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ASD Diagnosis
credit: Kidspot

With certain children, it can be hard to tell the difference between an autism spectrum disorder (ASD), obsessive compulsive disorder (OCD), and a Sensory Processing Disorder (SPD). You may see a child with just one of these, but it may not be completely clear which diagnosis would provide the most thorough and helpful way of describing the child’s differences.  For the most, part diagnoses are just shorthand descriptions of behavior.  Alternatively, you may frequently see a child with more than one of these problems.

Let’s look at the core symptoms of each disorder.

Autism Spectrum Disorder – ASD

A core difference seen in children with ASD’s is a difference in the ability to relate socially to others.

Children with ASD’s may also be obsessive in their interests and have repetitive movements.  These differences may mimic symptoms of OCD.

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However, along with the obsessive interests, these children have significant differences in their social relationships.  These differences may range from just awkward or odd to a complete lack of interest in other children.

Children with ASD’s may not show a broad range of facial expressions, use gestures or be able to demonstrate perspective taking skills or empathy.

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Obsessive Compulsive Disorder – OCD

The core issue in children with OCD, are either or both

1. obsessive anxious thoughts and/or

2. compulsions – repetitive behaviors that are designed to neutralize the obsessive worry.

A classic example of OCD is a child who has intense worries about germs and then washes his hands excessively. For this behavior to be considered OCD, the thoughts and/or compulsions must either cause distress or interfere in the child’s life.  To interfere with the child’s life this behavior must take up significant time in their day, or prevent them from doing things they might want to do.

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However, a child with OCD and not an ASD would still be able to engage in perspective taking and have empathy.

Some children with OCD are so distracted by their obsessive thoughts, that they may be thought to have ADHD due to apparent inattention.  However, with time in therapy, the root cause of the inattention is uncovered by careful investigation.

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A child with OCD may touch each corner of the couch in a certain pattern.  However, the child with OCD will not have the repetitive movements that characterize an ASD such as hand flapping or rocking.

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Sensory Processing Disorder – SPD

SPD is not a mental health diagnosis – that is, it is not something diagnosed and treated by mental health professionals.  It is not part of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Instead, SPD is diagnosed by Occupational Therapists (OT). Therefore the differentiation involved here is what kind of treatment one is getting for the child.

SPD covers such symptoms as being over-responsive or under-responsive to one of the senses.  Children with SPD will demonstrate some of the social and emotional challenges that a mental health professional might see as being on the autism spectrum.

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You might see an OT diagnose a child with SPD.  An Licensed Clinical Social Worker (LCSW) might diagnose the same child with an ASD, depending on the level of social differences involved.

Both diagnoses would be correct.  Each therapist would have a different focus on how they may treat the child.  The OT may set up a sensory diet while the LCSW might focus on social skills or academic accommodations.

Alternatively, you could see a child with SPD who has minimal social or emotional dysregulation.  This child would not get a mental health diagnosis of any kind.  Another child on the autism spectrum who has minimal sensory differences would not qualify for an SPD diagnosis.

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Case Examples

I once saw a young child with ASD.  He was licking objects and touching the floor repetitively. At first, the parent and I were wondering whether this showed that OCD was emerging.  Upon further investigation, it became clear that the licking and touching were sensory seeking – SPD not OCD.

Another young child was obsessive and rigid.  However, he made good eye contact, showed concern for others, and could maintain a good back and forth conversation – OCD not ASD.

It can be a bit of a challenge to tease apart the three diagnoses covered here.  It is important to not make a snap judgement or diagnosis within the first 10 minutes of an initial evaluation.  As a parent or therapist, if you are seeing potential sensory issues, refer to an OT to get the child evaluated for SPD.  Over a few sessions, evaluate the child to determine if the child is experiencing OCD or has an ASD and consider the possibility of both.