AUTHOR=Guastello Andrea D. , Lieneman Corey , Bailey Brittany , Munson Melissa , Barthle-Herrera Megan , Higham Miranda , Druskin Lindsay , McNeil Cheryl B. 

TITLE=Case report: Co-occurring autism spectrum disorder (Level One) and obsessive-compulsive disorder in a gender-diverse adolescent

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1072645

DOI=10.3389/fpsyt.2023.1072645

ISSN=1664-0640

ABSTRACT=This case report describes the diagnostic assessment and behavioral treatment of an adolescent demonstrating symptoms concerning for 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 who identified as gender-neutral but had been assigned female at birth. Presenting symptoms were social withdrawal, rigid, rule-following behavior, unusual repetitive behavior, social communication skill differences, 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 activities of daily living. We summarize 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 impairment or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder, single episode, 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.