Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in Children with ASD

Obsessive–compulsive behaviors in autism spectrum disorder: Behavior analytic conceptual frameworks.

“…Notably, compulsions in OCD and higher-order RRBs in ASD can show overlapping patterns of symptom presentation. Challenges with introspection or articulating motivations for behavior in children and youth with ASD present increased complexity for determining comorbid diagnoses of OCD in ASD (Vause, Neil, & Feldman, 2020; Wu et al, 2014). In light of the difficulty in distinguishing the symptoms of the two disorders in this population and the possibility of co-occurring OCD and higher-order RRBs in individuals with ASD, the approach of some clinical researchers has been to categorize overlapping symptoms as obsessive–compulsive behaviors (OCBs), acknowledging the overlapping symptoms while refraining from providing a comorbid diagnosis (Chok & Koesler, 2014; Vause, Jaksic, et al, 2020; Vause, Neil, & Feldman, 2020).…”

“…As a result of the ongoing ambiguity in categorization and assessment, clinical experts have attempted to provide descriptive guidelines for symptom differentiation based on the topography of private events (e.g., thoughts and emotional states) and behaviors (Wu et al, 2014). However, convergence in the literature suggests one of the key distinguishing factors between these topographically similar behaviors is the purpose or function of the behavior (Scahill & Challa, 2016; Vause, Neil, & Feldman, 2020; 2017; Wu et al, 2014). Some researchers suggest that the images, urges, or distress that accompany obsessions in OCD are ego dystonic, meaning they are disruptive or distressing to the individual (Scahill & Challa, 2016; Wu et al, 2014).…”

“…We then offer conceptual frameworks of overlapping symptom presentation with a theory-informed behavioral framework based on Mowrer’s (1951) two-process theory of respondent and operant learning processes and a contextual behavior science framework based in relational frame theory (RFT) that is a behavioral account of language and cognition (Hayes, 1991). Using clinical case examples outlining both conceptual frameworks, we propose some strategies for assessment and selection of treatment components based on empirical research using functional behavior-based CBT (Fb-CBT) for children and youth with ASD (Vause et al, 2014; Vause, Jaksic, et al, 2020; Vause, Neil, & Feldman, 2020). We also review potential acceptance and commitment therapy (ACT) treatment components from other single-case studies with children with ASD.…”