D
i Sa
rno,
D’A
ddio
,Chi
appa
ro,&
12
Lif
e Sp
an a
nd D
isab
ility
Fi
sche
r-Te
rwor
th C
./ P
robs
t P.
Bov
e,20
03)
and
may
indi
cate
dis
tres
s or
hid
den
anxi
etie
s (H
owlin
,200
4,p.
144)
.AO
CP
are
not
nec
essa
rily
ass
ocia
ted
wit
h fu
ncti
onal
impa
irm
ent,
al-
thou
gh th
is is
oft
en th
e ca
se.
4.2
Aut
ism
-rel
ated
obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
(AO
CP
)A
ccor
ding
to L
am,B
odfis
h an
d P
iven
(20
08)
ther
e is
con
side
rabl
e st
ruc-
ture
wit
hin
repe
titi
ve b
ehav
iors
in
auti
sm b
eing
dif
fere
ntia
lly r
elat
ed t
osu
bjec
t cha
ract
eris
tics
and
fam
ilial
ity.
Usi
ng e
xplo
rato
ry fa
ctor
ana
lysi
s th
eau
thor
s id
enti
fied
thre
e di
stin
ct fa
ctor
s re
late
d to
AO
CP
:(a)
rep
etit
ive
mo-
tor
beha
vior
s (b
) in
sist
ence
on
sam
enes
s an
d (c
) ci
rcum
scri
bed
inte
rest
s .
“Rep
etit
ive
mot
or b
ehav
iors
”w
ere
foun
d to
be
asso
ciat
ed w
ith
a va
riet
yof
sub
ject
cha
ract
eris
tics
suc
h as
IQ
or
age.
Lik
e “i
nsis
tenc
e of
sam
enes
s”th
ey a
re a
ssoc
iate
d w
ith
soci
al a
nd c
omm
unic
atio
n im
pair
men
ts,w
here
asci
rcum
scri
bed
inte
rest
s ap
pear
ed t
o be
inde
pend
ent
of s
ubje
ct c
hara
cter
is-
tics
.Bas
ed o
n si
b-pa
ir c
orre
lati
ons,
insi
sten
ce o
n sa
men
ess
and
circ
um-
scri
bed
inte
rest
s an
d ci
rcum
scri
bed
inte
rest
s ap
pear
to b
e fa
mili
al.A
ccor
d-in
g to
Lam
et a
l.(2
008)
the
pres
ence
of m
ulti
ple
form
s of
AO
CP
in a
n in
di-
vidu
al is
ass
ocia
ted
wit
h m
ore
impa
irm
ent i
n th
e so
cial
and
com
mun
icat
ion
dom
ains
,sug
gest
ing
a m
ore
seve
re a
utis
tic
diso
rder
.
4.2.
1 C
ircu
msc
ribe
d In
tere
sts
Cir
cum
scri
bed
inte
rest
s of
ten
appe
arin
g ob
sess
iona
l an
d bi
zarr
e,ar
eco
mm
on in
AD
/HFA
.The
pre
occu
pati
on o
ften
bec
omes
so
dom
inan
t in
the
indi
vidu
als’
live
s th
at o
ther
inte
rest
s an
d du
ties
are
neg
lect
ed (
Jörg
ense
n,19
94;H
owlin
,200
4).S
peci
al i
nter
ests
can
be
linke
d w
ith
spec
ial
abili
ties
and
diff
er fr
om th
e ot
her
cate
gori
es o
f AO
CP
(So
uth
et a
l.,20
05;L
am e
t al.,
2008
).In
divi
dual
s be
ing
fasc
inat
ed b
y th
e su
bjec
t of
the
ir i
nter
est,
com
-m
only
acq
uire
gre
at k
now
ledg
e in
a s
peci
al,c
ircu
msc
ribe
d fie
ld m
ostl
y ha
v-in
g to
do
wit
h te
chni
cal
aspe
cts
of o
bjec
ts a
nd t
hing
s (B
aron
-Coh
en &
Whe
elw
righ
t,19
99).
One
ind
ivid
ual
colle
cts
exac
t in
form
atio
n ab
out
the
orga
niza
tion
of
seat
sys
tem
s in
tra
ins,
anot
her
mem
oriz
es e
xact
ly t
imet
a-bl
es o
f arr
ivin
g an
d de
part
ing
plan
es a
nd a
thir
d on
e m
ay k
now
in d
etai
l all
type
s of
vac
uum
cle
aner
s.T
he in
tere
sts
are
ofte
n dy
sfun
ctio
nal,
sens
eles
san
d w
itho
ut a
ny c
onne
ctio
n to
a c
erta
in p
urpo
se,w
hile
in o
ther
cas
es a
utis
-ti
c pe
ople
can
use
the
ir k
now
ledg
e an
d ta
lent
s in
a j
ob (
see
Asp
erge
r,19
44/1
991;
Jörg
ense
n,19
94;H
owlin
,200
4).
4.2.
2 St
ereo
typi
esSt
ereo
type
d m
ovem
ents
(B
odfis
h,Sy
mon
s,P
arke
r,&
Lew
is,2
000)
occ
urm
ore
freq
uent
ly i
n au
tist
ic i
ndiv
idua
ls t
han
in t
hose
wit
h ot
her
deve
lop-
men
tal d
isor
ders
.Ste
reot
ypie
s lik
e ga
zing
at o
bjec
ts a
nd fi
nger
s ro
ckin
g,fin
-ge
r tw
itch
ing
or s
elf-
inju
ring
beh
avio
urs
are
freq
uent
ly t
rigg
ered
by
min
i-m
al c
hang
es i
n en
viro
nmen
t (G
oldm
an,W
ang,
Salg
ado,
Gre
ene,
Kim
,&R
apin
,200
9),d
aily
rou
tine
,fee
lings
of
empt
ines
s,bo
redo
m o
r in
adeq
uate
13
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
stim
ulat
ion
(Ken
nedy
et a
l.,20
00).
Ster
eoty
ped
beha
viou
r ca
n ha
ve m
ulti
-pl
e fu
ncti
ons
(Cun
ning
ham
& S
chre
ibm
an,2
008)
,oft
en b
eing
ass
ocia
ted
wit
h “n
arro
win
g or
wid
enin
g th
e au
tist
ic b
arri
er”
(Gri
tti e
t al
.,20
03).
The
beha
viou
rs a
nd m
ovem
ents
whi
ch t
end
to e
xace
rbat
e un
der
cond
itio
ns o
fst
ress
,can
hav
e se
nsor
y or
soc
ial
func
tion
(C
unni
ngha
m &
Sch
reib
man
,20
08),
som
etim
es t
hey
can
be a
nxie
ty-o
r te
nsio
n-re
duci
ng (
How
lin,2
004,
pp.1
44)
or r
evea
l inn
er c
onfl
icts
(T
inbe
rgen
& T
inbe
rgen
,198
4,p.
86).
Inot
her
case
s st
ereo
type
d m
ovem
ents
ser
ve t
o av
oid
man
agin
g ta
sks
or t
oar
ouse
the
att
enti
on o
f ot
hers
.Sel
f-in
juri
ous
beha
viou
r ca
n ha
ve m
ulti
ple
func
tion
s,e.
g.th
e on
e of
sel
f- s
tim
ulat
ion
in i
ndiv
idua
ls w
ho o
nly
“fee
lth
emse
lves
”w
hen
expe
rien
cing
phy
sica
l pai
n (K
enne
dy e
t al.,
2000
,p.5
60).
