It is looking like we may be looking at a pure-obsessional OCD dx for DD. This has come as something as a surprise (we thought she just had anxiety), but DD is nothing if not endlessly surprising. Does anyone have any experience with it?

Kind of. Experience in researching/trying to understand it.

You've mentioned DD is ASD/ADHD-ish before, I think? It wouldn't surprise me if it's all related.

This is an interesting article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227121/

The gist of it is that "Pure O" may be a little off base, descriptively, because people may have "mental compulsions" that are difficult to observe.

Is your DD having intrusive thoughts?

I agree with Eco. My older dd12 has anxiety and at times it manifests as OCD but the underlying issue is anxiety

She is having intrusive thoughts as well as obsessions centering around worry about harm coming to loved ones and her own physical health. She does not have any compulsive behaviors, other than asking for reassurance. I did not understand that this could be OCD at all. The suggestion was made by her therapist especially after a battery suggested cause for concern in this area, and discussion with DD has revealed that this is happening a lot, inside her head.

I see that article considers "reassurance seeking" (we definitely have this) as a compulsion. In that case, she does have that one compulsion.

Interestingly, this is the only battery she completed out of many that came up as problematic.

Speaking of obsessions, I am "obsessing" about this potential dx a little myself. (Not really. But I am really worrying about it. Some of the articles and info I found are really scary and distressing. If anyone has any success stories, it would help right now. I feel terrible for my DD. I didn't know that this was at this level inside her brain. )

DS12 (ASD/ADHD) has fixated about health issues as well, along with the asking for reassurance bit. It was out of control for him (first grade) for months and was the first time I contacted NP about possible OCD.

OCD is an anxiety disorder. It's also common for ASD (as is anxiety, generally), from what I've read.

DS new psychiatrist was running through the DSM ASD criteria with us and when he brought up fixative type behaviors--DS surprised me by sharing he can become very worried/fixated at school about something like "my leg hurt while I was climbing the stairs--I wonder what that could be?" I guess there are things going on in his mind about which I'm completely unaware.

The psychiatrist said sometimes the fixations are somatic in nature. He thought it fit with ASD.

All this to say: it doesn't seem so surprising, giving your description of DD as ASD/ADHD-ish, that she has this thing going on. Has she had a neuropsych eval? When DS was younger, we had psych evaluation and the diagnoses were Generalized Anxiety, Depression NOS, and rule-out on ODD, ADHD. Looking backward through ASD lens, the entire report described an Asperger's kid. The neuropsychologist actually cited the earlier report in her narrative and said it was consistent with ASD.

DS stopped the reassurance seeking (at least about health concerns) as he matured. When he was little, we did all kinds of deep breathing exercises at bedtime, which was his witching hour.


This is a poorly organized response. I hope you can make sense of it!

This is EXACTLY the kind of thing DD is reporting. And it is apparently bad enough at school that it is a distraction. But it's new that it's bad enough to make her be off in space at school, though she has been described as "spacey" off and on her whole life by some adults (yet she has always also been a straight A student). Of note, she is starting to experience the very beginnings of puberty.


Not....exactly. Oh, I don't even KNOW what she's had anymore. She was informally assessed for ASD by early intervention as part of another assessment for large motor delay at age 3 (they thought I was nuts, and she did not qualify for large motor delay either). She was screened with a computer screener for ADHD as part of a CAPD eval at age 8 (passed both eval and screener with flying colors). She was eval'ed for depression and anxiety at age 9 and was borderline for both, more diagnosable on anxiety. With this new practice, we all completed multiple screeners for ADHD (we requested this particularly) depression, anxiety, apparently OCD, and who even knows what else. Kit and caboodle, seemed like. They were not convinced by these results to do an ADHD eval, but said they'd get to know her better and see whether it seemed indicated. We had one appointment where she looked COMPLETELY ADHD to me so maybe they'll do one now! I also asked them to be aware for the need for ASD eval. The psych said she didn't think this was needed based on her observations.

So we have had a lot of random psych stuff but I guess never a full diagnostic eval. I think? We did spend hours filling out forms?

DD has a way of not looking ASD even though IMO she has a ton of things about her that subtly show it. She does not meet the criteria if we look at them in a formal sense. Most importantly, she is highly functional socially, even popular. But man, there are a lot of things about her that fit.

True for DS here, as well. He is very funny and gregarious and was always admired in elementary school for his wit. In MS, he has friends he pals around with and is very invested in his friendships, although they are a bit odd in that he only wants to interact with them at school

DeeDee is the expert, so I'll just parrot her advice: I'd specifically want ADOS. That's how DS was finally diagnosed, in the end. IQ patterns and other instruments supported the diagnosis, but not would not have been diagnostic in and of themselves.

It matters because treatment is different for a neurobiological disorder and an purely psychiatric disorder. I wouldn't expect a regular psychologist to understand how gifted/ASD might present.

CBT is good for this type of thing--also mindfulness. Poor DD, it is hard to imagine they are worrying all the time and we have no idea!

I thought of something else: my DS also passed the computerized ADHD thing with flying colors in second grade (during regular psych eval).

Nobody in their right mind could argue that DS isn't extraordinarily impaired in executive function--he takes 10 minutes to put on a sock, for instance. No matter what I do. It is the most pronounced feature of his ASD so neuropsych retained ADHD diagnosis.

A girl with ADHD-I (without impulsivity/hyperactivity) is likely to just look like a space cadet. Teachers really only seem to express concern when there are disruptive classroom behaviors associated. My DS doesn't have hyperactivity but is *kind of* (not terribly) impulsive, in that he will interrupt/blurt/talk too much. I think that is really more a social skill thing for him than impulsivity, though.

