Hand washing- ASD transition help or OCD?

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I am feeling a little lost and was hoping some of you wise people could help.
Our 12 year old was diagnosed with ASD in the summer after a brutal first year of secondary. He is now doing online schooling from home and doing much better with that side of things. Still a lot of anxiety etc, but nothing like what we were seeing.

One thing that is concerning me, however, is we are seeing more and more hand washing. It seems to be at points of transition - e.g. he washes his hands after reading his book and before playing on his nintendo, he washes before and after eating, before a lesson, before bed and even, if you can believe it, before he has a shower or a bath. If he has washed his hands before eating, for example, and then has to get up and open the fridge, I have noticed he will pull his sleeve down and open it with that covering his hand so he doesn't touch the fridge door. If he has washed his hands before bed, and is now in bed, he wont touch his books, but will touch his water glass....When he goes to the toilet before bed, and has washed his hands afterwards, he has to open the toilet door with his hand covered by his sleeve. If I tell him to just open the door with his hands, he will, but then has to quickly re-wash them.
While there is certainly some germaphobia going on, and a general strong dislike of dirt, I feel like it cant be that which makes him, for example, wash his hands before getting in the shower!
However, if this is OCD, and it is spreading (we are definitely seeing more of it now than we were a few months ago, and it only really started in the past 6-8 months I think), obviously my understanding is you need to be proactive to help stop it as it will just get worse and worse. But if it is is part of his ASD and helps him manage all these transitions (he says it feels nice (he likes the sensation of the water) and it helps him feel less stressed and he wants to do it, rather than feeling he has to and wishing he didnt) then we would not want to do anything to stop it.

Can anyone offer any insights? I know OCD is often co-morbid with ASD but have no idea how you can separate the two and know what to target and what to leave. It doesn't help that we are unable to access therapy at present as he gets too anxious and has a meltdown every time we try as finds the pressure of the questioning and the 1 to 1 side of it overwhelming....
So we are feeling a bit lost....
Thank you!

It sounds like you have a lot going on there. I hope I can help a little bit. I was diagnosed with ASD, but I've never been diagnosed with OCD. I think I have traces of OCD though and when it is comorbid with autism, it can complicate things. I think, generally speaking, a person with OCD feels a sense of security when they wash their hands because of contamination anxiety, but when you combine that with autism, that person may be looking to create that same sense of security when they transition from one task to another. This is because being autistic makes the transitioning itself somewhat stressful. I also think that once the habit of washing hands sets in, it can become part of a routine, which is oftentimes important to those of us with autism. Of course, I'm not a professional and this is just my opinion based on experience. I think it may be a good idea to seek professional counseling to help with this.

thank you - yes the routine side of things is clearly a big part of it. But also like he uses it to separate things - today, for example, he washed his hands when we got in, then again 10min later before he ate a cupcake, then after he had finished the cupcake...The post cupcake bit in particular cannot be about dirt or germs as he had done nothing except sit on the couch in our house and eat a cupcake! But it was the "end" of the cupcake part of the day, and the start of tv watching. There may also have been a sensory side of it if he had a big of chocolate on his fingers maybe? Hard to know, but I think we will just give him space and hopefully things wont spread into more serious OCD stuff...

Question: What level on the spectrum is he? I'm level 1. I wasn't clinically diagnosed until I was 59.

I used to teach high school Culinary Arts. I once had an autistic student who had OCD. Prior to starting work in the kitchen, students had to put on hair restraints and to then wash their hands. This student would wash his hands. He would then wash his hands a 2nd time. He would then wash his hands a 3rd time. I finally had to ask him to be the last student in line at his group washing his hands otherwise he would literally hold up the rest of his group.

Our school psychologist suggested that the student had transition problems combined with avoidance behavior. Since Culinary Arts builds upon preexisting skills that students have learned in the kitchen, it followed that as the year progressed, our recipe productions would become progressively more challenging. Daniel (not his real name) started to feel anxious over the pace of instruction and the expectation that he would use skills that had been taught over the preceding weeks.

For example, during our breakfast unit, I taught my Culinary I students how to scramble eggs. They then used their egg scrambling skills to learn how to make cheese omelets through the addition of an additional production step.

Following my video demonstration, I asked students to don their hair restraints and to wash their hands. This is when Daniel began having problems.

He wound up being dropped from my class because as the year progressed, his lack of technical skills were causing him to fall further and further behind. It did not help that he was scared of the gas stove and had wanted to hold the saute pan and the turner spatula with oven mitts.

His time in my class came to an end after I learned that he was scared of knives. When teaching students how to dice potatoes, he didn't want to hold onto the potato because he was scared that he would cut himself. When I declined to hold the potato for him, he complained to his mother who complained to my school administration.

When I was told to hold the potato for him, I put on a steel mesh glove (originally intended for use when shucking oysters). As I held the potato on the cutting board, he screamed a battle cry, raised his hand overhead, and brought the knife swooping down in complete violation of all safety procedures and knife cutting techniques. If I hadn't released the potato, his knife would have caught me on my forearm.