4.3
Tra
nsiti
on f
rom
AO
CP
to o
bses
sion
s an
d co
mpu
lsio
nsA
OC
P te
nd to
bec
ome
mor
e co
mpl
ex w
ith
grow
ing
age,
espe
cial
ly w
hen
ther
e is
a h
igh
inte
llect
ual p
oten
tial
.In
the
rese
arch
lite
ratu
re th
ere
are
de-
scri
ptio
ns o
f ca
ses
show
ing
mix
ture
s an
d tr
ansi
tion
s be
twee
n A
OC
P a
ndty
pica
l OC
D-s
ympt
oms.
The
per
man
ent
verb
aliz
atio
n of
spe
cial
inte
rest
sof
ten
incl
udes
exc
essi
ve r
umin
atin
g ab
out t
he s
peci
al to
pic,
whe
re e
upho
ria
can
chan
ge in
to a
nxie
ty (
How
lin,2
004;
Font
enel
le e
t al.,
2004
).T
he e
xces
sive
col
lect
ing
and
hoar
ding
of
obje
cts
like
sto
nes,
CD
s or
book
s is
a c
hara
cter
isti
c ac
tivi
ty o
f aut
isti
c in
divi
dual
s.C
olle
ctio
ns a
re o
ften
arra
nged
in e
labo
rate
cat
alog
ues
cont
aini
ng p
reci
se n
umbe
ring
and
dat
asy
stem
s (H
owlin
,200
4,p.
141)
.The
col
lect
ing
pass
ion
of a
utis
tic
indi
vidu
als
can
conv
ert
into
OC
D-s
peci
fic h
oard
ing
com
puls
ions
,whe
n co
llect
ing
and
hoar
ding
is
asso
ciat
ed w
ith
dist
ress
for
the
ind
ivid
ual
and/
or t
he f
amil
ym
embe
rs.A
part
men
ts o
f ho
arde
rs a
re o
ften
ove
rloa
ded
wit
h us
eles
s ob
-je
cts
tow
ards
whi
ch t
he in
divi
dual
is e
mot
iona
lly a
ttac
hed
to in
an
unus
ual
inte
nsit
y.P
atie
nts
wit
h co
mpu
lsiv
e ho
ardi
ng a
re e
xtre
mel
y an
xiou
s to
thro
w t
hing
s aw
ay a
nd f
eel
exce
ssiv
e re
spon
sibi
lity
for
kee
ping
the
m(S
chw
artz
& B
eyet
te,1
997,
p.29
).Fa
scin
atio
n an
d an
xiet
y ca
n al
so b
e en
-ta
ngle
d in
reg
ard
to o
bses
sion
al in
tere
sts.
Obj
ects
bei
ng p
rim
arily
fas
cina
t-in
g ca
n tu
rn in
to o
bjec
ts e
licit
ing
phob
ic a
nxie
ty a
nd o
bses
sive
fea
rs (
ex-
ampl
es s
ee H
owlin
,200
4,pp
.145
).
Box
No.
1:P
rim
arily
fas
cina
ting
obje
cts
trig
ger
obse
ssio
ns a
nd p
hobi
c an
xiet
y
An
inte
llige
nt a
utis
tic
boy,
who
had
bee
n fa
scin
ated
wit
h al
l asp
ects
of
elec
tric
ity
for
man
y ye
ars,
had
been
exp
erim
enti
ng w
ith
elec
tric
al e
quip
men
t fo
r m
any
hour
s da
ily.
Yea
rs la
ter
he d
evel
oped
inte
nse
and
exce
ssiv
e fe
ars
and
obse
ssio
ns r
elat
ed to
ele
ctri
c-it
y,tr
igge
red
by h
is p
aren
ts’ w
arni
ngs
conc
erni
ng h
is d
ange
rous
pre
occu
pati
on.H
e th
enre
fuse
d to
tou
ch a
ny e
lect
rica
l ap
plia
nce
wit
hout
exc
essi
vely
and
rep
eate
dly
havi
ngch
ecke
d th
eir
safe
ty b
efor
e.W
ith
the
exac
erba
tion
of
his
obse
ssio
nal f
ears
he
fina
llyw
asn’
t ab
le t
o us
e ki
tche
n an
d ba
thro
om b
ecau
se h
e fe
ared
cau
sing
an
acci
dent
bri
ng-
ing
elec
tric
ity
into
touc
h w
ith
wat
er.
14
Lif
e Sp
an a
nd D
isab
ility
Fisc
her-
Terw
orth
C./
Pro
bst P
.
Thi
s bo
y,w
hose
aut
ism
- rel
ated
spe
cial
inte
rest
con
vert
ed in
to a
n O
CD
-sy
mpt
om,d
evel
oped
an
elec
tric
ity
obse
ssio
n as
soci
ated
wit
h co
mpu
lsiv
ech
ecki
ng a
nd ty
pica
l avo
idan
ce b
ehav
iour
whi
ch w
ould
req
uire
the
diag
no-
sis
of a
utis
m w
ith
conc
omit
ant O
CD
.
The
kee
ping
of fi
xed
tim
es,r
itua
ls a
nd o
rder
ing
prin
cipl
es is
an
esse
ntia
lpa
rt o
f lif
e in
aut
isti
c in
divi
dual
s.P
robl
ems
are
likel
y to
occ
ur w
hen
life
cond
itio
ns c
hang
e an
d im
port
ant
acti
viti
es g
et n
egle
cted
in f
avou
r of
rit
u-al
ized
beh
avio
urs
(see
How
lin,2
004;
Box
No.
2).
Box
No.
2:P
robl
ems
caus
ed b
y th
e ch
ange
of
habi
ts
An
auti
stic
boy
livi
ng in
Aus
tral
ia h
ad b
een
fasc
inat
ed b
y m
eteo
rolo
gy.E
very
day
he
had
been
che
ckin
g th
e co
ngru
ence
of t
he w
eath
er fo
reca
st w
ith
the
obse
rvab
le w
eath
erw
hich
was
alw
ays
“gua
rant
eed”
in h
is h
ome
coun
try.
Aft
er h
avin
g m
oved
to
Eng
land
wit
h hi
s fa
mily
,he
beca
me
incr
easi
ngly
dis
turb
ed a
bout
the
fac
t th
at in
Gre
at B
rita
inth
e re
al w
eath
er fr
eque
ntly
dif
fere
d fr
om th
e w
eath
er p
redi
cted
in th
e fo
reca
st.
A y
oung
wom
an d
iagn
osed
wit
h an
aut
isti
c di
sord
er i
nsis
ted
com
pul-
sive
ly i
n ke
epin
g a
cert
ain
orde
r in
her
roo
m i
n he
r pa
rent
s’ h
ouse
.Al-
thou
gh li
ving
in a
n in
stit
utio
n,no
fam
ily m
embe
r w
as e
ver
allo
wed
to m
ove
any
item
in th
e ro
om b
ecau
se s
he h
ad s
tron
gly
forb
idde
n an
y ki
nd o
f min
i-m
al c
hang
e th
ere.
Lik
e in
man
y ca
ses
of O
CD
,a n
eed
for
abso
lute
com
plet
enes
s,sa
men
ess
and
sym
met
ry g
ets
evid
ent
in b
oth
exam
ples
of
Box
No.
2 (R
asm
usse
n &
Eis
en,1
992)
.The
boy
’s b
ehav
iour
,a t
ypic
al a
utis
m-r
elat
ed s
peci
al in
tere
stac
com
pani
ed b
y a
stro
ng r
itua
lizat
ion,
also
dis
play
s fe
atur
es o
f a
chec
king
com
puls
ion.
