Autism

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Similarities and differences between children and adolescents with autism

spectrum disorder and those with obsessive compulsive disorder: Executive
functioning and repetitive behaviour
Fiona Zandt, Margot Prior and Michael Kyrios
Autism 2009; 13; 43
DOI: 10.1177/1362361308097120

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 autism © 2009
Similarities and differences SAGE Publications
and The National
Autistic Society
between children and Vol 13(1) 43–57; 097120
1362-3613(200901)13:1

adolescents with autism

spectrum disorder and those
with obsessive compulsive
disorder
Executive functioning and repetitive behaviour

FIONA ZANDT Royal Children’s Hospital, Parkville,Australia

MARGOT PRIOR University of Melbourne,Australia

MICHAEL KYRIOS Swinburne University, Hawthorn,Australia

A B S T R AC T In order to examine hypothesized underlying neurocog- K E Y WO R D S

nitive processes in repetitive behaviour, children and adolescents (7–16 autism
years) with autism spectrum disorder (ASD) and obsessive compulsive spectrum
disorder (OCD) were compared on a range of executive function (EF) disorder;
measures. Performance on neuropsychological tests assessing executive executive
functioning showed a trend for children with ASD to perform poorly on function;
tasks requiring generation of multiple responses, while children with
OCD tended to demonstrate impairments on a task requiring inhibition.
obsessive
Parental ratings on a questionnaire measure of EF indicated impairments compulsive
in both groups relative to controls. Relationships between questionnaire disorder;
and performance measures of EF were generally weak. There was some repetitive
limited support for a relationship between EF and repetitive behaviour, behaviour
but effects tended to be small and variable across groups and measures.
ADDRESS Correspondence should be addressed to: P RO F E S S O R M . P R I O R , Depart-
ment of Psychology, University of Melbourne,Australia 3010. e-mail: priorm@unimelb.
edu.au

Repetitive behaviour is apparent in a range of psychiatric disorders and can

also be observed in normally developing individuals, but it is a core com-
ponent of two neurodevelopmental disorders: autism spectrum disorder
(ASD) and obsessive compulsive disorder (OCD). The similarities in the
repetitive behaviour observed in ASD and OCD mean that at times careful
Copyright © The Author(s), 2009. Reprints and permissions: 43
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DOI: 10.1177/1362361308097120

