Obsessive–compulsive traits in children and adolescents with Asperger syndrome

Abstract

The objective of this study is to examine the occurrence and characteristic features of obsessive-compulsive behaviours in children and adolescents with Asperger syndrome (AS), with respect to a matched obsessive compulsive disorder group (OCD) and a typically developing control group (CG). For this purpose, 60 subjects (20 OCD; 18 AS; 22 CG), aged 8-15 years, matched for age, gender and IQ were compared. AS and OCD patients were diagnosed according to the DSM-IV-TR criteria. The Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule were used to assist in the AS diagnosis; the WISC-R was administered to assess IQ. Obsessive and compulsive symptoms were evaluated by using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). None of the AS children received a formal diagnosis of OCD. The AS group presented significantly higher frequencies of Hoarding obsessions and Repeating, Ordering and Hoarding compulsions compared to CG. The OCD group, in turn, reported significantly higher frequencies of Contamination and Aggressive obsessions and Checking compulsions compared to both the AS group and CG. As expected, the OCD group displayed a higher severity of symptoms (Moderate level of severity) than did the AS group (Mild level of severity). Finally, in our sample, neither the OCD group nor the AS group demonstrated a completely full awareness of the intrusive, unreasonable and distressing nature of symptoms, and the level of insight did not differ between the OCD group and CG, although an absence of insight was observed in the AS group. Children with AS showed higher frequencies of obsessive and compulsive symptoms than did typically developing children, and these features seem to cluster around Hoarding behaviours. Additionally, different patterns of symptoms emerged between the OCD and AS groups. Finally, in our sample, the level of insight was poor in both the OCD and the AS children. Further research should be conducted to better understand the characteristics of repetitive thoughts and behaviours in autism spectrum disorders, and to clarify the underlying neurobiological basis of these symptoms.

Cognitive-Behavioral Therapy for Anxiety in Children With High-Functioning Autism: A Meta-analysis

“…In contrast, children with ASD are less likely to have clearly identifiable obsessions and insight into the senseless nature of a compulsion. 53 Repetitive and restricted behaviors tend to decrease in frequency with age and may be less severe in children with higher-functioning autism than in children with autism and intellectual disability. 54 Nonetheless, some children with ASD, particularly higher-functioning children, can be diagnosed with OCD and may engage in repetitive behavior to reduce anxiety.…”

Assessment and Treatment of Obsessions and Compulsions in Individuals with Autism Spectrum Disorders: a Systematic Review

“…Individuals with ASD may not experience distress associated with AOCP and may not perform their rituals necessarily to alleviate anxiety (Ruta et al 2010). In fact, AOCPs in individuals with ASD may not be associated with anxiety or guilt, but rather accompanied by feelings of euphoria (Fischer-Terworth and Probst 2009).…”

Revisión de estudios e investigaciones relacionadas con la comorbilidad diagnóstica de los Trastornos del Espectro del Autismo de Alto Funcionamiento (TEA-AF) y los trastornos de ansiedad

“…Este planteamiento parece sostenido por algunas evidencias (Ruta et al, 2010). Se halla una mayor prevalencia de rasgos autistas en sujetos con TOC tanto adultos (Bejerot, 2007;Bejerot, Nylander, Lindstro¨m, 2001) como niños (Ivarsson y Melin, 2008).…”

“…En un reciente estudio que intenta dilucidar si los sínto-mas de TOC han de ser considerados comórbidos según el enfoque categorial o si se les puede considerar como un continuo de síntomas, Ruta et al (2010) examina la presencia y características del TOC en niños y adolescentes de entre 8 y 15 años con TA (n=18) respecto a un grupo con TOC (n=20) y otro grupo control con desarrollo típico (n=22), equiparados en edad, género y CI. La gravedad de los sínto-mas obsesivos-compulsivos fue significativamente más alta no sólo en el grupo TOC (rango moderado de gravedad), sino también en los niños con TA.…”

“…c) A propósito del amplio debate sobre si el TEA puede estar separado clínicamente del TOC y las diferentes explicaciones sobre la comorbilidad (diagnóstica o sintomatológica), así como la aportación final reflexiva de este trabajo acorde con los resultados obtenidos a partir de estos análisis, destacamos que los comportamientos o actos mentales repetitivos que la persona con TOC se ve obligada a realizar en respuesta a una obsesión o reglas estrictas con el objetivo de prevenir o reducir el malestar (criterio a para el TOC del actual DSM IV-TR, APA, 2002), en principio parecen cumplir el criterio de inflexibilidad conductual y mental que encontramos en los TEA (criterio b para el TA y c para el Trastorno Autista, APA, 2002). Además, aunque la fenomenología clínica de los síntomas obsesivos-compulsivos parece similar en las personas con TOC y en los individuos con TEA, éstos últimos podrían tener poca conciencia (insight) del carácter excesivo e irracional de la naturaleza de sus pensamientos y conductas repetitivas (egodistonicidad, Ruta et al, 2010), lo que es preciso para la configuración diagnóstica del TOC (APA, 2002). Sin embargo es importante recordar que, si bien este malestar clínicamente significativo generado por esta sintomatología parece ser una característica típica de los TOC en la edad adulta, este criterio diagnóstico del DSM-IV-TR (APA, 2002) no se aplica a los niños con TOC, quienes pueden carecer de suficiente conciencia cognitiva para poder hacer estas reflexiones (Geller, 2006).…”