The
inte
rrup
tion
or
the
inco
mpl
eten
ess
of r
itua
ls c
ause
s si
gnif
-ic
ant
dist
ress
in a
utis
tic
indi
vidu
als
and
is a
lso
char
acte
rist
ic f
or O
CD
.The
inte
nse
fear
of c
hang
e un
derl
ying
thes
e ri
tual
s is
a ty
pica
lly a
utis
tic
feat
ure
also
app
lyin
g to
sev
eral
OC
D- s
ympt
oms.
The
wom
an’s
beh
avio
ur h
as ty
p-ic
al e
lem
ents
of a
n or
deri
ng c
ompu
lsio
n ac
com
pany
ing
the
auti
sm- r
elat
edin
sist
ence
on
sam
enes
s.In
bot
h ca
ses
OC
D s
ympt
oms
and
auti
stic
feat
ures
go h
and
in h
and
(Bej
erot
et a
l.,20
01;B
ejer
ot,2
007)
.
4.4
Obs
essi
ons
and
com
puls
ions
in a
utis
tic
diso
rder
s
4.4.
1 E
xam
ples
In t
he a
utis
m l
iter
atur
e th
ere
are
desc
ript
ions
of
seve
ral
obse
ssiv
eth
ough
ts a
nd c
ompu
lsiv
e be
havi
ours
mee
ting
the
DSM
- IV
- cr
iter
ia f
orO
CD
-rel
ated
obs
essi
ons
and
com
puls
ions
(se
e H
owlin
,200
4;B
ox N
o.3)
.
15
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
Box
No.
3:O
bses
sion
s an
d co
mpu
lsio
ns
A v
ery
gift
ed y
oung
wom
an h
ad a
utis
tic
sym
ptom
s be
ing
hard
ly r
ecog
niza
ble
for
othe
rpe
ople
.The
clin
ical
pic
ture
was
dom
inat
ed b
y co
mpu
lsiv
e ri
tual
s sh
e ha
d to
car
ry o
ut in
her
room
dur
ing
nigh
t- t
ime
beca
use
her
pare
nts
had
set
limit
s to
the
ir d
aily
per
for-
man
ce in
oth
er r
oom
s.Sh
e al
way
s ha
d to
pul
l the
cur
tain
s fr
om le
ft to
rig
ht a
nd v
ice
ver-
sa a
s of
ten
as t
hey
wer
e ex
actly
in th
e ri
ght p
ositi
on.S
he w
as a
lso
com
pelle
d to
rem
ove
even
the
smal
lest
dus
t par
ticl
es o
n th
e flo
or.
A b
oy w
ith
an a
utis
tic
diso
rder
dev
elop
ed t
he t
ypic
al a
ggre
ssiv
e ob
sess
ion
to le
ave
ash
op w
itho
ut h
avin
g pa
id.H
e fe
ared
to
have
sto
len
som
ethi
ng w
itho
ut h
avin
g re
cog-
nize
d it
.Eve
n fo
r th
e sm
alle
st e
xpen
ses
he in
sist
ed in
rec
eivi
ng th
e bi
ll to
be
abso
lute
lysu
re t
hat
he h
ad p
aid.
He
syst
emat
ical
ly c
olle
cted
all
the
bills
bec
ause
he
fear
ed b
eing
arre
sted
as
a th
ief.
Whe
n he
onc
e co
uld
not fi
nd o
ne o
f his
col
lect
ed b
ills,
he b
ecam
e ve
ry
anxi
ous
and
agit
ated
.
The
wom
an in
the
first
exa
mpl
e di
spla
ys o
bses
sion
s an
d co
mpu
lsio
ns r
e-la
ted
to s
ymm
etry
and
cle
anlin
ess.
She
had
to e
ngag
e in
rit
ualiz
ed a
djus
ting
the
curt
ains
and
cle
anin
g th
e flo
or t
ill s
he e
xper
ienc
ed a
typ
ical
OC
D-r
e-la
ted
just
rig
ht-f
eelin
g of
per
fect
sym
met
ry,c
ompl
eten
ess
and
clea
nlin
ess
(see
Ras
mus
sen
& E
isen
,199
2).T
he b
oy d
escr
ibed
in t
he s
econ
d ex
ampl
esu
ffer
ed f
rom
a t
ypic
al a
ggre
ssiv
e ob
sess
ion
asso
ciat
ed w
ith
the
fear
of
be-
com
ing
guilt
y.T
he o
bses
sion
is n
eutr
aliz
ed b
y co
mpu
lsiv
e re
assu
ring
and
chec
king
beh
avio
urs.
The
sym
ptom
aga
in d
ispl
ays
a ki
nd o
f dis
soci
atio
n ex
-pe
rien
ce b
ecau
se li
ke m
any
com
puls
ive
chec
kers
the
boy
coul
d no
t tru
st h
isow
n pe
rcep
tion
and
mem
ory.
The
se “
blac
k ou
ts”,
the
dark
spo
t in
the
expe
-ri
ence
of
OC
D-p
atie
nts,
lead
to
feel
ings
of
perm
anen
t in
secu
rity
,inc
om-
plet
enes
s an
d do
ubt
(Hof
fman
n &
Hof
man
n,20
04).
The
typ
e of
sym
ptom
sde
scri
bed
in B
ox.N
o.4
mig
ht a
lso
occu
r in
cas
es o
f O
CD
not
rel
ated
to
auti
stic
dis
orde
rs.
Gre
enet
al.
(200
0) d
escr
ibed
a b
oy w
ith
AS
who
dev
elop
ed a
n ob
sess
ive
fear
of v
omit
ing.
He
rum
inat
ed a
bout
how
to a
void
peo
ple
who
mig
ht v
om-
it in
fron
t of h
im b
ecau
se o
f hav
ing
cert
ain
dise
ases
.Alt
houg
h he
did
n’t r
e-ga
rd h
is f
ear
as c
ompl
etel
y un
reas
onab
le,h
e fe
lt t
he w
ish
to o
verc
ome
his
obse
ssio
n be
caus
e of
the
subs
tant
ial i
mpa
irm
ent i
t cau
sed
(Fon
tene
lle e
t al.,
2004
;Cat
h et
al.,
2008
).In
thi
s ca
se t
he c
lass
ifica
tion
as
a co
mor
bid
OC
D-
sym
ptom
bel
ongi
ng to
the
cate
gory
OC
D w
ith p
oor
insi
ght (
DSM
-IV
:APA
,20
00)
seem
s to
be
appr
opri
ate.
4.4.
2 C
linic
al tr
ials
(a)
McD
ougl
e et
al.
