OCD in Neurodivergent Individuals: Overlaps, Misdiagnosis, and Tailored Support

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When you’re neurodivergent, getting the right diagnosis can feel like solving a puzzle where the pieces keep changing shape. For many of us living with conditions like ADHD or autism, OCD symptoms can hide beneath more visible traits, leading to years of misunderstanding and inadequate support.

As someone who navigates OCD alongside ADHD (combined type), dyslexia, and dyspraxia, I’ve experienced firsthand how these conditions don’t exist in neat, separate boxes. They overlap, mask each other, and create unique presentations that standard diagnostic criteria often miss. Even experienced clinicians can find themselves confused when trying to untangle where one condition ends and another begins — something I know all too well from my own diagnostic journey.

This post explores the complex relationship between OCD and other forms of neurodivergence, helping you recognise the signs, understand the risks of misdiagnosis, and find support strategies that honour your entire neurological profile.

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The Disease of Doubt: Understanding OCD at Its Core

One insight that fundamentally changed my understanding of OCD came from research at Johns Hopkins. Dr. Gerald Nestadt, who has studied OCD for over 30 years, describes OCD not simply as a condition but as fundamentally rooted in doubt — historically even called “the doubting disease” (folie du doute).

Here’s what makes this profound: Doubt in OCD isn’t about lacking knowledge — it’s a behavioural trait. As Nestadt explains, it’s “a lack of confidence in one’s own memory, attention and perception necessary to reach a decision” (Nestadt et al., 2016).

This distinction matters enormously. When I doubt whether I’ve locked the door, it’s not because I don’t know how locks work. I can see with my own eyes that it’s locked, yet still need to check again and again. This doubt emerges from what researchers call “a neurocognitive vulnerability in the mental life of the individual, which has a basis in neurophysiology” (Samuels et al., 2017).

The research is striking: In a study of 1,182 adults with OCD, those with severe doubt showed extreme dysfunction in 80% of cases. The more doubtful participants were, the more impaired their daily functioning became (Johns Hopkins Medicine, 2017). This isn’t just uncertainty — it’s a fundamental disruption in the decision-making process that affects every aspect of life.

For neurodivergent individuals, this doubt can be easily mistaken for other traits:

• In ADHD: Confused with inattention or forgetfulness
• In autism: Misinterpreted as rigidity or need for sameness
• In dyspraxia: Assumed to be coordination or planning difficulties

Understanding OCD as the “disease of doubt” has been transformative for me. It explains why reassurance never helps, why checking never satisfies, and why the uncertainty feels so fundamentally different from simple lack of confidence.

How OCD Presents Differently in Neurodivergent Individuals

The Numbers Tell a Story

Research reveals striking patterns in how OCD intersects with other neurotypes:

• Autism and OCD: Studies show autistic individuals are approximately twice as likely to experience OCD, with prevalence rates reaching 17-37%. A Danish population study found that autistic people have twice the risk of developing OCD later in life, while those with OCD are four times more likely to receive an autism diagnosis at some point (Meier et al., 2015).
• ADHD and OCD: Co-occurrence rates reach up to 30% according to comprehensive clinical reviews (Abramovitch et al., 2015). Research also shows that adults with ADHD report significantly more sensory processing difficulties, which can overlap with and mask OCD symptoms (Bijlenga et al., 2017).
• Triple overlap: Nearly half of those with OCD show significant autistic traits, and over a quarter meet criteria for an autism diagnosis (Wikramanayake et al., 2018). When ADHD is added to the mix, the diagnostic complexity increases exponentially.

These aren’t just statistics — they represent thousands of people whose OCD might look different from textbook presentations because their brains process the world differently to begin with.

When Traits Overlap and Mask Each Other

For autistic individuals, the line between comforting routines and OCD compulsions can blur. Both might involve repetitive behaviours, but the motivation differs: autism-related routines often bring genuine enjoyment or regulation, while OCD compulsions are driven by anxiety and provide only temporary relief.

