Differential diagnosis of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) in adolescents is difficult due to similar behavioral topography. For instance, restrictive, repetitive behavior, cognitive rigidity, anxiety, and avoidance contribute to impairment in social relationships and daily living skills in both conditions. The diagnostic picture for youth with ASD and/or OCD may be further clouded by high rates of co-occurring gender-diverse clinical concerns, attention-deficit/hyperactivity disorder, tic disorder, depression, and anxiety disorders With increased prevalence and improved identification of ASD, OCD, and gender-identity-related distress, more adolescents are seeking treatment. It is vital that providers are knowledgeable about best practices for diagnosing and treating these overlapping symptoms. This review describes the state of the literature regarding presentation and prevalence of ASD, OCD, and gender-identity concerns separately and as co-occurring phenomena. Sex differences and gender-diversity among individuals with ASD and OCD are also reviewed. We briefly describe evidence-based behavioral treatments for ASD, OCD, gender-identity-related distress as separate and co-occurring considerations. Recommendations for tailoring within these therapies and family involvement are discussed.

Obsessive-compulsive disorder (OCD) impacts 1%—4% of the United States population. Scrupulosity, or obsessions related to morality and religion, is the fifth most common obsession. Although clinicians and researchers may have ample assessment information about their clients, such as OCD severity, gender, and religious background, little research in the field has shown how these variables relate to personality factors. Using Amazon's Mechanical Turk, we recruited 230 participants to (a) determine if scrupulosity were predictive of openness and neuroticism while accounting for gender, OCD severity, and religiosity; (b) investigate whether religious identity interacted with scrupulosity when predicting openness and neuroticism; and (c) examine if gender identity contributed to openness and neuroticism. Using linear mixed models, we found that higher scrupulosity predicted lower levels of openness across all religious groups, and that higher scrupulosity was associated with higher negative emotionality for nonreligious individuals. Implications for practice and continued research are discussed.

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Parent-Child Interaction Therapy (PCIT) is a well-established treatment for disruptive behavior disorders in preschool-aged children. Treatment gains are made by reducing negative parent-child interactions and increasing parental warmth and consistency. While the current literature focuses mainly on child outcome variables, it stands to reason that PCIT may also lead to changes in well-being for caregivers, including improvements in marital quality, parental self-efficacy, personal stress, and parental depression. This research brief will summarize the existing literature on change of parental well-being variables during the course of standard PCIT and will have important clinical implications for clinicians working with parents experiencing personal distress.

Clinicians are often trained to conceptualize cases from a biopsychosocial model, though many of us receive considerably less training and continuing education in the biological variables related to the disorders we treat. This research brief will summarize the existing literature related to the hypothalamic-pituitary-adrenal axis functioning and sympathetic nervous system functioning in children with disruptive behavior disorders with special focus on children age 2 to 7. Additionally, the available studies examining the change in these variables over the course of behavioral interventions for disruptive behaviors will be included. Clinicians will benefit from an increased understanding of biological processes underlying disruptive behaviors, allowing them to improve their case conceptualizations and the psychoeducation they can provide caregivers. Moreover, though the current research is still working toward identifying a biomarker for disruptive behaviors, this research brief will explain the rationale behind biomarkers in psychological treatment and the current research in this area. Next steps for research in this growing subfield will also be discussed.

Children with conditions affecting cognitive processes experience high levels of sleep disturbance, which may further compound the cognitive ramifications of their disorders. Despite this, existing studies in this area have been primarily confined to only particular diagnostic groups and/or a limited scope of sleep and cognitive parameters. The current study characterized the nature of sleep problems and examined the relationship between a wide range of sleep-related problems and cognitive functioning in a large (N = 103) diagnostically heterogeneous sample of youth (aged 6–16) referred for neuropsychological assessment. Structural equation modeling was used to examine the relationship between sleep-related problems (i.e., daytime sleepiness, sleep onset latency, sleep fragmentation, sleep time variability, sleep debt) and cognitive performance (i.e., executive functioning, sustained attention, memory, processing speed). Sleep fragmentation emerged as the most prominent sleep-related problem in the present sample. Structural equation modeling demonstrated a negative association between sleep-related problems and cognition that did not reach statistical significance (β = −0.084, p = 0.629). The current statistical approach may be used as a conceptual framework for future work examining these multi-dimensional constructs in a parsimonious fashion.