(199
5) s
tudi
ed r
epet
itiv
e th
ough
ts a
nd b
ehav
iour
s in
adul
ts w
ith
a pr
imar
y di
agno
sis
of a
utis
tic
diso
rder
and
com
pare
d th
emw
ith
the
obse
ssio
ns a
nd c
ompu
lsio
ns o
f O
CD
,mea
sure
d w
ith
the
Yal
e-B
row
n O
bses
sive
-Com
puls
ive
Scal
e (Y
BO
CS)
.In
divi
dual
s w
ith
OC
D h
ad m
ore
was
hing
,che
ckin
g an
d co
unti
ng c
om-
puls
ions
,whe
reas
aut
isti
c pr
oban
ds d
ispl
ayed
a g
reat
er f
requ
ency
of
com
-
16
Lif
e Sp
an a
nd D
isab
ility
Fi
sche
r-Te
rwor
th C
./ P
robs
t P.
puls
ive
ques
tion
ing,
telli
ng,h
oard
ing,
orde
ring
and
touc
hing
as
wel
l as
self
-in
juri
ous
beha
viou
rs.T
he a
utis
tic
pati
ents
had
sig
nific
antl
y le
ss a
ggre
ssiv
e,re
ligi
ous,
sexu
al a
nd s
omat
ic o
bses
sion
s th
an t
he O
CD
-pat
ient
s.A
sub
-gr
oup
of s
even
YB
OC
S sy
mpt
om v
aria
bles
cou
ld b
e id
enti
fied
whi
ch r
eli-
ably
pre
dict
ed b
elon
ging
to
the
auti
sm g
roup
.The
aut
hors
con
clud
ed t
hat
repe
titi
ve t
houg
hts,
beha
viou
rs a
nd a
ctiv
itie
s in
aut
ism
sig
nific
antl
y di
ffer
from
the
obs
essi
ons
and
com
puls
ions
dis
play
ed i
n th
e O
CD
-gro
up (
Mc-
Dou
gle
et a
l.,19
95).
(b)
Zan
dt e
t al.
(200
6) c
ompa
red
repe
titi
ve b
ehav
iour
s of
chi
ldre
n w
ith
HFA
and
tho
se d
ispl
ayed
by
chil
dren
wit
h O
CD
.Bot
h gr
oups
rep
orte
dm
ore
obse
ssio
ns a
nd c
ompu
lsio
ns t
han
a ty
pica
lly d
evel
opin
g co
mpa
riso
ngr
oup,
whe
reas
chi
ldre
n w
ith
OC
D r
epor
ted
mor
e ob
sess
ions
and
com
pul-
sion
s th
an c
hild
ren
wit
h H
FA.L
evel
s of
sam
enes
s be
havi
our
and
repe
titi
vem
ovem
ents
in th
e cl
inic
al g
roup
s w
ere
sim
ilar,
whe
reas
chi
ldre
n w
ith
OC
Den
gage
d in
mor
e re
peti
tive
beh
avio
ur fo
cuss
ed o
n ro
utin
es a
nd r
itua
ls.A
c-co
rdin
g to
the
aut
hors
,typ
es o
f ob
sess
ions
and
com
puls
ions
ten
ded
to b
ele
ss s
ophi
stic
ated
in c
hild
ren
wit
h H
FA t
han
in t
hose
wit
h O
CD
(Z
andt
et
al.,
2006
).(c
) R
usse
ll et
al.
(200
5) c
ompa
red
obse
ssiv
e- c
ompu
lsiv
e th
ough
ts a
ndbe
havi
ors
in A
S an
d H
FA-p
atie
nts
(n=
40)
wit
h ob
sess
ions
and
com
pul-
sion
s ex
peri
ence
d by
OC
D-P
atie
nts
(n=
45)
;10
(25%
) pa
rtic
ipan
ts w
ere
di-
agno
sed
wit
h A
S/H
FA p
lus
com
orbi
d O
CD
(A
S/H
FA+
OC
D).
AS/
HFA
-pa
rtic
ipan
ts w
ith
an a
vera
ge I
Q f
requ
entl
y di
spla
yed
intr
usiv
e,ti
me-
con
-su
min
g ob
sess
ions
and
com
puls
ions
cau
sing
sig
nifi
cant
dis
tres
s.O
nly
so-
mat
ic o
bses
sion
s,re
peat
ing
com
puls
ions
and
che
ckin
g co
mpu
lsio
ns o
c-cu
red
sign
ific
antl
y m
ore
ofte
n in
th
e O
CD
-gro
up.
Com
pari
ng
the
OC
D+
AS/
HFA
-gro
up w
ith
the
OC
D-g
roup
it b
ecam
e ev
iden
t th
at s
omat
-ic
obs
essi
ons
occu
red
sign
ific
antl
y m
ore
com
mon
ly i
n th
e O
CD
-gro
up,
whe
reas
mor
e A
S/H
FA+
OC
D-p
atie
nts
suff
ered
fro
m s
exua
l ob
sess
ions
(Rus
sell
et a
l.,20
05).
As
50 %
of
the
part
icip
ants
in t
he s
tudy
of
McD
ougl
e et
al.
(199
5) (
a)ha
d IQ
leve
ls b
elow
ave
rage
,man
y of
them
may
not
hav
e be
en a
ble
to c
om-
mun
icat
e ab
out
all t
heir
OC
D-s
ympt
oms,
espe
cial
ly t
hey
coul
dn’t
rep
ort
obse
ssio
ns (
Rus
sell
et a
l.,20
05).
The
res
ults
of
Zan
dt e
t al
.(20
06)
(b)
and
Rus
sell
et a
l.(2
005)
(c)
rev
eal t
hat i
ndiv
idua
ls w
ith
AS/
HFA
oft
en h
ave
ob-
sess
ions
and
com
puls
ions
acc
ordi
ng to
DSM
-IV
-cri
teri
a.
4.5
Tre
atm
ent
4.5.
1 O
bses
sive
-com
puls
ive
diso
rder
The
mos
t ef
fect
ive
trea
tmen
t of
OC
D is
cog
niti
ve b
ehav
iour
al t
hera
py(R
osa-
Alc
àzar
,San
chez
-Mec
a,G
ómez
-Con
esa,
& M
arin
-Mar
tine
z,20
08),
ofte
n in
com
bina
tion
wit
h an
tide
pres
sant
s se
lect
ivel
y bl
ocki
ng S
erot
onin
re-u
ptak
e (S
SRI;
Cho
i,20
09).
The
the
rape
utic
rat
iona
le o
f C
BT
is d
omi-
17
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
nate
d by
the
tec
hniq
ues
of e
xpos
ure
and
resp
onse
pre
vent
ion
(ER
P)
com
-bi
ned
wit
h co
gnit
ive
inte
rven
tion
s (H
and,
1992
;Sal
kovs
kis
et a
l.,19
97).
Af-
ter
iden
tify
ing
an o
bses
sion
or
a co
mpu
lsiv
e ur
ge a
s a
sym
ptom
of O
CD
on
the
cogn
itiv
e le
vel,
a pa
tien
t wit
h a
was
hing
com
puls
ion
e.g.
deci
des
volu
n-ta
rily
to
touc
h ”c
onta
min
ated
obj
ects
”(e
xpos
ure)
and
the
n re
frai
ns f
rom
was
hing
his
han
ds f
or e
.g.3
0 m
inut
es o
r lo
nger
(re
spon
se p
reve
ntio
n).H
eca
n no
w r
ealiz
e th
at a
nxie
ty a
nd d
isco
mfo
rt g
radu
ally
dec
reas
e w
ith
each
expo
sure
,alt
houg
h he
doe
s no
t eng
age
in c
ompu
lsiv
e w
ashi
ng.B
y re
duci
ngan
xiet
y an
d th
e in
tens
ity
of c
ompu
lsiv
e ur
ges,
SSR
Is h
elp
the
indi
vidu
al t
ore
sist
obs
essi
ons
com
puls
ions
and
to
shif
t at
tent
ion
to m
ore
adap
tive
be-
havi
ours
.CB
T h
elps
gra
dual
ly to
dis
enga
ge O
CD
-rel
ated
neu
rona
l cir
cuit
san
d to
act
ivat
e ne
uron
al p
athw
ays
asso
ciat
ed w
ith
adap
tive
beh
avio
urs
(Sch
war
tzet
al.,
1992
;Sch
war
tz &
Bey
ette
,199
7).A
s fa
mily
mem
bers
are
ofte
n st
rong
ly in
volv
ed in
to O
CD
(P
robs
t et a
l.,19
79;L
ivin
gsto
n- v
an N
op-
pen,
Ras
mus
sen,
Eis
en,&
McC
artn
ey,1
990)
,in
man
y ca
ses
addi
tion
al fa
m-
ily tr
eatm
ent i
s re
quir
ed (
Stek
etee
& P
igot
t,20
06,p
p.46
),es
peci
ally
in c
hil-
dren
and
ado
lesc
ents
.
