Obsessive Compulsive Behaviors in Children with Developmental Disabilities: A Function-based Conceptual Framework and Single-case Application

Repetitive behaviors are prevalent in a number of neurodevelopmental disorders including autism spectrum disorder (ASD) and intellectual disability (ID). A subset of repetitive behaviors found in ASD and ID can be topographically similar to symptoms in obsessive compulsive disorder (OCD). Through two manuscripts in preparation (Chapters 2 and 4), this project aims to discuss a function-based approach to conceptualizing, assessing, and treating obsessive compulsive behaviors (OCBs) in ASD and ID. The first manuscript is a conceptual paper responding to the variety of approaches researchers use to categorize the behaviors (i.e., assigning a comorbid diagnosis or acknowledging overlapping symptoms of ASD). To date, a clear consensus has not yet been reached amongst the researchers in this field. This paper builds on the differential diagnosis guidelines of the DSM-5 and clinical experts in the field by providing a multidisciplinary, function-based approach to conceptualizing, assessing, and treating individual OCBs in ASD using clinical case examples. Obsessive compulsive behaviors can serve a variety of functions beyond the reduction of anxiety including automatic positive reinforcement or socially mediated reinforcement. The strengths of function-based treatment combined with cognitive behavioral therapy for working with complex obsessive compulsive behaviors in ASD are presented. A second manuscript demonstrates the applicability of this framework in a single case study of four-year-old boy with mild ID and obsessive compulsive behaviors. An intensive, adapted version of function-based cognitive behavioral therapy was administered in the boy’s preschool. The treatment successfully eliminated two OCBs while concomitantly teaching joint engagement with peers on work-related tasks. Results were maintained at a three-week follow- up. The implications of the treatment protocol, in addition to the broader importance of working from a multidisciplinary perspective for children with obsessive compulsive behaviors, are discussed