Transdiagnostic Examination of Interrelationships Between Anxiety, Insistence on Sameness and Compulsions.
Anxiety predicts insistence on sameness and compulsions the same way across autism, ADHD, and OCD, so always screen for it.
01Research in Context
What this study did
Spackman et al. (2025) looked at anxiety, insistence on sameness, and compulsions across four groups: autism, ADHD, OCD, and mixed clinical cases.
They used existing records, not new tests, to see if anxiety links to rigid behavior the same way in every diagnosis.
What they found
Anxiety showed a small but steady tie to both insistence on sameness and compulsions in all groups.
The links did not jump higher for any one diagnosis; the pattern looked the same across labels.
How this fits with other research
Richards et al. (2017) asked teens with autism about their own behavior and found the same anxiety–repetition link, showing kids can report it themselves.
Spriggs et al. (2015) went further, showing anxiety and other psych troubles explain most of the tie between autism traits and repetitive acts, hinting at why the link exists.
Smith et al. (2010) saw that adults with OCD often carry autism and ADHD traits, foreshadowing this broader view that rigid behavior travels across diagnoses.
Lefebvre et al. (2021) found repetitive behaviors in parents of autism and OCD families look more alike than different, backing the idea of one shared continuum rather than separate boxes.
Why it matters
If anxiety drives rigid or compulsive behavior no matter the main label, you should screen for anxiety in every intake.
Treating anxiety first may soften the very behaviors we often target with autism or OCD plans, saving you time and the client stress.
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02At a glance
03Original abstract
Although insistence on sameness (IS) and compulsions occur across a wide range of neurodevelopmental (NDD) and neuropsychiatric (NPD) conditions, they are typically only examined within the confines of specific singular disorders. Indeed, while anxiety has been consistently linked to IS in autism and compulsions in obsessive-compulsive disorder (OCD), no empirical study has examined these associations in a sample spanning a range of NDD and NPD. Therefore, this study utilized a large sample of children and adolescents spanning several NDD and NPD to examine whether anxiety shows different patterns of association with IS or compulsions within and across diagnostic groups. The transdiagnostic sample encompassed youth (mean age = 10.36 [3.40]; N = 1852) diagnosed with autism (N = 387), attention-deficit hyperactivity disorder (ADHD; N = 931), internalizing disorders (N = 208), OCD/Tic disorder (N = 59) and oppositional defiant/conduct disorder (ODD/CD; N = 267). IS and compulsions were assessed using the Repetitive Behavior Scale-Revised, and anxiety using the Screen for Child Anxiety Related Disorders. Within-group comparisons revealed that, in the autism, ADHD, and OCD/Tic groups, anxiety showed a slightly stronger association with IS than compulsions although effect sizes indicated small to no effect (q < 0.24). Between-group comparisons showed that interrelationships between anxiety, IS, and compulsions did not differ across groups, except for the association between IS and compulsions, which was slightly weaker in the ADHD group compared to the autism (z = 4.20) and ODD/CD groups (z = 3.32). Findings affirm the transdiagnostic nature of IS and compulsions and suggest that anxiety plays a key role in these behaviors, irrespective of primary diagnosis.
Autism research : official journal of the International Society for Autism Research, 2025 · doi:10.1002/aur.70096