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AU T I S M 13(1)
assessment is required to assist with differential diagnosis (King and Scahill,
1999; Leckman et al., 1999). Another issue that has received some attention
in the literature is whether secondary OCD can, or should be, diagnosed in
individuals with ASD (Reaven and Hepburn, 2003; Towbin, 2003).
McDougle et al. (1995) administered the Yale Brown Obsessive Com-
pulsive Scale to adults with ASD who reported more compulsions than
obsessions, and generally reported less sophisticated obsessions and com-
pulsions than adults with OCD. A recent study by the authors of this article
demonstrated that children with OCD reported more compulsions and
obsessions than children with ASD, who in turn reported more compul-
sions and obsessions than typically developing children. Consideration of
the type of compulsions and obsessions in each disorder suggested that the
compulsions in ASD tended to be less sophisticated. Children with ASD and
OCD were reported by their parents to engage in similar levels of sameness
behaviours and repetitive movements (Zandt et al., 2007).
In addition to behavioural similarities, particular neurocognitive patterns
of functioning may be significant in the two disorders, with executive
functioning (EF) impairments being hypothesised in both ASD and OCD.
Executive functions are ‘depicted as the central executive component of the
information-processing system – the component that directs attention,
monitors activity, and coordinates and integrates information and activity’
(V. Anderson et al., 2001, p. 92). Executive functioning has a crucial role
in a child’s cognitive functioning, behaviour, emotional control, and social
interaction, and appears to develop rapidly through early and middle child-
hood, with the development continuing but slowing considerably in adoles-
cence (V. Anderson et al., 2001). Executive functions are typically impaired
in patients with frontal lobe injury and in a range of neurodevelopmental
disorders thought to involve congenital impairments in the frontal lobes,
including attention deficit hyperactivity disorder, Tourette syndrome, and
phenylketonuria (Hill, 2004).
The concept of executive functioning remains controversial, and assess-
ment is complicated, often as a result of the way executive functioning is
conceptualized. For example, isolating the impact of executive skills, as
opposed to the contribution of intelligence or language development is a
challenge (V. Anderson et al., 2001). Further, the nature of the testing situ-
ation – structured, quiet, and without competing demands – may provide
sufficient scaffolding to allow an individual who struggles with problem
solving in everyday life to perform well. Questionnaire measures, which
allow for an assessment of executive functioning in a child’s everyday
environment, may be helpful in expanding the picture.
Research on executive functioning in ASD suggests that individuals
with the disorder generally experience more difficulty on problem solving
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 ZANDT ET AL.: ASD AND OCD
tasks than controls, and may have particular difficulty with set shifting,
although some inconsistent findings are apparent (see Hill, 2004; Prior and
Ozonoff, 2006). Perhaps the most consistent area has been with tasks
designed to assess inhibition, on which children with ASD typically appear
to be unimpaired relative to matched controls (Hill, 2004; Prior and
Ozonoff, 2006). Nevertheless impairments on tasks of inhibition relative
to controls (Geurts et al., 2004) have been reported. The inconsistencies in
the literature are likely to reflect the use of heterogeneous groups, differing
tests of varied complexity, assorted scoring procedures, different compari-
son groups and matching procedures. In particular, careful matching of
intelligence or the use of intelligence as a covariate appears to influence
the results (Hill, 2004; Prior and Ozonoff, 2006).
Only a small number of studies have explored the relationship between
executive functioning performance and repetitive behaviour. Turner (1999)
reported that poorer performance on two tasks designed to assess genera-
tivity and one measure of inhibition were related to higher levels of repet-
itive behaviour in high and low functioning ASD. In contrast, Ozonoff et al.
(2004) reported no relationship between performance on executive func-
tioning tests and repetitive behaviour. More recently, Lopez et al. (2005)
demonstrated that repetitive behaviour in adults with autistic disorder was
associated with some executive functions (cognitive flexibility, response
inhibition, and working memory), but not others (planning and fluency).
The majority of empirical work related to executive functioning in OCD
has been conducted with adults and suggests that adults with OCD exhibit
impairments relative to controls on executive functioning tasks (Griesberg
and McKay, 2003). Research on the relationship between executive func-
tioning performance and symptoms in adults with OCD generally suggests
that impairments in executive functioning are related to clinical presen-
tation, although some inconsistencies are apparent (Griesberg and McKay,
2003). To the authors’ knowledge just two studies have explored executive
functioning in children and adolescents with OCD. Behar et al. (1984)
reported that children and adolescents with OCD made significantly more
errors on two maze tasks, in comparison to controls. However, the OCD
group performed at a comparable level to the control group on two other
tasks of executive functioning. Beers et al. (1999) found that children and
adolescents with OCD were similar to controls on a range of executive
functioning tests, and indeed performed better than controls on some tasks.
Executive functioning results were not significantly related to any of the
symptom measures.
To summarize, repetitive behaviour is a core component of ASD and
OCD, two disorders that share other neurological, genetic and biological
similarities. Inconsistent findings of executive function impairments have
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AU T I S M13(1)
been reported for both disorders, with some limited support for a relation-
ship between executive function impairments and repetitive behaviour. The
present study sought to (a) compare executive functioning in the two dis-
orders, and (b) to explore the relationship between repetitive behaviour
and executive functioning in children with ASD and OCD.

