AUTISTIC SPECTRUM DISORDER IN ADULTS WITH OBSESSIVE COMPULSIVE DISORDER: RESULTS FROM A UK SURVEY

• Published in: European neuropsychopharmacology 2017-06, Vol.27 (6), p.614-615
• Main Authors: Kaur, S, Wikramanayake, M, Kolli, S, Shahper, S, Jefferies-Sewell, K, Reid, J, Osman, S, Mandy, W, Fineberg, NA
• Format: Article
• Language: English
• Subjects: Internal Medicine; Psychiatry
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2016.07.019

Aims and Hypothesis To study the frequency and clinical impact of co-morbid autistic traits and Autistic Spectrum Disorder (ASD) on patients with Obsessive Compulsive Disorder (OCD), using the Autism Quotient (AQ) as the primary measure of autistic traits. Background Repetitive compulsive acts represent key symptoms in OCD and ASD. Existing data suggest that as many as one in five treatment-seeking individuals with OCD show autistic traits. Methodology Patients attending a UK specialist OCD clinic were screened using the AQ. A score of 26/50 on AQ was chosen as a cut-off to determine the likelihood of ASD. Those scoring 26 or above on the AQ then participated in a semi-structured diagnostic interview, the Clinical Autism Structured Assessment (CASA). Participants were rated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for OCD severity, the Compulsive Personality Assessment Scale for obsessive-compulsive personality disorder (OCPD) and the Brown Assessment of Beliefs Scale for insight. Results 73 patients consented to participate in the study. Out of these 34 (46%) scored ≥26/50 on the AQ and 21/34 (28%) were diagnosed with an ASD. Almost all cases were previously undiagnosed. No significant differences were observed between the high AQ-scoring and low-AQ scoring groups in terms of gender ratio, age of onset of OCD or total Y-BOCS score, suggesting that co-morbid ASD does not simply represent a more severe form of OCD. The presence of autistic traits was associated with OCPD and poor insight. The autistic trait most strongly associated with OCD was impaired attention shifting, suggesting overlap with OCD. However, other autistic traits not usually associated with OCD were also frequently endorsed in the comorbid group, including poor social, communication and imaginative skills. Conclusions We found a high prevalence of a broad spectrum of clinically relevant autistic traits and ASD (altogether around one third) in the treatment-seeking OCD population. Our findings carry implications for the clinical assessment and management of OCD.