Association for Behavior Analysis International

Comorbidity estimates of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) range 7% to 24%, which is likely an underestimation due to the topographical similarities between ritualistic behavior characteristic of autism and compulsions characteristic of OCD (Dell’Osso et al. 2024). The current symposium will explore four studies demonstrating the utility of behavior analytic procedures in the assessment and treatment of problem behavior in autistic individuals with OCD or related disorders. The first study evaluates the utility of practical functional assessment and relevant skill-based treatment to decrease challenging behavior evoked by access to hoarded items. The second study evaluates a model of functional assessment to determine the reinforcing variables maintaining maladaptive rituals and severe problem behavior of adults with ASD and OCD. The third study proposes a novel assessment to guide treatments based on effective behavior analytic and psychological methods for adults with ASD and OCD demonstrating multiple topographies of maladaptive rituals and challenging behaviors. The last study provides a case demonstration of collaboration between behavior analysis, psychology, and psychiatry to treat multiple high-severity, OCD-related behaviors for an individual with ASD and OCD. Overall, these studies highlight the importance of refining and exploring novel assessment and treatment methods to enhance clinical practice and research for individuals with ASD and OCD.

basic understanding of functional analysis of problem behavior and differences between automatic and social reinforcement

Engaging in ritualistic behaviors is a frequent issue observed in those diagnosed with Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD) (Leekam et al., 2011). However, little is known regarding the functional variables maintaining ritualistic behavior, especially in adults who also exhibit severe problem behavior. The purpose of the present study was first to identify the variables maintaining ritualistic behavior and then to identify if access to the ritualistic behavior maintained problem behavior in three autistic adults with comorbid OCD. Problem behavior consisted of aggressive and self-injurious behaviors. Extended alone/ignore functional analyses were first conducted to confirm ritualistic behavior was maintained by automatic reinforcement. Subsequent functional analyses included (1) a test condition in which access to rituals was blocked, but granted contingent on targeted problem behavior and (2) a control condition in which access to rituals was not blocked. Results for all three participants indicated that aggression/self-injury was maintained by access to ritualistic behavior. The present findings provide preliminary evidence for treatment resistance observed in individuals ASD and comorbid OCD .

The prevalence of Obsessive Compulsive Disorder (OCD) in adults with autism spectrum disorder (ASD) is estimated to range from 7% to 24%, which is likely an underestimation due to the topographical similarities between ritualistic behavior characteristic of autism (Dell’Osso et al. 2024). Common psychological treatments for OCD begin with identifying obsessive thoughts and stimuli associated with the onset of these thoughts (Pampaloni et al., 2022). These treatment methods are often insufficient for individuals with comorbid ASD and intellectual disability (ID). The purpose of the present study was to utilize observational and physiological measures to create a hierarchy of stimuli or rituals associated with severe problem behavior to inform treatment progression. Two adults diagnosed with ASD, ID, and OCD participated in the present study. At the beginning of a session, a ritual was present, and the participant was informed they could not complete the ritual. Observational data (rituals, problem behavior, negative vocalizations, perseverative speech) and physiological data (heart rate) were tracked until a pre-determine termination criterion was met, or five minutes elapsed. The present study provides a model to create a hierarchy to systematically approach the treatment of severe problem behavior associated with ritualistic behavior.

Obsessive-compulsive disorder (OCD) is a chronic disorder that is characterized by aversive and repetitive private events (i.e., obsessions) and a chain of behaviors that occurs as a function of avoidance and/or escape (i.e., compulsions) that impacts roughly two to three percent of the population in their lifetime. Typical treatment for behaviors related to OCD includes psychotherapy techniques through cognitive behavioral therapy (CBT), exposure and response prevention therapy (ERP), and pharmacotherapy through prescription of serotonin reuptake inhibitor. While there is ample research demonstrating the effectiveness and efficacy of these treatments for OCD behaviors, the psychotherapy methodology mentioned relies heavily on vocal verbal behavior and has limited applications for individuals without the verbal repertoire to engage with said therapy methods. To date, limited research has examined the treatment of obsessive-compulsive behaviors for individuals with limited verbal behavior repertoire. This project is a collaboration between behavior analysts, psychologists, and psychiatrists on a case demonstration for a modified ERP treatment for an individual who engages in multiple high-severity, OCD-related, behaviors through a single case design.