Recognizing and Addressing Atypical Obsessive Compulsive Presentations in Autism and Intellectual Di

Obsessive-compulsive disorder (OCD) frequently co-occurs with autism spectrum disorder (ASD) and intellectual disabilities (IDD) yet often presents atypically and remains underrecognized. Diagnostic overshadowing, where symptoms are incorrectly attributed solely to autism or intellectual disability, frequently delays appropriate treatment and contributes to unnecessary polypharmacy. This presentation synthesizes current research on OCD phenomenology in neurodevelopmental populations, clinical case examples demonstrating atypical presentations, and evidence-based assessment approaches. Participants will learn to differentiate between autism-related restricted interests/repetitive behaviors and OCD-driven compulsions through clinical markers including distress levels, functional impairment patterns, and ego-dystonicity (when discernible). The presentation provides concrete clinical vignettes illustrating atypical obsessions and modified assessment strategies including observational methods, caregiver interviews using structured tools, and visual supports for self-report. By understanding the unique presentation patterns and implementing adapted assessment strategies, clinicians can reduce diagnostic overshadowing, minimize unnecessary polypharmacy, and ensure individuals receive appropriate evidence-based interventions. Practical frameworks for family education and physician communication empower caregivers to advocate effectively for comprehensive evaluation and targeted treatment. Presented by Scott Sanders, M.S., BCBA, QMHP