Why His Rituals Don’t Look Like Anxiety: Understanding OCD in Autistic Children

You’ve probably heard that OCD is about fear.

Fear of germs. Fear of harm. Fear of losing control.

But what happens when your child doesn’t look afraid?

What if the ritual doesn’t come with panic?

What if it looks like a routine — or even a preference?

What if professionals say: “Well, that’s just how autistic children are”?

If that’s your experience, you’re not alone.

And more importantly — you’re not wrong to ask questions.

This blog is for parents and carers who’ve been told their child’s rituals aren’t OCD “because they don’t seem anxious.”

We want to think with you, not dismiss what you’re seeing.

The Overlap: OCD and Autism in the Same Mind

It’s possible — and increasingly recognised — that a child can be both autistic and have OCD.

But when that happens, the lines between:

comforting sameness

sensory routines

rigid patterns

compulsions

...can get blurry.

That’s because both autistic thinking and OCD can involve:

Repetition

Resistance to change

Focused interests or fixations

Structured ways of coping

So what’s the difference?

When a Routine Becomes a Compulsion

Here’s a way to think about it:

A routine brings comfort.

A compulsion brings relief from distress.

The autistic child may:

Line up toys because it feels satisfying or orderly.

Watch the same video to regulate sensory input or decompress.

But when OCD is present, the act becomes urgent.

There’s a “must” behind it. A hidden pressure. A fear of what might happen — even if they can’t say what.

They might:

Rewatch a video not to enjoy it, but to cancel out a bad thought.

Need to do something “just right” or else feel unbearable discomfort.

Why They Might Not Look Anxious — But Still Be Struggling

This is one of the most important things we want families to understand:

Not all distress looks like distress.

Some children:

Don’t have the language to describe what’s happening inside.

Have learned to mask or flatten their expressions.

Experience emotions through sensory tension rather than facial cues.

Redirect discomfort into repetitive behaviours.

So while a neurotypical child might cry or freeze during an OCD episode…

an autistic child might just restart the ritual — again and again and again.

What looks calm might actually be chaos on the inside.

What Can Parents Look For?

You know your child. But here are some signs the behaviour might be compulsive rather than just routine:

It must be done a certain way, or repeated over and over.

Attempts to interrupt lead to panic, shutdown, or rage.

The child can’t explain why they’re doing it — or says, “I don’t know, I just have to.”

The ritual seems to be about neutralising a bad feeling, not pleasure.

It intensifies during transitions, stress, or change.

It’s linked to a sense of something bad happening if not completed.

What This Means for Families

If you’ve raised these concerns and been told:

“That’s just part of the autism,”

— you’re not wrong to pause.

It might be part of the autism.

But it might also be OCD.

Or — as is often the case — both.

And if it is OCD, it deserves understanding and support.

Not behavioural policing. Not dismissal. And not shame.

What Helps?

I believe in treating the whole child, not just the diagnosis. Here’s what we recommend:

Slow down before stopping the ritual.

Understand what it’s doing first. Is it soothing? Avoiding? Cancelling?

Support communication.

If your child is minimally verbal, notice how rituals follow emotion.

(Did they start after something changed? After sensory overwhelm?)

Work with professionals who know both.

OCD treatment in neurodivergent children often needs adaptation. That doesn’t mean it's impossible — it means it needs care.

Trust what you’re seeing.

If it feels compulsive to you, bring it up again. The more clearly we understand what the behaviour does, the better we can help.

You’re Allowed to Be Curious

You don’t need to be a clinician to wonder, to observe, to notice when something isn’t sitting right.

You don’t need to have the perfect words.

You just need your instinct — the one that sees past “he’s just being difficult” or “that’s just autism.”

You know when something is starting to take over.

That’s when we need to start asking better questions — not giving quick answers.