"Special Interest" or Obsessive-Compulsive Disorder?

"How do I know whether or not my child's 'special interest' is actually an Obsessive-Compulsive Disorder?"

The term “Obsessive-Compulsive Disorder” (OCD) is a clinical diagnosis that only a doctor can make. Many Aspergers and high functioning autistic (HFA) kids also share an OCD diagnosis, but the Diagnostic and Statistical Manual definition for Aspergers and HFA calls for very OCD-like behavior as one criterion.

It can be very confusing for parents, and even diagnosticians, as to whether or not the “special interest” is simply an Aspergers or HFA trait, or part of another diagnosis (in this case, OCD).

So, when is a “special interest” simply a “special interest,” and when is it legitimate OCD?

Obsessive-compulsive disorder is a chronic illness, a type of anxiety disorder characterized by obsessive thoughts and compulsive behavior. Unlike other anxiety disorders, the child knows that such thoughts and behaviors are irrational and silly, but cannot prevent themselves from having them.

(Note: There is a difference between OCD and Obsessive-Compulsive Personality Disorder (OCPD). OCPD is a mental disorder that is characterized by "preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.")

With OCD, there are obsessions. Obsessions are defined as “distressing ideas, images or impulses that repeatedly intrude into the child’s awareness.” These thoughts are typically experienced as inappropriate, anxiety-arousing, and contrary to the child’s will or desires. Common obsessions include:

• a need to have things "just so"
• a need to tell, ask, or confess
• contamination (e.g., fear of germs, dirt, etc.)
• excessive religious or moral doubt
• forbidden thoughts
• imagining having harmed self or others
• imagining losing control of aggressive urges
• intrusive sexual thoughts or urges

However, obsessions are not the only telltale sign for OCD. Another symptom of OCD is compulsions. Compulsions are "repetitive behaviors or rituals that the child performs to counteract the anxiety and distress produced by obsessive thoughts." Common compulsions include:

• checking

• counting

• hoarding

• ordering/arranging

• praying

• repeating

• touching

• washing

Some of these compulsions are easily witnessed, but this is not always true. Not all compulsions are obvious; many are mental processes (e.g., counting, praying) and harder – if not impossible – to notice. Typically the compulsions correspond to the obsessions. For example:

• aggressive, sexual, religious and somatic anxieties result in checking
• an obsession with hoarding leads to hoarding and collecting
• fears of contamination are accompanied by hand washing and cleaning
• need for symmetry produces ordering, arranging, counting and repeating rituals

OCD kids usually have obsessions and corresponding compulsions, but may have either obsessions or compulsions alone. Observing these obsessions and compulsions may be difficult for a parent to notice, because the child may hide his symptoms. Noticing obsessions and compulsions is the first step in discovering whether or not a child has OCD, but several other conditions must be met for the diagnosis to be made. For you to diagnose your child as having OCD (instead of being just a little strange), a few other factors must be present.

If your child really has OCD, he will recognize that the obsessions or compulsions are excessive or unreasonable – he knows that what he is doing makes no sense. Many people who developed OCD did so as a child, and report knowing that there was something different (or wrong) about them in comparison to other children.

Another factor of OCD is that the obsessions and compulsions:

• are inordinately time-consuming
• cause marked distress
• significantly interfere with the child's normal routine, occupational functioning, or social activities or relationships

OCD occurs when your youngster has thoughts (obsessions) or physical actions (compulsions) that seem out of his control, such that it becomes unpleasant, very stressful, or harmful in some way. This may - or may not - involve his special interest. It may involve some new, seemingly odd or purposeless focus on a bodily function, for example, or the need to repeatedly check his hands for cleanliness. If you notice that your child does have obsessions or compulsions that cause him to avoid people and social activities, than he may indeed have OCD. Some “red flag” indicators of OCD include:

1. The need to indulge in his activity causes him to lose sleep, skip meals, or be late for school.
2. He cannot seem to focus on - or discuss anything - but the activity.
3. He has lost interest in his appearance, dress, and hygiene because the activity has become all-consuming.
4. He is quick to lash-out and becomes verbally and/or physically abusive when you try to redirect him away from the activity of interest.
5. He withdraws from family, friends, and pets in favor of spending unusual amounts of time involved in the special activity.

If you note any of these changes in your youngster, it will be important for you to gather information about what you are observing in order to prepare for meeting with a Child and Adolescent Psychiatrist for a comprehensive psychiatric evaluation.

Even with all these symptoms, it is often difficult to diagnose a child with OCD. Since the OCD youngster knows his thoughts and actions are irrational, he may tend to conceal his problems. Often, parents will bring the child they suspect of OCD to a doctor's attention. Sometimes the disorder is revealed through secondary symptoms (e.g., dry hands from excessive hand washing). However, the diagnosis must be made by specific questioning by a doctor. Clinical interviews establishing a history of obsessive thought or ritualistic behavior is the primary method of diagnosis.

There are some things you can do to determine if your child should be evaluated for OCD. You could ask him the following questions: "Do you find yourself doing something unusual repeatedly? Does this seem normal to you - or does it seem weird?" You could also make it fun and use a diagnostic scale as a magazine quiz (these surveys pretty much work the same way as most magazine quizzes). The most commonly used is the Yale-Brown Obsessive Compulsive Scale (available online). Also, the Work and Social Adjustment Scale (often used in combination with other diagnostic scales), and the Maudsely Obsessive Compulsive Inventory are good tools as well. There are also several online resources, such as the Obsessive Compulsive Screening Checklist and the National Institute of Mental Health Screening Test.

(Note: You should not attempt to make such a diagnosis on your own. The online resources above are only to help you determine whether your child has symptoms of OCD in order for him to seek a professional diagnosis.)

If your youngster's “special interest” fit the criteria for OCD, you may need to reinforce parental parameters by being very firm about scheduling activities and responsibilities and holding your youngster accountable. Use visual time frames (e.g., calendars, clocks and watches, personal schedules) to set limits for the amount of time your youngster is permitted to indulge in his special interests. Your child’s teachers will also need to be clear and concrete about rules and responsibilities during the school day. Apply appropriate disciplinary measures once you ensure all expectations have been made clear to your youngster.

Parents have the right to have expectations of their Aspergers or HFA youngster. You expect your youngster to uphold the standards you've set with regard to house rules and other obligations (e.g., doing chores, completing homework, showing respect, etc.). It is also fair to set parameters around the amount of time your youngster indulges in his special interest – especially if you can readily foresee the potential for him to get “lost” in it for long periods of time.

==> Preventing Meltdowns and Tantrums in Aspergers and HFA Children and Teens