Examining clinical correlates, treatment outcomes and mediators in young people with comorbid obsessive–compulsive disorder and autism spectrum disorder

A D Jassi,D Mataix-Cols,B Monzani,P Vidal-Ribas,G Krebs

doi:10.1007/s00787-021-01921-4

Abstract

Despite the high comorbidity, surprisingly little is known about the clinical features, treatment prognosis, and treatment mediators for youth with Obsessive–Compulsive Disorder (OCD) and Autism Spectrum Disorder (ASD). This study, the largest to date, compared 172 young people with OCD and ASD (OCD + ASD) to 447 without ASD (OCD) on clinical characteristics, finding those with OCD + ASD were more likely to endorse poorer insight into their OCD, have greater global functional impairment, greater levels of concurrent psychopathology, higher levels of family accommodation and to be on medication. Treatment outcomes following a course of Cognitive Behaviour Therapy with or without medication were explored for a subgroup; 100 young people with OCD + ASD and 223 with OCD. Whilst both groups benefitted from treatment, the OCD + ASD group had significantly poorer treatment outcomes. Greater global functional impairment and being on medication mediated the between-group difference in outcomes. Further research and treatment refinements are needed to improve outcomes for youth with OCD + ASD.

Highlights

Obsessive–compulsive disorder (OCD) is a common psychiatric condition affecting approximately 0.25–3% of children and adolescents [1, 2]
Youth with OCD + Autism Spectrum Disorder (ASD) presented with more psychopathological symptoms as measured by the Strengths and difficulties questionnaire (SDQ) (d = – 0.74, 95% CI – 0.98, – 0.50), including emotional (d = – 0.28, 95% CI – 0.52, – 0.06), hyperactivity (d = – 0.40, 95% CI – 0.61, – 0.19) and peer problems (d = – 0.79, 95% CI – 1.00, – 0.58), and less prosocial behaviours (d = 0.63, 95% CI 0.40, 0.87)
Bold p-values and effect sizes indicate significance after False Discovery Rate (FDR) correction for multiple testing. This is the largest study to date comparing the clinical phenotype and treatment outcomes for young people with OCD with and without comorbid ASD using a broad range of outcome measures and the first one to examine factors that may explain differences in treatment outcomes, above and beyond having a diagnosis of ASD

Summary

Introduction

Obsessive–compulsive disorder (OCD) is a common psychiatric condition affecting approximately 0.25–3% of children and adolescents [1, 2]. OCD [8], higher rates of diagnosed attention deficit hyperactivity disorder or inattention/hyperactivity symptoms [6,7,8], externalising disorders [8], peer problems [6] and social and separation anxiety [7] Those with OCD + ASD have been found to have lower prosocial behaviors compared to those with OCD [6]. The current study employed the largest sample to date of well-characterised youth with OCD and OCD + ASD to examine and compare these groups on clinical characteristics and treatment outcomes. Given the lack of available studies, no specific hypotheses were advanced with respect to variables that may mediate the differential response to treatment in these groups

Participants

Results

Discussion