4.5.
2 Tr
eatm
ent
appr
oach
es t
o A
utis
m-r
elat
ed o
bses
sive
com
puls
ive
phen
omen
aD
iffe
rent
beh
avio
ural
and
pha
rmac
olog
ical
inte
rven
tion
s be
ing
effe
c-ti
ve fo
r O
CD
hav
e be
en s
how
n to
be
help
ful i
n re
duci
ng A
OC
P a
nd O
CD
-sy
mpt
oms
in a
utis
tic
indi
vidu
als.
On
the
med
icat
ion
leve
l SSR
Is a
re s
ome-
tim
es e
ffici
ent
(Kol
evzo
n,M
athe
wso
n,&
Hol
land
er,2
006)
.,al
so t
he c
o-ad
-m
inis
trat
ion
or m
onot
hera
py w
ith
atyp
ical
ant
ipsy
chot
ics
has
been
sho
wn
to b
e he
lpfu
l,es
peci
ally
in c
ases
of
stro
ng t
ic-
like
ster
eoty
pies
(M
alon
e &
Wah
eed,
2009
).C
BT
inte
rven
tion
s in
clud
e th
e O
CD
sta
ndar
d te
chni
que
ofgr
adua
l ex
posu
re a
nd r
espo
nse
prev
enti
on (
Lin
dley
,Mar
ks,P
hilip
ott,
&Sn
owde
n 19
77),
whi
ch c
an b
e in
divi
dual
ly a
dapt
ed t
o au
tist
ic in
divi
dual
s,lik
e as
sho
wn
by t
he s
ucce
ssfu
l int
erve
ntio
n fo
r an
12-
year
old
AD
pat
ient
wit
h co
mor
bid
OC
D (
Leh
mku
hl e
t al
.,20
08).
Met
hods
whi
ch a
lso
may
be
effe
ctiv
e ar
e ha
bit
reve
rsal
,beh
avio
ural
ref
ocus
ing
and
indi
vidu
al v
aria
nts
of t
houg
ht s
topp
ing
(How
lin,
2004
,p.1
47).
Nil
sson
and
Eks
eliu
s (2
009)
even
hav
e sh
own
the
effe
ctiv
enes
s of
rep
eate
d el
ectr
ocon
vuls
ive
ther
apy
for
an 3
8-ye
ar-o
ld A
D p
atie
nt w
ith
refr
acto
ry O
CD
-sym
ptom
s.
5.C
oncl
usio
n
Indi
vidu
als
wit
h au
tist
ic d
isor
ders
fre
quen
tly
disp
lay
obse
ssio
ns a
ndco
mpu
lsio
ns c
o-oc
curr
ing
wit
h A
utis
m- r
elat
ed o
bses
sive
- com
puls
ive
phe-
nom
ena
(AO
CP
).In
com
pari
son
wit
h O
CD
-sym
ptom
s,A
OC
P a
re p
rim
ar-
ily e
go- s
ynto
nic,
serv
e w
ith
diff
eren
t fun
ctio
ns fo
r th
e in
divi
dual
s an
d do
n’t
elic
it a
nxie
ty a
nd d
isco
mfo
rt.H
owev
er,o
bses
sive
-com
puls
ive
phen
omen
a
18
Lif
e Sp
an a
nd D
isab
ility
Fisc
her-
Terw
orth
C./
Pro
bst P
.
in O
CD
and
aut
ism
can
not
be d
icho
tom
ized
in t
erm
s of
ego
-syn
tony
and
ego-
dyst
ony
(Fon
tene
lle e
t al.,
2004
;Iva
rsso
n &
Mel
in,2
008)
.The
lack
of i
n-si
ght
or p
oor
insi
ght (
DSM
-IV
;APA
,200
0) in
to t
he s
ense
less
ness
of
obse
s-si
ve-c
ompu
lsiv
e ph
enom
ena
is n
ot a
spe
cific
feat
ure
of A
OC
P.It
is a
lso
seen
in o
bses
sive
com
puls
ive
pers
onal
ity
diso
rder
(R
asm
usse
n &
Eis
en,1
992)
and
OC
D-s
ympt
oms
rela
ted
to s
chiz
otyp
ical
dis
orde
rs b
elon
ging
to th
e bo
r-de
rlin
e be
twee
n ob
sess
ions
and
del
usio
ns (
Sobi
n et
al.,
2000
;Bej
erot
,200
7).
Alt
houg
h pr
imar
ily b
eing
ego
-syn
toni
c,A
OC
P-r
elat
ed s
peci
al in
tere
sts
can
have
a d
eep
impa
ct o
n fa
mily
life
,e.g
.whe
n fa
mily
mem
bers
are
tyra
nniz
edbe
ing
forc
ed to
exc
essi
vely
par
tici
pate
in r
itua
lized
spe
cial
inte
rest
s.A
utis
mw
ith
com
orbi
d O
CD
-sym
ptom
s or
a “
mix
ture
”of
spe
cial
-int
eres
ts a
ndO
CD
-sym
ptom
s,m
ovin
g on
a c
onti
nuum
bet
wee
n fa
scin
atio
n an
d an
xiet
y,ca
n ca
use
sign
ifica
nt d
istr
ess
in p
atie
nts
and
fam
ily m
embe
rs.
AS/
HFA
-ind
ivid
uals
hav
ing
high
er c
ogni
tive
and
ling
uist
ic a
bilit
ies
are
able
to
verb
aliz
e ty
pica
l ob
sess
ions
,ass
ocia
ted
emot
ions
,mag
ical
bel
iefs
and
the
degr
ee o
f in
sigh
t.F
urth
er s
tudi
es m
ust
reve
al w
hich
obs
essi
onal
and
com
puls
ive
thou
ghts
and
beh
avio
rs in
aut
isti
c di
sord
ers
have
to
be r
e-ga
rded
sym
ptom
s of
com
orbi
d O
CD
.Clin
icia
ns m
ust t
ake
into
acc
ount
that
typi
cal O
CD
- sym
ptom
s m
ay n
ot b
e an
inte
gral
par
t of t
he a
utis
tic
diso
rder
.A
n ex
act
diff
eren
tial
dia
gnos
tic
asse
ssm
ent
is e
ssen
tial
,as
auti
stic
pat
ient
sw
ith
com
orbi
d O
CD
may
ben
efit
from
sta
ndar
d O
CD
-tre
atm
ents
(R
usse
llet
al.,
2005
) or
indi
vidu
al t
reat
men
t de
sign
s fo
r au
tism
-rel
ated
OC
D.C
on-
trol
led
tria
ls h
ave
to r
evea
l whi
ch p
atie
nts
may
res
pond
to
indi
vidu
al v
ari-
ants
of C
BT
and
/or
phar
mac
olog
ical
trea
tmen
t.O
n th
e le
vel o
f dif
fere
ntia
ldi
agno
sis
is h
as t
o be
spe
cifie
d w
hich
sym
ptom
pro
files
mig
ht s
erve
as
pre-
dict
ors
for
a pa
tien
t’s
resp
onse
to c
erta
in tr
eatm
ent s
trat
egie
s.