Method

Participants
Participants were 54 children and adolescents aged 7 to 16 years. All of
the participants will be referred to as children henceforth, for the sake of
brevity. The ASD group consisted of 19 children (16 males, three females)
with a mean age of 11 years (SD = 2.42). The majority of these children
had a diagnosis of Asperger syndrome (AS) (n = 15), two had a diagnosis
of autistic disorder, and one had a diagnosis of pervasive developmental dis-
order not otherwise specified (PDD-NOS). Individuals with AS, autistic
disorder, and PDD-NOS vary predominantly in symptom severity, and this
in turn is related to intelligence level (Dickerson Mayes and Calhoun, 2003),
making it reasonable to combine children with AS, autistic disorder, and
PDD-NOS of comparable intelligence for the purpose of research. The term
autism spectrum disorder (ASD) will be used henceforth to refer to children
with these diagnoses. The majority of children with ASD were not medicated
at the time of the study; however, three children were taking dexampheta-
mine and two were taking ritalin. Most of the children in this group were
diagnosed by an experienced multidisciplinary assessment team at the
Royal Children’s Hospital, consisting of a paediatrician, a psychologist, and
a speech pathologist, according to the Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition Text Revision (DSM-IV-TR) criteria (American Psychiatric
Association, 2000). Families of four children with ASD responded to adver-
tisements in autism newsletters and had been diagnosed in other services by
experienced psychiatrists and psychologists according to DSM-IV criteria.
The OCD group consisted of 17 children (eight males, nine females)
with a mean age of 12 years (SD = 2.17). At the time of the study four
children in the OCD group were taking selective serotonin reuptake inhi-
bitors, and two parents indicated that their child was taking medication
but did not provide further details. Most children in this group were also
receiving some form of psychological therapy (n = 15), compared with
four children in the ASD group. Children with OCD were referred by
clinicians in the Royal Children’s Hospital network (n = 7), as well as
psychiatrists and psychologists in private practice (n = 8). Two families
responded to advertisements in relevant newsletters. Again, experienced
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 ZANDT ET AL.: ASD AND OCD
professionals had diagnosed these children according to DSM-IV criteria.
For both children with ASD and OCD, diagnoses were based on a clinical
interview with children and parents and a range of other findings, such as
language and cognitive tests. Standardized diagnostic tools, such as the
ADOS, are not typically used as part of this process in Australia.
The typically developing or control group consisted of 18 children (six
males, 12 females) with a mean age of 12 years (SD = 2.94), none of whom
were receiving psychological or pharmacological treatment. Ten typically
developing children were recruited from a primary school in Melbourne
and a convenience sample of eight children aged between 12 and 16 years
was recruited through families known to the researcher.
Exclusion criteria for the study were the presence of a comorbid neuro-
logical disorder such as Tourette syndrome or a tic disorder, a comorbid
intellectual disability or language disorder, or a comorbid axis 1 disorder
such as another anxiety disorder or depression. Strategies for confirming
that the participants did not have a comorbid disorder included ensuring
that referers were aware of the selection criteria, including items regarding
comorbid disorders on an information sheet completed by parents, using
the results of cognitive tests to eliminate any children with an intellectual
disability or language disorder, and reviewing children’s files.

Measures
Parents completed an information sheet of demographic information that
included their child’s diagnosis, medication, known comorbid psychologi-
cal and neurological conditions, and family psychiatric history.

Intelligence The children were administered a short form of the WISC-

III consisting of the block design, similarities, vocabulary, and coding sub-
tests. Verbal and performance intelligence (VIQ and PIQ) were estimated
using the procedure outlined by Sattler (1992). If a child had been assessed
with the WISC-III in the past 2 years, parents completed a release of infor-
mation consent form and the researcher obtained the results from the rele-
vant psychologist.

Executive function measures Choice of tests for the assessment of exec-

utive functioning was based on a number of criteria. Tests were chosen that
were specifically designed for or had shown reliability and validity with
paediatric populations, were suitable for the broad age range included in
the study, allowed for the assessment of a range of executive function skills,
and incorporated both summary and strategy scores. The final selection
consisted of the Verbal Fluency Task, the Concept Generation Task–Child
Version, the Rey Figure, and the Walk, Don’t Walk task.
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AU T I S M 13(1)
The Verbal Fluency Task from A Developmental Neuropsychological
Assessment (Korkman et al., 1998) is thought to reflect an individual’s
generativity or mental flexibility. The task consists of two subscales, semantic
and phonemic fluency, with a total score calculated by summing the two.
Semantic fluency refers to a child’s ability to generate words within a
category, while phonemic fluency assesses a child’s ability to list words that
begin with a given letter. This task has been demonstrated to have adequate
reliability and validity.
The Concept Generation Test–Child Version (CGT–CV: Jacobs et al.,
2001), which was adapted from an adult version of the task, is also a
measure of generativity or mental flexibility. Jacobs et al. (2001) demon-
strated that performance in a typically developing sample improved with
age, with results being related to performance on more traditional measures
of executive functioning.
The Rey Complex Figure Test (Rey, 1941/1993) is a commonly used
neuropsychological test designed to assess planning and organizational
skills. P. Anderson et al. (2001) developed the organizational strategy score
as a method of analysing responses to the Rey Figure and demonstrated
that performance tended to increase with age and was related to the results
of more traditional executive functioning measures.
The Walk, Don’t Walk subtest of the Test of Everyday Attention for
Children (TEACh) (Manly et al., 1999) provides a measure of a child’s ability
to inhibit a previously acceptable response and to sustain their attention over
the course of the task. Manly et al. (1999) demonstrated that the TEACh is
correlated with other tests of attention and is able to identify clinical popu-
lations such as children with attention deficit hyperactivity disorder. The
test also has adequate reliability.
Because of the noted potential discrepancy between everyday behaviour
and clinical measures of executive function, we included the Behavior Rating
Inventory of Executive Functioning (BRIEF: Gioia et al., 2000), a parent
completed questionnaire designed to assess executive functioning in every-
day life covering behavioural regulation, and metacognition indices. This
measure has been demonstrated to have adequate reliability and validity,
with correlations between this scale and other attention and behaviour rating
scales providing support for construct validity.