This and your subsequent post also fits my dd12 to a 'T'. She has seen a CBT and her opinion these things were caused by dd's anxiety.

I hope you don't mind my threadjacking to ask, dd12 has no official diagnosis of anxiety, she was just seeing a CBT. Are medical insurance companies more likely to cover neuropsych evals for anxiety, OCD, possible ADHD or CAPD diagnosing?

DD passed the computerized ADHD test as well, which surprised me, because she can be (and usually is) incredibly unfocused doing any kind of school work, playing a game, doing a chore, etc. Neuropsych explained that the test is in a very controlled environment unlike real life, and I'm guessing an ADHD child could pass it just by putting in a lot of effort for that short period of time. She is so unfocused that yesterday i think the school actually got a para into the classroom to sit with her and help her get through assessments. At school, she holds herself together long enough that she doesn't come across as a behavior problem. She is up and wandering a lot though, and fidgeting (she has combined type). The fact that she is not a behavior problem has made it difficult for us to get the school to take the issue seriously, esp. since she can pass their reading/math standardized tests.

To whomever asked about neuropsych evals, we have had two different insurance providers that would not cover this for ADHD (or even ASD). They DID cover it when DS had a traumatic brain injury. I got the school district to pay for a neuropsych eval for DD (I had to let them do--and mess up--their own eval first).

I was a gifted child with these issues (complicated by having a younger sister with a chronic, terminal illness) and am now a mother to DD6 who is showing signs of severe anxiety, now showing OCD behaviors. So weighing in here with sympathy and also some hope. Despite a chaotic and rough childhood, my anxiety issues weren't diagnosed until I was married and living far away from family and basically stopped functioning. After a few years of therapy I am now comfortable saying I can control the anxiety and intrusive thoughts better than I had ever even hoped possible. I can't stress the benefits of therapy enough. Yoga has helped a lot as well. I have to make decompression and spending time being mindful of my health and the good things around me a part of my routine in order to keep myself from fraying at the edges. Fighting off the intrusive thoughts can be exhausting, so rest and trying to maintain enough peace in the midst of a pretty chaotic life is important as well.

DD's anxiety has been something we've tried to manage but not pathologize over the past few years. Unfortunately as the recent school year began it got much worse, and the OCD stuff became disruptive and distressing enough that I've now made her an appointment with a therapist recommended by my own. I am struggling with the mom guilt stuff (I caused this. I should be able to help her.) but am hopeful that by seeking help now, we can give her the tools she needs.

The psych who gave DS that test attributed his acing it to his slow processing speed, which he attributed to perfectionism.

Um, no...I wish...a little perfectionism would be welcomed over here.

I paid for DS neuropsych because it was out of network. I think, but am not sure, insurance would have paid with referral from pediatrician or psychologist.

Medicaid will pay for a NP exam in my state, with just a master's level referral.

We were advised that we would likely have trouble getting the ADHD eval covered based on where we are at this point. CAPD eval was covered, interestingly enough.

The person DD HAS NOT seen for sure is a neuropsych. This is a psychology practice she is at now. But they are located in a university hospital and highly tied in with resources. I feel like we are going around the mulberry bush, and I already did pay $400 for the initial consult here. I probably should have just gone to a neuropsych first, but I have always felt and still feel that she could get 5 different diagnoses from 5 different people (I still feel this) and what we really need is strategies.

DD is absolutely not a behavior problem at school EXCEPT that she can be a little chatty and impulsive when with her BFFs, but this seems more neurotypical than many of her behaviors! DD is also a straight A student and not perceived as having problems with anything by teachers, although she is struggling somewhat with the transition to middle school.

If the teachers don't have concerns about focus it is probably not ADHD. A kid can have EF weaknesses without having ADHD. i have report cards dating back to preschool with the word "focus" (or variations thereof) repeated over and over and over.

FWIW, depending on severity, OCD can interfere with attention and EF.

If this is a newer development, you might also consider the can of worms that is PANS/PANDAS, whereby inflammation (whether autoimmune and/or infectious) is thought to be at the root of the OCD/anxiety. It is controversial and the exact mechanism is not well understood.

Yeah has she had strep throat or another infection of note preceding the beginning of this?

DD is reporting that the obsessional thoughts are interfering with attention and EF to some degree. It doesn't seem to be severe, but she says it can happen.

Teachers have occasionally noted that DD takes a long time to complete work, but that it also tends to be exceptional work. She always finishes tests on time, if not early. At home, we find that she is rather distractible, except when she's not (and it's not really hyperfocus...just, sometimes it's better and sometimes not). She is talkative and extroverted and that's part of it. If we isolate her, she will work faster, but she hates it. I will go through phases of thinking it's really bad and then I'm around boys her age and she looks like a paragon of focus and maturity. OTOH, compared to some girls we know she looks all over the place. FWIW, DH probably has some subclinical ADHD-I. It's not terrible, but it's there. It looks a lot like his daughter, actually. His EF is low, but he compensates by being exceptionally good at things and doing a beautiful, careful job on them as long as he can find them and hand them in. (And this confuses me, because isn't ADHD often also about being careless?) Both of them have messy desks and rooms but beautiful handwriting and a gorgeous artistic aesthetic and ability.

I'm late to the discussion, but wanted to mention that I had very severe OCD as a child and it definitely made work hard. My daughter was diagnosed with OCD earlier this year and did have obsessional compulsions. Her symptoms are subclinical now due to excellent CBT (including exposure response therapy). We haven't had difficulty with insurance covering it.

Lanie, I missed your post earlier....thank you for chiming in with your experience.


DD has had severe strep twice, once missing an entire week of school However, I can't say that these incidents preceded this behavior in a way that was at all clear or noticeable. But so much of it has been entirely internal.