Ref
eren
ces
Abr
amso
n,R
.,R
avan
,S.,
Wri
ght,
H.,
Wie
duw
ilt,K
.,W
olpe
rt,C
.,D
onne
lly,S
.,P
eri-
cak-
Van
ce,M
.,&
Cuc
caro
,M.(
2005
).T
he r
elat
ions
hip
betw
een
rest
rict
ive
and
repe
titi
ve b
ehav
iors
in
indi
vidu
als
wit
h au
tism
and
obs
essi
ve-c
ompu
lsiv
e sy
mp-
tom
s in
par
ents
.Chi
ld P
sych
iatr
y an
d H
uman
Dev
elop
men
t,36
(2)
,155
-65.
Am
aral
,D.G
.,&
Cor
bett
,B.A
.(20
02).
The
am
ygda
la,a
utis
m a
nd a
nxie
ty.N
ovar
tisFo
und
Sym
p.25
1,17
7-18
7.
Am
eric
an P
sych
iatr
ic A
ssoc
iati
on (
1994
).D
iagn
osti
c an
d st
atis
tica
l M
anua
l of
Men
tal D
isor
ders
(DSM
-IV
) 4th
ed.W
ashi
ngto
n,D
C:A
PA.
Am
eric
an P
sych
iatr
ic A
ssoc
iati
on (
2000
).D
iagn
ostic
and
Sta
tistic
Man
ual o
f Men
tal
Dis
orde
rs(D
SM-I
V)
4th
ed.T
ext R
evis
ed (
DSM
-IV
-TR
).W
ashi
ngto
n,D
C:A
PA.
19
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
And
rese
n,B
.,&
Maß
,R.(
2001
).Sc
hizo
typi
e:P
sych
omet
risc
he E
ntw
ickl
unge
n un
dbi
opsy
chol
ogis
che
Fors
chun
gsan
sätz
e(T
he c
once
pt o
f sc
hizo
typy
:psy
chom
etri
cde
velo
pmen
ts a
nd b
iops
ycho
logi
cal a
ppro
ache
s).G
ötti
ngen
:Hog
refe
.
Asp
erge
r ,H
.(19
44).
Die
“Aut
isti
sche
n P
sych
opat
hen“
im K
inde
salt
er (
The
“Aut
is-
tic
Psy
chop
aths
”in
chi
ldho
od).
Arc
hiv
für
Psy
chia
trie
und
Ner
venk
rank
heite
n,11
7,76
-136
.
Asp
erge
r,H
.(19
44/1
991)
.“A
utis
tic
psyc
hopa
thy”
in c
hild
hood
(tr
ansl
ated
and
an-
nota
ted
by U
ta F
rith
from
the
text
book
of A
sper
ger,
H.,
1952
,Hei
lpäd
agog
ik (
Re-
med
ial
educ
atio
n) w
hich
inc
lude
s a
slig
htly
rev
ised
rep
rint
of
his
orig
inal
pap
erw
ritt
en in
194
4).I
n U
.Fri
th (
Ed.
),A
utis
m a
nd A
sper
ger
synd
rom
e (p
p.37
-92)
.Cam
-br
idge
,UK
:Cam
brid
ge U
nive
rsit
y P
ress
.
Bar
on-C
ohen
,S.(
1989
).D
o au
tist
ic c
hild
ren
have
obs
essi
ons
and
com
puls
ions
?B
ritis
h Jo
urna
l of
Clin
ical
Psy
chol
ogy,
28 (
3),1
03-2
00.
Bar
on-C
ohen
,S.(
2004
).T
he c
ogni
tive
neu
rosc
ienc
e of
aut
ism
.Jou
rnal
of N
euro
lo-
gy,N
euro
surg
ery
and
Psy
chia
try,
75 (
7),9
45-9
48.
Bar
on-C
ohen
,S.&
Whe
elw
righ
t,S.
(199
9).‘
Obs
essi
ons’
in c
hild
ren
wit
h au
tism
or
Asp
erge
r sy
ndro
me.
Con
tent
ana
lysi
s in
term
s of
cor
e do
mai
ns o
f cog
niti
on.B
ritis
hJo
urna
l of
Psy
chia
try,
175,
484-
490.
Bau
mga
rten
,H.G
.,&
Gro
zdan
ovic
,Z.(
1998
).T
he r
ole
of s
erot
onin
in o
bses
sive
-co
mpu
lsiv
e di
sord
er.B
ritis
h Jo
urna
l of
Psy
chia
try,
173
(sup
pl.3
5),1
3-20
.
Bej
erot
,S.,
Nyl
ande
r,L
.,&
Lin
dstr
öm,E
.(20
01).
Aut
isti
c tr
aits
in o
bses
sive
-com
-pu
lsiv
e di
sord
er.N
ordi
c Jo
urna
l of
Psy
chia
try,
55(3
),16
9-17
6.
Bej
erot
,S.(
2007
).A
n au
tist
ic d
imen
sion
.A p
ropo
sed
subt
ype
of o
bses
sive
-com
-pu
lsiv
e di
sord
er.A
utis
m,1
1 (2
),10
1-11
0.
Bej
erot
,S.,
& M
örtb
erg,
E.(
2009
).D
o au
tist
ic t
rait
s pl
ay a
rol
e in
the
bul
lyin
g of
obse
ssiv
e-co
mpu
lsiv
e di
sord
er a
nd s
ocia
l pho
bia
suff
erer
s? P
sych
opat
holo
gy,4
2(3
),17
0-17
6.
Bha
rdw
aj,A
.,A
garw
al,V
.,&
Sit
hole
y,P.
(200
5).A
sper
ger’
s di
sord
er w
ith
com
orbi
dse
para
tion
anx
iety
dis
orde
r:a
case
rep
ort.
Jour
nal
of A
utis
m a
nd D
evel
opm
enta
lD
isor
ders
,35
(1),
135-
136.
Bod
fish,
J.W
.,Sy
mon
s,F.
J.,P
arke
r,D
.E.,
& L
ewis
,M.H
.(20
00).
Var
ieti
es o
f rep
et-
itiv
e be
havi
or in
aut
ism
:com
pari
sons
to m
enta
l ret
arda
tion
.Jou
rnal
of A
utis
m a
ndD
evel
opm
enta
l Dis
orde
rs,3
0(3
),23
7-24
3.
Bog
er-M
eggi
do,I
.,Sh
aw,D
.W.,
Frie
dman
,S.D
.,Sp
arks
,B.F
.,A
rtru
,A.A
.,G
iedd
,J.
N.,
Daw
son,
G.,
& D
ager
,S.R
.(20
06).
Cor
pus
callo
sum
mor
phom
etri
cs in
you
ngch
ildre
n w
ith
auti
sm s
pect
rum
dis
orde
r.Jo
urna
l of A
utis
m a
nd D
evel
opm
enta
l Dis
-or
ders
(epu
b ah
ead
of p
rint
).
20
Lif
e Sp
an a
nd D
isab
ility
Fi
sche
r-Te
rwor
th C
./ P
robs
t P.
Bol
ton,
P.F.
,Pic
kles
,A.,
Mur
phy,
M.,
& R
utte
r,M
.(19
98).
Aut
ism
,aff
ecti
ve a
nd o
th-
er p
sych
iatr
ic d
isor
ders
:pat
tern
s of
fam
ilial
agg
rega
tion
.Psy
chol
ogic
al M
edic
ine,
28(2
),38
5-39
5.