Repetitive behaviour measures The Repetitive Behaviour Questionnaire

(RBQ) was developed by Turner (1995) to assess repetitive behaviours in
ASD. It is a comprehensive parent or teacher rated questionnaire that
allows the assessor to calculate scale scores for repetitive language, sameness
behaviour, and repetitive movements, as well as a total repetitive behaviour
score. Information regarding the validity and reliability of this scale has not
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 ZANDT ET AL.: ASD AND OCD
been published, but can be found in Turner’s thesis (Turner, 1995). As a
complement to the RBQ, the Children’s Yale–Brown Obsessive Compulsive
Scale (CY–BOCS) was added (Scahill et al., 1997). The initial section, which
contains two comprehensive symptom checklists, one for obsessions, and
one for compulsions across a range of behaviours, was administered. Scahill
et al. (1997) demonstrated that this task was both valid and reliable.

Procedure
Ethics approval was obtained prior to the commencement of data collection.
Informed consent was obtained from parents and assent was obtained from
children. Parents completed the demographic information sheet, the RBQ,
and the BRIEF inventory of executive functioning. The principal researcher
was aware of each child’s diagnosis and completed all of the child assess-
ments. The short form of the WISC-III was administered first, followed by
the executive functioning tests and the CY–BOCS. Whether or not the
CY–BOCS was administered with the child alone, with a parent present, or
with a parent only, was dependent upon the family’s preference, or on
clinical judgement based on the child’s developmental level and language
skills. Where administration was conducted with either the child or the
parent individually, information was also obtained from the other infor-
mant and was integrated into the results.

Results
Given the small sample sizes in this study, effect sizes (ES) were calculated
using Cohen’s (1988) formula: for t-tests ES = d/2, where d = M1 – M2/σ
(p. 276); for F-tests ES = √[η2/(1 – η2)] (p. 284). ‘Small’ effect size is 0.10,
‘medium’ is 0.25, and ‘large’ is 0.40 (Cohen, 1988). Initial data screening
revealed that the results were not altered when the two children with a
diagnosis of autistic disorder and the child with a diagnosis of PDD-NOS
were excluded from the sample; therefore these children were retained as
part of the ASD group. Table 1 contains descriptive characteristics for each
of the groups. The three groups did not differ in mean age, VIQ or PIQ, or
on the subtest scores used to calculate the VIQ and PIQ estimates.
Table 1 Descriptive characteristics of the samples (mean (SD))

ASD (n = 19) OCD (n = 17) Control (n = 18)

Age 10.97 (2.42) 12.30 (2.17) 11.94 (2.74)

VIQ 96.45 (14.71) 94.35 (10.75) 94.89 (9.28)
PIQ 95.38 (19.96) 95.94 (7.86) 102.72 (12.15)

No significant differences between the groups were found, p > 0.05.

