A child organizes their books on a shelf by size and color; if their little sister puts one back in the wrong place, the child’s mood is almost certain to plummet. At this point, parents often wonder whether this is merely a quirk or something more akin to a compulsion. From the outside, it is difficult to tell, as the behaviors can look remarkably similar.
How can you tell the difference?
Many autistic children tend to prefer familiar routines, as these involve no surprises or unknown stimuli. Such routines generally feel right to them; they make the day predictable and help keep overstimulation in check. If one of these routines is interrupted, the child might react with irritability or feel overwhelmed—without this necessarily stemming from a fear of catastrophe.
For someone with an obsessive-compulsive disorder—for instance, someone who feels compelled to flip every light switch in a specific sequence, believing that something terrible will happen otherwise—the ritual itself often feels absurd and distressing. Yet, stopping is not an option. Such actions are driven by thoughts intended, above all, to ward off fear and unease.
However, it is not always possible to make a clear-cut distinction. Under stress, repetitive behaviors tend to increase in both cases, and not every autistic child finds their routines to be pleasant.
Why is this so important for therapy?
For obsessive-compulsive disorder, a method known as “exposure with response prevention” is considered an established approach. Through this process, individuals learn—in small, incremental steps—to endure uncomfortable feelings without performing a ritual, until those feelings eventually subside on their own. If one were to simply apply this approach to an autistic routine, it would strip the child of something that actually provides them with a sense of stability. In such cases, predictable sequences and an environment with fewer sensory stimuli are more helpful. Similarly, “stimming” should be allowed to remain, as it helps many autistic individuals with self-regulation.
In everyday life, parents can simply ask their child, in such moments, whether what is happening is actually helpful to them. The answer often reveals a great deal. Those who suspect an obsessive-compulsive disorder can find support at clinics and outpatient centers that have experience with both autism and obsessive-compulsive issues.
More from JuCare?
Whether a behavior stems from a need for stability or from fear determines what will truly help a child. You can learn how we work with families to assess this on our autism therapy page. You may also request therapy directly here.
You can find regular updates on autism in our Newsletter and on Instagram.
