Some neurodivergent children can be very particular about routines, the position of items, which clothing items should be worn together, and other non-sensory specifics. (Sensory needs are a separate issue). These things can appear inconsequential to other people, and may be considered indicative of OCD. A number of young neurodivergent people are even diagnosed as having OCD. How many of these diagnoses are accurate is questionable.
The DSM-5 specifically defines Obsessive Compulsive Disorder as not being excessive worries about real life problems. Whether they look logical to outsiders or not, the vast majority of neurodivergent people who experience these thought patterns do consider their worries to be relevant, and about real life problems. In fact, the effort put into worrying about these things prevents dysregulation, which not only makes this logical but necessary. And definitely not OCD.
Why So Particular?
Some neurodivergencies, such as autism and apraxia, are strongly related to trust. Can they trust their bodies? Can they trust the world, and their perception of it? How about trusting other people? Artificially creating structure and predictability allows neurodivergent people to have a greater sense of trust. Doing things in a particular order, for example, allows them to be more confident that they won’t skip something in a process. Keeping things in a specific place makes it less likely they’ll lose or forget something.
In a neurotypical world, being neurodivergent frequently feels like having no control over your own life. There is a constant flow of corrective feedback: you’re doing it wrong, you’re saying it wrong, you look wrong. Taking what appears to be excessive control over elements of life that can be controlled is a neurodivergent person’s way of attempting to counter this experience. Can’t control that the school routine keeps changing? Can control what is in your lunchbox. Can’t control whether your parents are cheerful or grumpy in the morning? Can control the way your toys are lined up each day.
Disorder, surprise, and dysregulation are all common factors in neurodivergent meltdowns and burn out. Keeping things the same, doing things in a predictable manner, and knowing what to expect, are all self-protective measures for neurodivergent people. If an autistic person is painfully aware of the impact of not being able to find their school shoes when they need to leave the house in the morning, laying out their entire uniform each night is a clever solution. It may look excessive, even obsessive, but it’s an example of the type of coping mechanism adopted by many neurodivergent people, consciously or otherwise.
Should We Reject OCD?
So if your paediatrician, or other medical professional, is suggesting your neurodivergent child has Obsessive Compulsive Disorder, should you reject it? No. Not necessarily.
Despite all diagnoses in the DSM-5 having clear definitions and parameters, a good medical professional will accept that there are exceptions. Other factors. Rules to be bent or broken. Just like OCD shouldn’t be about real life problems, Generalised Anxiety Disorder shouldn’t be about genuine concerns either. However, a good medical practitioner can still recognise anxiety that requires support and/or treatment, even if the stresses are logical. If a neurodivergent person’s need for control and organisation becomes problematic, or the inability to control as much as they would like to causes distress or anxiety, they need help. Whether or not these behaviours are a logical response to real world problems becomes almost irrelevant. While a clinical diagnosis of OCD might not be entirely accurate, giving your child this diagnosis may afford them the support they need to cope when control isn’t an option.
It is worth approaching your paediatrician or psych if your child hasn’t been diagnosed, but you observe the need for control is problematic (beyond being different to how you’d do things, or taking a little extra time here and there). You might find your child wanting to sort toys into categories, and upset that some don’t fit in a category or fit in more than one. A child could get distressed if they like to drive to school the same route every day, and a road is closed for roadworks. Growing out of the trousers that they feel must be worn with a particular shirt which still fits can lead to a meltdown. These children need help. Not necessarily medical intervention, but definitely more than allowing them to continue to attempt to control these situations. If you don’t presently have the tools to assist them, do seek guidance and support.
The treatment, support, and potential medication is often the same whether a child has clinical OCD, or is distressed by their need for control.
How Can I Help?
Where possible, allow your child to protect themselves. If you can afford the extra five minutes each morning so they can make their bed and set up their toys on it exactly the way they want them, gift them that time. If they like to wear socks with days of the week on them on the right days of the week, do what you can to keep up with the laundry accordingly – or buy extra socks. Even if you can’t imagine how tedious it would be to eat the same food in their lunchbox every day, if that’s what they’d like, let them.
Don’t mess with the system. Outdated and traumatising therapies such as ABA have recommended ruining these sorts of systems. They then “teach” the child to suppress their response. Don’t do this. Don’t ever do this. This will not build resilience, or encourage them to accept alternatives. It will only contribute further to their need to control their world, and cause trauma when they cannot.
While your child might do things differently to you, don’t criticise them. Even if they seem to be wasting their time on “silly things”, or some of their idiosyncrasies irritate you. Find the positives. Tell them their outfit matches beautifully. Instead of complaining about how long it takes them to make their bed, praise them for making it. If it feels to you that they’re preparing excessively for the next day, let them know how impressed you are that they’re preventing hiccups.
And, so importantly, always allow for the possibility of mental health concerns and neurodivergence coexisting. Sometimes because neuronormative life can be damaging for a neurodivergent child. Sometimes because certain traits of neurodivergence can be incredibly impactful themselves. And sometimes because they can have both, independently, due to genetics or environment. Never dismiss signs of mental health concerns in neurodivergent children simply because their brains aren’t neurotypical.