With ADHD, the presentation becomes even more complex. The hyperactivity might manifest as rapid-fire compulsions, while inattention can make traditional exposure therapy challenging. Sometimes ADHD’s impulsivity directly conflicts with OCD’s need for control, creating an exhausting internal tug-of-war.

My own experience reflects this complexity. My ADHD brain seeks novelty and stimulation, but my OCD demands certainty and sameness. Some days, checking behaviours become a way to feel “productive” when ADHD restlessness kicks in — a maladaptive coping strategy that took years to recognise.

The Risk of Misdiagnosis and Delayed Support

When OCD Hides in Plain Sight

Misdiagnosis isn’t just frustrating — it can delay essential treatment for years. OCD symptoms in neurodivergent individuals are often misinterpreted as:

• Autism-related special interests (when they’re actually obsessions)
• ADHD hyperfocus (when it’s actually rumination)
• Sensory processing differences (when they’re contamination fears)
• Executive dysfunction (when it’s paralysis from perfectionism)

Research from Johns Hopkins indicates that up to 50% of OCD cases are initially misdiagnosed, with this number likely higher in neurodivergent populations where overlapping traits complicate assessment.

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The Real-World Consequences

Delayed or incorrect diagnosis means:

• Years of inappropriate interventions that don’t address core OCD symptoms
• Increased severity as untreated OCD tends to worsen over time
• Development of secondary mental health conditions from unmanaged distress
• Erosion of self-esteem from feeling “treatment-resistant” when the real issue wasn’t being addressed

A Personal Note: When Even Specialists Are Confused

During my own autism assessment, the clinician stopped midway, sighed, and said she couldn’t determine if it was OCD or autism — I ticked “every other box” of the DSM-5 criteria but not the complete block required for diagnosis. She said when she’d read my information, she thought it was autism, but the more I talked, the more confused she became. “Let me get back to you, let me process,” she said. Weeks later, I’m still waiting to hear back.

That experience of being “almost but not quite” autistic, of having my OCD potentially mask or mimic autistic traits, perfectly captures why we need more sophisticated understanding of how these conditions interact. The doubt that followed — was it OCD? Autism? Both? Neither? — became its own form of torture, feeding into the very OCD patterns we’re discussing. The irony of experiencing profound doubt about my neurodivergence while potentially having OCD, “the disease of doubt,” wasn’t lost on me.

This diagnostic limbo is exactly what happens when professionals aren’t equipped to recognise how these conditions overlap and influence each other. It’s why this conversation matters so deeply.

Signs of OCD Alongside Neurodivergence

Recognising OCD in the context of neurodivergence requires looking beyond stereotypes. Here are key indicators:

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Understanding Your Sensory Profile

With some of my clients I work with, I’ve created sensory profile audits that have proven transformative. These assessments help identify not just what sensory needs exist, but why they exist — distinguishing between:

• Sensory seeking behaviours (common in ADHD)
• Sensory avoidance (can occur in OCD, autism, or anxiety)
• Sensory regulation needs (often present across all conditions)

Research shows that young people with OCD experience significantly more sensory processing difficulties, with multiple sensory challenges correlating with increased symptom severity, particularly around symmetry and ordering compulsions (Cervin, 2023). Understanding your sensory profile helps differentiate between:

• OCD compulsions triggered by sensory discomfort
• Autism-related sensory preferences for regulation
• ADHD sensory-seeking for stimulation

This distinction is crucial because the support strategies differ dramatically based on the underlying need.