Bra
dsha
w,J
.L.,
& S
hepp
ard,
D.M
.(20
00).
The
neu
rode
velo
pmen
t fr
onto
- st
riat
aldi
sord
ers:
evol
utio
nary
ada
ptiv
enes
s an
d an
omal
ous
late
raliz
atio
n.B
rain
and
Lan
-gu
age,
73(2
),29
7-32
0.
Bou
cher
,J.,
Cow
ell,
P.,H
owar
d,M
.,B
roks
,P.,
Farr
ant,
A.,
Rob
erts
,N.,
& M
ayes
,A.
(200
5).A
com
bine
d cl
inic
al,n
euro
psyc
holo
gica
l an
d ne
uroa
nato
mic
al s
tudy
of
adul
ts w
ith
Hig
h-F
unct
ioni
ng A
utis
m.C
ogni
tive
Neu
rops
ychi
atry
,10
(3),
165-
213.
Cat
h,D
.C.,
Ran
,N.,
Smit
,J.H
.,va
n B
alko
m,A
.J.,
& C
omijs
,H.C
.(20
08).
Sym
ptom
over
lap
betw
een
auti
sm s
pect
rum
dis
orde
r,ge
nera
lized
soc
ial a
nxie
ty d
isor
der
and
obse
ssiv
e-co
mpu
lsiv
e di
sord
er in
adu
lts:
a pr
elim
inar
y ca
se-c
ontr
olle
d St
udy.
Psy
-ch
opat
holo
gy,4
1,10
1-11
0.
Cho
i,Y
.J.(
2009
).E
ffica
cy o
f tre
atm
ents
for
pati
ents
wit
h ob
sess
ive-
com
puls
ive
dis-
orde
r:a
syst
emat
ic r
evie
w.J
ourn
al o
f th
e A
mer
ican
Aca
dem
y of
Nur
se P
ract
ione
rs,
21(4
),20
7-13
.
Cuc
caro
,M.L
.,N
atio
ns,L
.,B
rink
ley,
J.,A
bram
son,
R.K
.,W
righ
t,H
.H.,
Hal
l,A
.,G
ilber
t,J.
,& P
eric
ak-V
ance
,M.A
.(20
07).
A c
ompa
riso
n of
rep
etit
ive
beha
vior
s in
Asp
erge
rs d
isor
der
and
high
func
tion
ing
auti
sm.C
hild
Psy
chia
try
and
Hum
an D
e-ve
lopm
ent,
37(4
),34
7-36
0.
Cul
len,
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Sam
uels
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Gra
dos,
M.,
Lan
da,R
.,B
ienv
enu,
O.J
.,L
iang
,K.Y
.,R
iddl
e,M
.,H
oehn
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ic,R
.,&
Nes
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).So
cial
and
com
mun
icat
ion
diffi
cult
ies
inob
sess
ive
com
puls
ive
diso
rder
.Psy
chop
atho
logy
,41(
3),1
94-2
00
Cun
ning
ham
,A.B
.,&
Sch
reib
man
,L.(
2008
) St
ereo
typy
in a
utis
m:t
he im
port
ance
of fu
ncti
on.R
esea
rch
in a
utis
m s
pect
rum
dis
orde
rs,2
(3),
469-
479.
Dam
asio
,A.R
.,&
Mau
rer,
R.G
.(19
78).
A n
euro
logi
cal
mod
el f
or c
hild
hood
auti
sm.A
rchi
ves
of N
euro
logy
,35
(12)
,777
-786
.
Del
orm
e,R
.,G
ouss
e,V
.,R
oy,I
.,Tr
anda
fir,A
.,M
athi
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.,M
oure
n-Si
meo
ni,M
.C.,
Bet
ancu
r,C
.,&
Leb
oyer
,M.(
2007
).Sh
ared
exe
cuti
ve d
ysfu
ncti
ons
in u
naff
ecte
dre
lati
ves
of p
aren
ts w
ith
auti
sm a
nd o
bses
sive
-com
puls
ive
diso
rder
.Eur
opea
n P
sy-
chia
try,
22(1
),32
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Dzi
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Fle
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.,R
oger
s,K
.,W
olf,
O.T
.,&
Con
vit,
A.(
2006
).T
he ‘a
myg
dala
theo
ry o
f au
tism
’ rev
isit
ed:l
inki
ng s
truc
ture
to
beha
vior
.Neu
rops
ycho
logi
a,M
ar24
(epu
b ah
ead
of p
rint
).
Est
erbe
rg,M
.L.,
Trot
man
,H.D
.,B
rasfi
eld,
J.L
.,C
ompt
on,M
.T.,
& W
alke
r,E
.F.
(200
8).C
hild
hood
and
cur
rent
aut
isti
c fe
atur
es in
ado
lesc
ents
wit
h sc
hizo
typa
l per
-so
nalit
y di
sord
er.S
chiz
ophr
enia
Res
earc
h,10
4,26
5-27
3.
21
Obs
essi
ve-c
ompu
lsiv
e ph
enom
ena
and
sym
ptom
s in
Asp
erge
r’s
diso
rder
and
Hig
h-fu
ncti
onin
g A
utis
m
Eva
ns,D
.M.,
Lec
kman
,J.F
.,C
arte
r,A
.,R
ezni
ck,J
.S.,
Hen
shaw
,D.,
Kin
g,R
.A.,
&P
auls
,D.(
1997
).R
itua
l,ha
bit
and
perf
ecti
onis
m:t
he p
reva
lenc
e an
d de
velo
pmen
tof
com
puls
ive-
like
beha
vior
in n
orm
al y
oung
chi
ldre
n.C
hild
Dev
elop
men
t,68
(1)
,58
-68.
Fism
an,S
.,St
eele
,M.,
Shor
t,J.
,Byr
ne,T
.,&
Lav
alle
e,C
.(19
96).
Cas
e st
udy:
anor
ex-
ia n
ervo
sa a
nd a
utis
tic
diso
rder
in a
n ad
oles
cent
gir
l.T
he J
ourn
al o
f th
e A
mer
ican
Aca
dem
y of
Chi
ld a
nd A
dole
scen
t Psy
chia
try,
35 (
7),9
37-9
40.
Font
enel
le,L
.F.,
Men
dlov
icz,
M.V
.,B
ezer
ra d
e M
enez
es,G
.,do
s Sa
ntos
Mar
tins
,R.
R.,
& V
eris
ano,
M.(
2004
).A
sper
ger
Synd
rom
e,ob
sess
ive-
com
puls
ive
diso
rder
and
maj
or d
epre
ssio
n in
a p
atie
nt w
ith
45,X
/ 46,
XY
Mos
aici
sm.P
sych
opat
holo
gy,3
7,10
5-10
9.
Frit
h,U
.(19
89).
Aut
ism
:Exp
lain
ing
the
enig
ma.
Oxf
ord,
UK
:Bla
ckw
ell.
Frit
h,U
.(19
92).
Aut
ism
us –
ein
kog
nitio
nsps
ycho
logi
sche
s P
uzzl
e(A
utis
m-a
cog
ni-
tive
-psy
chol
ogic
al p
uzzl
e) H
eide
lber
g:Sp
ektr
um 1
992.
From
mho
ld,K
.(20
06).
Zw
ang
und
Schi
zoph
reni
e.Fo
rtsc
hritt
e de
r N
euro
logi
e- P
sy-
chia
trie
,74,
32-4
8.
