Preschool and current autistic symptoms in children and adolescents with obsessive-compulsive disorder (OCD) Bernhard Weidle a,d,n , Karin Melin b,c , Elisabeth Drotz b , Thomas Jozefiak d , Tord Ivarsson a,b,c a Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaug Torg 4B, 0484 Oslo; Postal address: Post box 4623 Nydalen, N-0405 Oslo, Norway b Department of Child and Adolescent Psychiatry, G¨ oteborg University, Kungsgatan 12, SE-411 19 G¨ oteborg, Sweden c Department of Child- and Adolescent Psychiatry, Queen Silvia Children’s hospital, G¨ oteborg, Sweden d Department of Child and Adolescent Psychiatry, St.Olavs University Hospital; Postal address: Post box 6810 Elgeseter, N-7433 Trondheim, Norway and Norwegian University of Science and Technology (NTNU), Department of Neuroscience, Trondheim, Norway article info Article history: Received 22 December 2011 Received in revised form 2 April 2012 Accepted 2 April 2012 Available online 5 May 2012 Keywords: Obsessive-compulsive disorder Autistic traits Autism spectrum disorders Childhood Adolescence abstract Objective: Contemporaneous nosological debates include the presence of an Obsessive-Compulsive Spectrum Disorder (OCSD) group incorporating disorders as OCD, Tourette’s syndrome, eating and autism spectrum disorders (ASD). If true, we propose, ASD symptoms should occur in the early childhood of OCD patients, show substantial continuity to later childhood and be present in a large proportion of cases. This study explores whether this is the case or not. Methods: Paediatric patients with OCD (n ¼105) according to DSM IV were studied using parent ratings of the Social Communication Questionnaire. A general population group without ASD (n ¼108) was used to control for ASD symptoms in the normal population. Results: ASD symptoms were more common in children with OCD than in controls (m¼5.9 versus 3.1; p ¼.0001). However, few (one in each group) had scores in the clinical range for ASD. Symptom prevalence was low, except for symptoms that could be confused with OCD or tics. The correlation between preschool and current ASD symptoms was low. Conclusion: ASD symptoms in OCD as reported here do not support claims about OCD as strongly related to ASD. However, a subgroup of paediatric OCD patients has significant subclinical ASD symptom levels. & 2012 Elsevier Ltd. All rights reserved. 1. Introduction 1.1. OCD nosology debate Obsessive-compulsive disorder (OCD) is a common disorder among children and adolescents (Heyman et al., 2001), that often takes a chronic course (Stewart et al., 2004) and has for decades been classified in the DSM as an anxiety disorder in view of the anxiety associated with obsessions and the function of rituals to ease it. However, there has been considerable debate about the nosological placement of OCD. Arguments for a unifying relation- ship between OCD and autism spectrum disorders in a family of Obsessive-Compulsive Spectrum Disorders (OCSD) also contain- ing tic disorders and disorders such as hypochondriasis, body dysmorphic disorder and trichotillomania have been raised (Bartz & Hollander, 2006; Hollander, Kim, Khanna, & Pallanti, 2007). The grounds for this unification are fourfold: that the OCSDs share a core feature, i.e. repetitive thoughts and behaviour; the presence of phenotypic similarities like age of onset, comorbidity, and family loading; the sharing of brain circuitry abnormalities, familial/genetic factors, and neurotransmitter/peptide abnormal- ities; and finally that the disorders may be treated pharmacolo- gically with similar drugs. Others have strongly questioned this attempt. Storch, Abramowitz, and Goodman (2008) argued forcibly that the symptoms of these disorders have different cognitive, motiva- tional and functional underpinnings. The functional role of com- pulsions was specifically pointed out as different from that of behaviours in the other OCS-disorders. Consequently, he argued, the OCSD construct is misleading. One reason for the hypothesis of an OCSD was the phenom- enological overlap between OCD, ASD, and tics/Tourette’s syn- drome (Hollander, et al., 2007). The presence of, for example, repetitive behaviour in these disorders would be one unifying feature. In ASD, repetitive behaviour is one out of three defining symptom clusters, often serving the need for sameness. In OCD, repetitive rituals are likewise present in most patients, although Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/jocrd Journal of Obsessive-Compulsive and Related Disorders 2211-3649/$ - see front matter & 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jocrd.2012.04.002 n Corresponding author at: Department of Child and Adolescent Psychiatry, St.Olavs University Hospital, Post box 6810 Elgeseter, N-7433 Trondheim, Norway. Tel.: þ 47 91 88 46 38; fax: þ 47 72 82 22 51. E-mail address: b-weidle@online.no (B. Weidle). Journal of Obsessive-Compulsive and Related Disorders 1 (2012) 168–174