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What do the scores of the Y-BOCS mean?
When it comes to autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD), the autism traits with OCD behaviors can be confusing. While these are two distinct conditions, they often overlap in ways that can make it difficult to differentiate between them. Both involve repetitive behaviors, intense fixations, and rigid routines, but the underlying motivations behind these behaviors can be quite different. That’s where tools like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) help differentiate them.
Y-BOCS is a clinical assessment designed to evaluate the severity of OCD symptoms. For individuals with autism, it can help clinicians discern whether certain repetitive behaviors belong to OCD or are part of the individual’s autism-related characteristics. Understanding the differences between the two can lead to better, more targeted treatments. But how does this assessment work in practice? What does it reveal about the connection between OCD and autism? And what does the Y-BOCS score mean?
In this blog by ABA Centers of Georgia, we’ll explore how OCD and autism can co-exist, how clinicians use tools like Y-BOCS to assess OCD in individuals with autism, and what the results mean for ongoing therapies.
OCD and Autism: Co-occurring Conditions
Research by Plos One indicates that individuals with ASD have a two-fold higher risk of later being diagnosed with it. In contrast, those initially diagnosed with OCD are nearly four times more likely to develop autism. The connection is solid in individuals with less severe forms of autism. These findings suggest that both conditions may share some genetic or biological causes, and they often occur together in families, indicating potential common factors in their development.
OCD and autism share some surface-level similarities, especially when it comes to repetitive actions or fixations. Individuals with autism often engage in behaviors that seem ritualistic, such as lining up toys, following strict routines, or becoming intensely interested in specific subjects. For someone with OCD, these rituals are more about relieving anxiety—performing a particular behavior a set number of times might prevent them from feeling a dreaded outcome.
The difference lies in the intention and emotional response. For a person with autism, repetitive behaviors may be calming or pleasurable as they serve to cope with sensory overload. In contrast, people with OCD are often motivated by intrusive thoughts and perform rituals out of fear that, for example, something terrible will happen to them if they do not perform the specific behavior. This situation makes coexistence challenging to identify, as both disorders involve recurrent actions and thoughts, but for very different reasons.
How Clinicians Assets OCD in Individuals with Autism?
Autism and OCD share specific characteristics, such as recurrent thoughts and repetitive behaviors, which can be challenging to differentiate. To assess the suitable condition, clinicians often use the Y-BOCS to evaluate OCD to determine whether the actions of an individual stem from obsession and compulsion rather than the need for routine or predictability that many individuals with ASD seek.
When assessing a person with autism for OCD, clinicians pay close attention to the motivation behind the behaviors. For example, is a child washing their hands because they’re afraid of contamination, or do they enjoy the sensory experience of running water? Are they repeating a phrase because it’s soothing or because they feel compelled to say it a certain number of times to avoid distress?
Y-BOCS to Determine OCD
The Y-BOCS is a questionnaire that clinicians use to evaluate the presence and severity of OCD symptoms. It assesses both obsessions (intrusive, unwanted thoughts) and compulsions (ritualistic behaviors performed to alleviate the anxiety caused by those thoughts). By using this scale, clinicians can determine how much of an individual’s day is consumed by OCD-related behaviors and how much distress those behaviors cause.
In individuals with autism, the Y-BOCS helps in differentiating between behaviors that are part of their ASD and those that stem from OCD. This differentiation is significant because treating OCD and managing autism-related behaviors require different approaches. For instance, therapists use exposure and response prevention (ERP) to treat OCD, while clinicians recommend ABA therapy to address the needs of individuals with autism.
Understanding the Y-BOCS Score
According to Standford Medicine, the Yale-Brown Obsessive Compulsive Scale helps clinicians assess OCD symptom severity but does not diagnose the disorder. It features ten items, starting with a checklist that patients complete to identify obsessive thoughts and behaviors related to their condition. This process allows the clinician and patient to agree on the symptoms to address during treatment.
The scale measures five areas for obsessions and compulsions: time spent on symptoms, interference with daily life, distress level, resistance, and control over symptoms. Each item receives a rating from 0 (no symptoms) to 4 (extreme symptoms).
The scores for the first five items assess obsessions, while the last five focus on compulsions. The total score indicates symptom severity:
- 0-7 – Subclinical
- 8-15 – Mild
- 16-23 – Moderate
- 24-31 – Severe
- 32-40 – Extreme
What is the Impact of the Y-BOCS Result in ABA Therapy Sessions?
When a Y-BOCS assessment identifies OCD in an individual with autism, it can significantly reshape the approach of the current ABA therapy program. ABA therapists usually focus on teaching functional skills, improving communication, and reducing challenging behaviors associated with autism. However, when OCD is present, the strategies used in ABA sessions must also shift to address the compulsive behaviors and obsessive thoughts that come with OCD.
For instance, repetitive behaviors in ASD often revolve around a need for predictability or sensory preferences. At the same time, OCD-related compulsions come from anxiety and a desire to relieve distress. If a child’s repetitive handwashing, for example, is tied to OCD, continuing to treat it as a simple routine habit could overlook the anxiety driving the behavior.
In ABA sessions, this means that applying traditional ABA strategies, like reinforcing alternative behaviors, may need to be supplemented with techniques more aligned with OCD treatment. This method could include using ERP (Exposure and Response Prevention), which involves gradually exposing the person to the source of their anxiety without allowing them to engage in the compulsive behavior that follows. At the same time, therapists keep using the core elements of ABA therapy—reinforcement, prompting, and skill-building, but with the added layer of addressing the compulsions in a way that reduces anxiety, not just the action itself.
ABA Centers of Georgia Top Autism Care Provider
At ABA Centers of Georgia, we are the top autism care providers in Alpharetta, Atlanta, Buckhead, and Marietta. We not only provide tailored ABA programs but also consider the complexities of autism and co-occurring conditions like OCD.
Our team works closely with families and clinicians to create individualized treatment plans that incorporate tools like Y-BOCS for a more comprehensive approach to care. By understanding the unique challenges associated with autism and OCD, we help children and adults thrive in a supportive, compassionate environment.
If you or a loved one is navigating autism and OCD, call us at (855) 929-5058 to gain more understanding on how to navigate the spectrum.
