Obsessive-Compulsive Disorder in Adults with High-Functioning Autism Spectrum Disorder: What Does Self-Report with the OCI-R Tell Us?
The 18-item OCI-R is a valid quick screener for OCD in verbally fluent autistic adults—use Total ≥42 or Checking ≥8 to flag comorbid cases.
01Research in Context
What this study did
Cadman et al. (2015) asked verbally fluent autistic adults to fill out the 18-item OCI-R.
The team wanted to know if this quick paper checklist could tell ASD-plus-OCD from ASD-alone and from OCD-alone.
They ran math checks to see where to draw the cut-off scores.
What they found
Total score at or above 42, or a Checking item score at or above 8, flagged likely OCD.
The tool cleanly split obsessive-compulsive symptoms from the repetitive behaviors that are part of autism.
In plain words: the OCI-R works for autistic grown-ups.
How this fits with other research
Zandt et al. (2009) first showed that repetitive behaviors in kids with ASD and OCD are different beasts; Tim’s team now proves the same is true in adults and gives you a one-page ruler to measure it.
Smith et al. (2010) found that autistic traits make OCD worse; Tim et al. answer the next question—how to spot that comorbid OCD quickly in your ASD clients.
Lefebvre et al. (2021) looked at relatives and saw the two symptom pools mostly overlap; Tim et al. clarify that, at the individual level, the OCI-R still separates them well enough for clinical use.
Hesselmark et al. (2015) showed autistic adults can reliably self-report personality; Tim et al. extend that green light to OCD screening, so you can trust the answers you get.
Why it matters
You now have a free, 5-minute tool that spots likely OCD in verbally fluent autistic adults without mixing it up with autism traits. Use the cut-offs to decide who needs a full OCD evaluation and who doesn’t. Faster triage, faster treatment, better outcomes.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add the OCI-R to your intake packet and score it on the spot—refer any client who hits ≥42 total or ≥8 on Checking for full OCD evaluation.
02At a glance
03Original abstract
Little is known about the symptom profile of obsessive-compulsive disorder (OCD) in individuals who have autism spectrum disorders (ASD). It is also unknown whether self-report questionnaires are useful in measuring OCD in ASD. We sought to describe the symptom profiles of adults with ASD, OCD, and ASD + OCD using the Obsessive Compulsive Inventory-Revised (OCI-R), and to assess the utility of the OCI-R as a screening measure in a high-functioning adult ASD sample. Individuals with ASD (n = 171), OCD (n = 108), ASD + OCD (n = 54) and control participants (n = 92) completed the OCI-R. Individuals with ASD + OCD reported significantly higher levels of obsessive-compulsive symptoms than those with ASD alone. OCD symptoms were not significantly correlated with core ASD repetitive behaviors as measured on the ADI-R or ADOS-G. The OCI-R showed good psychometric properties and corresponded well with clinician diagnosis of OCD. Receiver operating characteristic analysis suggested cut-offs for OCI-R Total and Checking scores that discriminated well between ASD + versus -OCD, and fairly well between ASD-alone and OCD-alone. OCD manifests separately from ASD and is characterized by a different profile of repetitive thoughts and behaviors. The OCI-R appears to be useful as a screening tool in the ASD adult population.
Autism research : official journal of the International Society for Autism Research, 2015 · doi:10.1002/aur.1461