Preface x
Acknowledgements xxi
Part I Understanding OCD and ASD 1
1 What Is Obsessive-compulsive Disorder? 3
OCD and OCBs 6
2 Key OCD-related Terms for the Behavior Analyst 11
Obsession 11
John: Obsession as an "Urge" 12
Khalil: OCD as an "Image" 13
Elliot: OCD as a "Thought" 16
Obsessions as a Behavior Analyst Might Understand Them 17
Types of Obsessions 18
Compulsion 25
Compulsions as a Behavior Analyst Might Understand Them 26
Ego-dystonic 27
Ego-dystonic as a Behavior Analyst Might Understand It 27
Insight 28
Insight as the Behavior Analyst Might Understand It 29
Mindfulness 30
Mindfulness as the Behavior Analyst Might Understand It 31
3 A Short Summary of Autism Spectrum Disorders 36
Social and Communication Impairments 38
Restricted and Repetitive Behaviors and Interests 40
Sensory Differences 40
Insistence on Sameness 40
Restricted Interests 41
Stereotyped Motor Movements 42
4 Why Does OCD Co-occur with ASD? 45
Genetic Links Between OCD and ASD 45
Etiological Theories of ASD Causation and Potential Connection to OCD 47
Contributions of Social Difficulties 50
Contributions of RRBs 51
OCD and Difficulties Related to ASD 52
Alexithymia 53
Trauma 53
Distinguishing Compulsions and RRBS and OCBs 53
5 Assessing OCD and OCBs in Individuals with ASD 61
Sources of Assessment Difficulties 61
OCD Assessments 63
So What Can a Behavior Analyst Do? 64
Part II Providing Services for Autistic Clients with OCD and OCBs 67
6 Ethics, Supervision, and Scope of Competence 69
Scope of Competence 69
Scope of Competence and OCD 71
Recognizing and Expanding Your Scope of Competence 71
OCD and Insurance Authorization 74
7 Medication and OCD 76
Medication and ASD: A Short Summary 76
The Role of Medication in OCD-focused Services 77
Overview of Common Medications for OCD 78
Selective Serotonin Reuptake Inhibitors 78
Clomipramine 79
Antipsychotics 79
Differences in Medication Patterns for ASD/OCD Overlap 79
Medication Considerations 81
8 Foundations for Serving Autistic Clients with OCD 84
Tips for Working with Clients with OCD or OCBs 84
Tip #1: Recognize the Effects of Situational Factors on Obsessive-compulsive Behaviors 84
Tip #2: Stimulus Context Can Make the Difference 85
Tip #3: Not All Days Are Equal! Look for "Easier" and "Harder" Days 86
Tip #4: Consider Insight 87
Tip #5: Beware of Accommodating OCD 88
Tip #6: OCD Picks on Things That Matter 89
Tip #7: Are You Sure It's Compulsive? 90
Tip #8: Distress May Be OK, but Meltdowns Are Not! 91
Tip #9: Focus on the Compulsions 91
Tip #10: Let's Try to Be Flexible! Structured Practice 93
Tip #11: What About Special Interests? 93
9 Behavior-analytic Services to Assist Autistic Clients with OCD or OCBs 98
General Behavioral Methods for OCD-related Services 98
ABC Models and FBAs 99
Communication Skills Training and Functional Communication Training 101
Sample Short Plan for Functional Communication 102
Sample Short Plan for Communication Skill Training 103
Antecedent Interventions and Setting Event Management 104
Tolerance Training 106
Sample Short Plan for Tolerance Training 107
Differential Reinforcement and Replacement Behaviors 107
Sample Short Plan for Differential Reinforcement 108
Sample Short Plan for Differential Reinforcement with RIR 109
Emotion Regulation Skills 110
Tips for Using Emotion Regulation Skills 111
Social Skills Training 112
Tips for Social Skills Training 113
Specialized Behavioral Methods for OCB and Compulsive Behavior Management 113
Gradual Exposure and ERP 114
Why Does This Work? 115
Sample Procedure to Design a Gradual Exposure Technique 116
Sample: Designing a Gradual Exposure Plan 117
Sample Gradual Exposure Plan Proposal 119
How to Run a Gradual Exposure Trial 120
Tips to Remember When Using Gradual Exposure Techniques 125
Sample (Short) Dialog: Talking with Client About Gradual Exposure 126
Acceptance and Commitment Training 130
What Is Acceptance and Commitment Training? 130
Why Does This Work? 130
Six Key Principles 131
Can a Behavior Analyst Really Use ACT? 134
ACTr and Rule-governed Behavior 135
Some Ways to Use Acceptance Techniques to Help Clients with OCD or OCBs 137
How to Prepare an Acceptance-based Service 137
Sample: Designing an ACTr Plan 138
ACTr Exercises 147
Things to Remember When Using Acceptance Strategies 162
Self-awareness Techniques 163
Why Does This Work? 164
How Do I Prepare? 164
Activities for Building Self-awareness 165
Summary 170
10 Caregiver-focused Service Strategies 175
Major Benefits of Caregiver-focused Strategies 175
Types of Caregiver-focused Interventions 176
Caregiver Education 176
SPACE 182
Behavioral Skills Training 183
Final Notes on Caregiver-focused Service Treatment 184
11 Interdisciplinary Collaboration 186
Collaboration: Basic Principles 187
What a Behavior Analyst Brings to Collaboration 187
Brief Descriptions of Likely Collaborators for Clients with OCD or OCBs 188
Psychologists 188
Speech-language Pathologists 189
School Psychologists 190
Special Education Teachers 190
Occupational Therapists 191
References 192
12 Knowing Your Client's World 194
Conclusion 196
Index 197