For Autistic Individuals:

• Routines that cause distress rather than comfort when disrupted
• Repetitive behaviours driven by “what if” fears rather than sensory needs
• Special interests that have shifted from enjoyable to anxiety-inducing
• Mental rituals around social interactions beyond typical autism-related social anxiety

For Those with ADHD:

• Hyperfocus episodes centred on checking or mental reviewing
• Procrastination driven by perfectionism rather than executive dysfunction
• Impulsive behaviours followed by extensive rumination and regret
• Organisation systems that must be “perfect” or they’re abandoned entirely

Additional Red Flags:

• Spending hours on tasks that should take minutes
• Avoiding activities you once enjoyed due to intrusive thoughts
• Seeking constant reassurance about the same concerns
• Physical symptoms like headaches or exhaustion from mental compulsions

How to Cope with Overlapping Conditions

Practical Strategies for Daily Management

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1. Adapted Exposure Work

Traditional Exposure and Response Prevention (ERP) often needs significant modification for neurodivergent brains:

For ADHD:

• Break exposure sessions into 10-15 minute chunks with movement breaks
• Use timers and visual progress trackers to maintain engagement
• Incorporate physical activity before sessions to improve focus
• Consider “exposure sprints” — brief, intense practice sessions that match ADHD energy patterns

For Autism:

• Create visual schedules showing exactly what will happen during exposure
• Incorporate special interests as rewards or motivation
• Use social stories to explain the purpose and process
• Maintain predictable session structures while varying the exposure content
• Build in sensory regulation time before and after sessions

2. Sensory Regulation First

Before attempting any OCD work, establish sensory baseline:

• Create a sensory toolkit: weighted blankets, noise-cancelling headphones, fidget tools, aromatherapy
• Map your sensory triggers and soothers across all eight senses (including vestibular, proprioceptive, and interoceptive)
• Schedule regular sensory breaks throughout the day
• Use the “sensory sandwich” approach: calming input before and after challenging tasks

Research indicates that addressing sensory needs first can reduce overall anxiety by up to 40%, making OCD symptoms more manageable (Miller et al., 2012).

3. The “Both/And” Approach

Instead of forcing yourself to identify whether something is OCD, autism, or ADHD:

• Address all possible needs simultaneously
• Use sensory tools AND cognitive restructuring
• Honour routines AND gradually challenge compulsions
• Provide stimulation AND structure

Example: If you’re unsure whether repeated checking is OCD or ADHD forgetfulness:

• Use visual reminders and checklists (ADHD support)
• Practice delayed checking with scheduled times (OCD exposure)
• Add sensory input while waiting (regulation for both)

4. Medication Considerations

Research shows important nuances for neurodivergent individuals:

• SSRIs may need different dosing for autistic individuals (start lower, increase slower)
• Stimulant medication for ADHD might initially increase OCD symptoms before improving overall functioning
• Some individuals benefit from combination therapy addressing multiple conditions
• Monitor sensory sensitivities, as some medications can heighten or dull sensory experiences

Always work with professionals familiar with neurodivergent medication responses who understand that “standard” protocols may need adjustment.

5. Creating Environmental Accommodations

Design your space to support all your neurotypes:

• Designated “OCD-free zones” where checking/rituals aren’t allowed
• Sensory corners with regulation tools readily available
• Visual schedules and reminders to support executive function
• Clutter-free spaces that don’t trigger perfectionism or overwhelm
• “Transition zones” between different activities or rooms

6. The Power of Routine Flexibility

Develop what I call “flexible frameworks”:

• Core routines that provide structure (supporting autism/ADHD)
• Built-in variation to prevent OCD rigidity
• “Choice points” where you can select between pre-approved options
• Regular “routine reviews” to ensure they’re serving, not controlling you

Example morning routine:

• Fixed: Wake up, bathroom, medication
• Flexible: Choose between 3 breakfast options
• Fixed: Get dressed
• Flexible: 10-minute activity of choice (movement, reading, music)
• Fixed: Gather items for day
• Flexible: Choose transport method if possible

Support Strategies for Parents

Supporting a child with overlapping neurodivergent conditions requires a nuanced approach:

1. Validate the Complexity

• Acknowledge that your child’s experience is unique and challenging
• Avoid comparing to other children with “just” one diagnosis
• Celebrate small wins — progress might look different for your child