Gill
ott,
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Fur
niss
,F.,
& W
alte
r,A
.(20
01).
Anx
iety
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high
-fun
ctio
ning
chi
ldre
nw
ith
auti
sm.A
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m,5
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,277
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.
Gol
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,S.,
Wan
g,C
.,Sa
lgad
o,M
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Gre
ene,
P.E
.,K
im,M
.,&
Rap
in,I
.(20
09).
Mot
or s
tere
otyp
ies
in c
hild
ren
wit
h au
tism
and
oth
er d
evel
opm
enta
l dis
orde
rs.D
e-ve
lopm
enta
l Med
icin
e an
d C
hild
Neu
rolo
gy,5
1(1
),30
-38.
Gre
aves
,N.,
Pri
nce,
E.,
Eva
ns,D
.W.,
& C
harm
an,T
.(20
06).
Rep
etit
ive
and
ritu
alis
-ti
c be
havi
or i
n ch
ildr
en w
ith
Pra
der-
Wil
li-S
yndr
ome
and
chil
dren
wit
h au
tism
.Jo
urna
l of
Inte
llect
ual D
isab
ility
Res
earc
h,50
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100.
Gre
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ilchr
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D.(
2000
) So
cial
and
psy
chia
tric
fun
ctio
ning
inad
oles
cent
s w
ith
Asp
erge
r sy
ndro
me
com
pare
d w
ith
cond
uct
diso
rder
.Jou
rnal
of
Aut
ism
and
Dev
elop
men
tal D
isor
ders
,30,
279-
293.
Gre
ist,
J.H
.,Je
ffer
son,
J.W
.,&
Kob
ak,K
.A.(
1995
).E
ffic
acy
and
tole
rabi
lity
ofse
roto
nin
tran
spor
t in
hibi
tors
in o
bses
sive
-com
puls
ive
diso
rder
.Arc
hive
s of
Gen
-er
al P
sych
iatr
y,52
,53-
60.
Gri
tti,
A.,
Bov
e,D
.,D
i Sar
no,A
.M.,
D’A
ddio
,A.A
.,C
hiap
paro
,S.,
& B
ove,
R.M
.(2
003)
.Ste
reot
yped
mov
emen
ts in
a g
roup
of
auti
stic
chi
ldre
n.F
unct
iona
l Neu
rol-
ogy,
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Gro
ss-I
sser
off,
R.,
Her
mes
h,H
.,&
Wei
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,A.(
2001
).O
bses
sive
- com
puls
ive
be-
havi
our
in a
utis
m-
tow
ards
an
auti
stic
-obs
essi
ve c
ompu
lsiv
e sy
ndro
me.
The
Wor
ldJo
urna
l of
Bio
logi
cal P
sych
iatr
y,2
(4),
193-
197.
22
Lif
e Sp
an a
nd D
isab
ility
Fi
sche
r-Te
rwor
th C
./ P
robs
t P.
Han
d,I.
(199
2).V
erha
lten
sthe
rapi
e de
r Z
wan
gsst
örun
gen:
The
rapi
ever
fahr
en u
ndE
rgeb
niss
e (B
ehav
ior
ther
apy
for
OC
D:t
hera
py m
etho
ds a
nd t
heir
res
ults
).In
I.
Han
d,W
.K
.G
oodm
an,
&
U.
Eve
rs
(eds
.),
Zw
angs
stör
unge
n:N
eue
Fors
chun
gser
gebn
isse
(Obs
essi
ve-c
ompu
lsiv
e di
sord
ers:
New
res
earc
h re
sult
s)(V
ol.5
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.Hei
delb
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Dup
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Has
him
oto,
O.(
2007
).Si
mila
riti
es a
nd d
iffe
renc
es b
etw
een
the
beha
vior
of
As-
perg
er’s
syn
drom
e an
d ob
sess
ive-
com
puls
ive
diso
rder
.Nip
pon
Rin
sho:
Japa
nese
Jour
nal o
f C
linic
al M
edic
ine,
65(3
),50
6-51
1 (A
rtic
le in
Jap
anes
e).
Her
bert
,M.R
.,Z
iegl
er,D
.A.,
Deu
tsch
,C.K
.,O
’Bri
en,L
.M.,
Lan
ge,N
.,B
akar
djie
v,A
.,H
odgs
on,J
.,A
drie
n,K
.T.,
Stee
le,S
.,M
akri
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enne
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.,H
arri
s,G
.J.,
&C
avin
ess
V.S
.(20
03).
Dis
soci
atio
ns o
f ce
rebr
al c
orte
x,su
bcor
tica
l an
d ce
rebr
alw
hite
mat
ter
volu
mes
in a
utis
tic
boys
.Bra
in,1
26 (
5),1
182-
1192
.
Hof
fman
n,N
.,&
Hof
man
n,B
.(20
04).
Exp
ositi
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bei
Äng
sten
und
Zw
änge
n(E
x-po
sure
trea
tmen
t in
anxi
ety
diso
rder
s an
d ob
sess
ive-
com
puls
ive
diso
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s).W
ein-
heim
(G
erm
any)
:Bel
tz.
Hol
land
er,E
.,D
elG
iudi
ce-A
sch,
G.,
Sim
on,L
.,Sc
hmei
dler
,J.,
Car
twri
ght,
C.,
De-
Car
ia,C
.M.,
Kw
on,J
.,C
unni
ngha
m-R
undl
es,C
.,C
hapm
an,F
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Zab
risk
ie,J
.B.
(199
9).B
lym
phoc
yte
anti
gen
D8/
17 a
nd r
epet
itiv
e be
havi
ors
in a
utis
m.T
he J
our-
nal o
f Am
eric
an P
sych
iatr
y,15
6 (2
),31
7-32
0.
Hol
land
er,E
.,K
ing,
A.,
Del
aney
,K.,
Smit
h,C
.J.,
& S
ilver
man
,J.M
.(20
03).
Obs
es-
sive
-com
puls
ive
beha
vior
s in
par
ents
of
mul
tipl
ex a
utis
m f
amili
es.P
sych
iatr
y R
e-se
arch
,117
(1)
,11-
16.
Hol
land
er,E
.,A
nagn
osto
u,E
.,C
hapl
in,W
.,E
spos
ito,
K.,
Haz
neda
r,M
.M.,
Lic
alzi
,E
.,W
asse
rman
n,S.
,Soo
rya,
L.,
& B
uchs
baum
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2005
).B
iolo
gica
l Psy
chia
try,
58(3
),22
6-23
2.
How
lin,P
.(20
04).
Aut
ism
and
Asp
erge
r Sy
ndro
me:
prep
arin
g fo
r ad
ulth
ood,
seco
nded
itio
n.L
ondo
n &
New
Yor
k:R
outl
edge
.
Ivar
sson
,T.,
& M
elin
K.(
2008
).A
utis
m s
pect
rum
trai
ts in
chi
ldre
n an
d ad
oles
cent
sw
ith
obse
ssiv
e-co
mpu
lsiv
e di
sord
er (
OC
D).
Jour
nal
of A
nxie
ty D
isor
ders
,22
(6),
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978.
Jörg
ense
n,O
.S.(
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).A
sper
ger:
Synd
rom
zw
isch
en A
utis
mus
und
Nor
mal
ität:
Di-
agno
stik
und
Hei
lung
scha
ncen
.Wei
nhei
m u
nd B
asel
:Bel
tz.
Kan
ner,
L.(
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).A
utis
tic
dist
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A c
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24
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havi
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Psy
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CD
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Zei
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lls in
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esce
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in S
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tre
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CD
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