I reported what happened to the office. While I did not report this as an attempted assault, I did report it as a safety violation. He was gone the next day.

Getting back to your situation, consistency and routines can be important to those of us who are on the spectrum.

I have asd and ocd. My OCD gets worse when I need to transition from one activity to another and I can get stuck doing one thing over and over. Any anxious situation can make ocd worse.

Having ocd is awful. However, washing hands (despite being part of the ocd) is stress relieving, which is why it is done in ocd. If a person doesn't understand ocd or why they are doing things, then they might well reply that they want to wash their hands and it makes them feel better. Washing hands relieves the anxiety they feel due to their ocd obsessions. However, in ocd, the more a person washes their hands, the worse their ocd gets, despite it providing relief in the short term.

Sounds to me like he probably has ocd. Hand washing before showering could still be ocd, depending on what's going through his head. I wash hands after showering because the shower head I held might be dirty...

Maybe let him read a book about ocd? Understanding what he is feeling and why he feels the need to wash his hands could be a good first step in dealing with it. There are also ocd workbooks you could do with him if he can't deal with a therapist. Also, if he reads the book and doesn't think it describes what he's feeling, then you'll know it isn't ocd.

I don't think you should judge if something is ocd or not based on normal logic. OCD is a mental illness and doesn't involve normal logic. Washing hands after cupcake... Someone with OCD might be thinking... Sugar on hands --> germs like sugar ---> if I touch anything else now I'll get sugar on it, then germs will feed on the sugar and multiply, so I'll be spreading germs everywhere and there will be no escape from the dirt and I will die and the germs will kill everyone I love as well. In ocd, pretty much anything and everything can lead to you feeling like you'll die or unintentionally cause the death of your loved ones. Even when the thoughts are so ridiculous that the person having them doesn't even believe or understand how it could lead to someone dying, they can't shake the intense feeling of fear that accompanies the thought, so think it's better to be safe than sorry.

How many times does he wash his hands each time he is at the sink? If it is just once each time, I don't think it's too worrisome. If he's standing there washing his hands over and over each time, then you really should worry.

Hi, I just read your question and want to respond you quickly (sorry for the bad English, I am German):
In my opinion it seems to be very clearly that it might be OCD... sorry. It is comorbid to ASD and the relief topic is the same, indeed.
You should ask a therapist or try a online test before, maybe you could try online therapy and a book to help you as parents...

The reason why I am quite sure is, that my twins (ASD) got a OCD with washing at the same time with the change of school to secondary... it is a big change and might lead to such a reaction, unfortunately. We work on the topic with help and I wish you good luck and the best to help and cure.

This suggests a nuanced perspective on the behavior of hand washing in individuals with Autism Spectrum Disorder (ASD). Autism is characterized by a range of behaviors and challenges, and some individuals with ASD may exhibit repetitive behaviors or rituals, including hand washing.
In the context of ASD, hand washing might serve as a form of transition help, providing a routine or coping mechanism for navigating changes in activities or environments. Establishing consistent habits can offer a sense of predictability and comfort for individuals with ASD, aiding in the transition from one task or setting to another.

Understanding the individual's specific motivations and the impact of the behavior on their daily life is crucial. A comprehensive assessment by healthcare professionals can help differentiate between behaviors associated with ASD and those indicative of other conditions, like OCD. Tailored interventions, which may include behavioral strategies or therapeutic approaches, can then be implemented to support the individual based on their unique needs.

My son has ADHD and anxiety and has been doing this hand washing thing since he did a few months of ABA therapy over a year ago. They tried to teach him how to wash his hands and now he won't stop doing it. Like 30 times a day. His hands are red and dry. He's moved down to just using water and no soap, but it's still hard on his skin.

I have wondered if this is a form of stimming, which is something both autists and people with ADHD do.

My son does have some signs of avoiding things he sees as dirty or reacting violently to some sights and sounds, but he completely ignores other things that one would think would logically follow. For example, if one of the dogs licks himself, he reacts violently. If the other dog does it, he doesn't notice. He could not look at a certain kind of animal in any form on TV for months, couldn't even read the word of the animal in a book, but then suddenly he saw the animal in a movie and he stopped being affected by it at all. He can't stand the thought of "grease" or "crumbs" on his hands, but will pick up some food with his hands and eat it with no fork. So it's hard for me to say he has OCD. I think it is still just anxiety about selective things.

And don't ever do ABA therapy. It's not a good idea.

Might want to read about TIPP and DBT and how this therapy suggests cold water and other sensory stimulating behaviors to help manage extreme emotional stress and anxiety.

In any case, washing hands (notwithstanding being important for the ocd) is pressure easing, which is the reason it is finished in ocd. In the event that an individual doesn't comprehend ocd or why they are getting things done, then, at that point. They could well answer that they need to clean up and it cheers them up in the events or on the road in cars. Washing hands alleviates the tension they feel due to their ocd fixations. Be that as it may, in ocd, the more an individual cleans up, the more terrible their ocd gets, regardless of it giving help temporarily.