Brief report: exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism.

McLennan et al. (2008) worked with one 12-year-old boy who had both autism and OCD. They used exposure and response prevention, a CBT method where the child faces a fear but is blocked from doing the usual ritual.

Sessions happened twice a week for eight weeks. The team built a fear ladder, starting with easy triggers and moving to harder ones, while the boy earned stickers for staying in the situation.

The boy’s OCD scores dropped from the clinical range to the mild range by the end of treatment. The rituals that used to take hours shrank to minutes or stopped completely.

Parents said the gains held at a three-month check-in. No new drugs were added during the study.

Wetterneck et al. (2006) also used ERP with an 8-11-year-old, but that child had Tourette’s tics instead of OCD. Both single-case studies show ERP can cut repetitive behavior fast, yet T et al. saw partial relapse after three months—so plan for booster sessions.

Arwert et al. (2020) looked at typical kids with OCD and found those who overpredicted their fear during exposure improved quicker. The autistic boy in D et al. was not asked to rate fear, so we do not know if the same rule holds for kids with autism.

Zemestani et al. (2022) compared ERP to ACT in Iranian adults already on SSRIs. Both therapies beat pills alone, but the adult RCT tells us little about how ERP works for a 12-year-old with autism and no meds.

Many BCBAs are told that autistic children cannot handle CBT. This case shows they can. You can add ERP to your ABA toolkit when OCD rituals block learning or daily life. Start with a short fear ladder, use strong reinforcers, and track both compulsions and skill acquisition. If the child uses words, have them guess how scary each step will be—Arwert et al. (2020) says the “easier than expected” moments speed up progress.