2. Become a Detective Track patterns to identify triggers and functions:

• What time of day do symptoms worsen?
• Are behaviours sensory-seeking, anxiety-driven, or executive function-related?
• Do certain environments increase or decrease symptoms?
• Keep a behaviour diary noting: antecedent, behaviour, consequence, and your child’s state (hungry, tired, overstimulated)

3. Work with Neurodivergent-Affirming Professionals Essential qualities to look for:

• Experience with multiple co-occurring conditions
• Flexibility in treatment approaches
• Understanding of how conditions mask and mimic each other
• Willingness to adapt evidence-based practices for your child’s profile
• Recognition that behaviour is communication

4. Focus on Function Over Labels Rather than getting stuck on “Is this OCD or autism?”, ask:

• What need is this behaviour meeting?
• What skill is missing?
• What support would help right now?
• How can we make this easier for everyone?

5. Create a Supportive Home Environment

• Establish predictable routines with built-in flexibility
• Provide sensory tools and safe spaces
• Reduce unnecessary demands during high-stress periods
• Model emotional regulation and self-compassion
• Use visual supports for expectations and transitions

6. Build Your Support Network

• Connect with other parents navigating similar complexities
• Join online communities for specific overlapping conditions
• Share resources with your child’s educational team
• Consider family therapy to support siblings and maintain balance

Conclusion and Call to Action

Living with OCD alongside other forms of neurodivergence isn’t about having “more wrong” with you — it’s about having a unique neurological profile that deserves tailored understanding and support.

The research is clear: these conditions frequently co-occur, creating complex presentations that require sophisticated, individualised approaches. Understanding OCD as fundamentally rooted in doubt, recognising how sensory profiles influence symptoms, and acknowledging the overlapping traits between conditions can transform how we approach support and treatment.

If you recognise yourself in these descriptions, remember: your experience is valid, even if it doesn’t fit neat diagnostic boxes. Seeking assessment from professionals who understand neurodivergent presentations of OCD can be transformative.

Take These Steps This Week:

• Document your symptoms without trying to categorise them
• Create a simple sensory audit: what sensations calm you, what overwhelms you
• Track your doubt patterns: when does uncertainty become unbearable?
• Seek professionals who explicitly mention neurodivergent-affirming approaches
• Connect with communities that understand overlapping conditions
• Remember that healing doesn’t require perfect diagnostic clarity — it requires compassionate, flexible support

Ready for specialised support? At Exceptional Individuals, we understand the complex intersections of neurodivergence and provide coaching, workplace assessments, and resources designed for minds like ours.

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References

Abramovitch, A., et al. (2015). Comorbidity between ADHD and OCD across the lifespan: A systematic and critical review. Harvard Review of Psychiatry, 23(4), 245–262.

Bijlenga, D., et al. (2017). Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms. European Psychiatry, 43, 51–57.

Cervin, M. (2023). Sensory processing difficulties in youth with obsessive-compulsive and anxiety disorders. Comprehensive Psychiatry, 121, 152360.

Johns Hopkins Medicine. (2017). The Role of Doubt in OCD. Retrieved from https://www.hopkinsmedicine.org/news/articles/2017/11/the-role-of-doubt-in-ocd

Meier, S. M., et al. (2015). Obsessive-compulsive disorder and autism spectrum disorders: Longitudinal and offspring risk. PLOS ONE, 10(11), e0141703.

Miller, L. J., et al. (2012). Identification of sensory processing and integration symptom clusters: A preliminary study. Occupational Therapy International, 2017, 2876080.

Nestadt, G., et al. (2016). Doubt and the decision-making process in obsessive-compulsive disorder. Medical Hypotheses, 96, 1-4.

Samuels, J., et al. (2017). An investigation of doubt in obsessive-compulsive disorder. Comprehensive Psychiatry, 75, 117-124.

Wikramanayake, W. N. M., et al. (2018). Autism spectrum disorders in adult outpatients with obsessive compulsive disorder in the UK: A cross-sectional study. International Journal of Psychiatry in Clinical Practice, 22(1), 54–62.