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AU T I S M 13(1)
Table 2 presents the mean scores on the performance measures of exec-
utive functioning for each group. The total number of words generated in
the Verbal Fluency Task differed significantly by group with a large effect
size, F(2, 51) = 5.12, p = 0.00, ES = 0.45, with post hoc tests revealing that
the ASD group performed more poorly than both OCD and control groups,
p < 0.05. This difference remained significant even when VIQ was statisti-
cally controlled, F(2, 53) = 6.75, p = 0.00. Further analyses revealed that
this finding was accounted for by results from both semantic fluency,
F(2, 51) = 3.77, p = 0.03, and phonemic fluency subtests, F(2, 51) = 4.57,
p = 0.02, with the ASD group performing more poorly than the control
group in both cases, p = 0.04 and 0.02 respectively.
Scores on the Rey Figure were not normally distributed so a non-
parametric test was used, and confirmed that there were no significant
group differences, H(2) = 0.23, p = 0.89. There was a trend for the groups
to differ on the Concept Generation Task, F(2, 50) = 2.44, p = 0.09, ES =
0.31. The OCD group performed best on this task followed by the control
group, with the ASD group demonstrating the lowest mean performance.
There was also a trend for the groups to differ on the Walk, Don’t Walk
task, F(2, 47) = 2.47, p = 0.09, ES = 0.33, with children with OCD
performing worse than controls, p = 0.08. An analysis of extreme values
on this task identified a 12-year-old boy in the control group who had
received a scale score of 1. With this child removed the difference between
groups became significant, F(2, 46) = 3.52, p = 0.04, ES = 0.39, with post
hoc tests confirming a significant difference between the control and OCD
groups, p < 0.05.
In addition to endpoint scores, repetitions on the Verbal Fluency Task
and the Concept Generation Task were scored. A floor effect was apparent
in both instances, with very few children in any of the groups making repe-
titions on either of the tasks.

Table 2 Group mean performance on psychometric measures of executive

functioning (mean (SD))

ASD (n = 19) OCD (n = 17) Control (n = 18)

Verbal fluency (total words)a 47.26 (13.81) 60.53 (13.81) 62.94 (17.93)
CGT–CVb (correct sorts) 2.44 (1.82) 3.82 (1.70) 3.11 (2.00)
Rey Figurec 4.33 (1.14) 4.35 (1.22) 4.55 (1.15)
Walk, Don’t Walkd 5.69 (3.32) 4.75 (2.49) 7.00 (3.03)
a ASD < control and OCD, p < 0.05.
b ASD (n = 18), one child did not complete due to technical difficulties.
c ASD (n = 18), one child did not complete due to anxiety about getting the picture ‘wrong’.
d ASD (n = 16), three children did not complete this task due to anxiety; OCD (n = 16), one child did

not complete this task due to technical difficulties.

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 ZANDT ET AL.: ASD AND OCD
Better performance on each measure of executive functioning was
positively related to at least one measure of intelligence as assessed by the
WISC-III (r > 0.30 or p < 0.05). The most consistent finding across all
groups was the significant contribution of the vocabulary score to overall
executive functioning performance.
Means and standard deviations for BRIEF measures are presented in
Table 3. The parent of one child with ASD completed too few items on this
questionnaire for it to be reliably scored and therefore it was excluded
from this analysis. Group differences were found for behavioural regula-
tion, F(2, 50) = 38.29, p = 0.00, ES = 1.25, with a significant difference
between both the ASD and OCD groups and the control group, p < 0.01.
Similar results were found for the metacognition index, with the ASD
and OCD groups rated as significantly more impaired than the control
group, U = 8.00 and 72.00, p < 0.01. There was also a trend for children
with ASD to be rated as more problematic than children with OCD, U =
99.50, p = 0.08.
Group differences were also found for the global executive composite,
F(2, 50) = 30.45, p = 0.000, ES = 1.11, with a significant difference between
both the ASD and OCD groups and the control group, p < 0.01, and between
the ASD and OCD groups, p < 0.05.
The individual subscales of the BRIEF – inhibit, shift, emotional control,
initiate, working memory, planning and organization, organization of mater-
ials, and monitor – were also analysed. Figure 1 presents the mean score
for each of the groups on these subscales, with higher scores indicating
greater levels of impairment. Significant group differences were found on
all of the above scales, p = 0.00, with the exception of the organization of
materials scale, F(2, 50) = 1.39, p = 0.26.
Post hoc tests revealed that children with OCD and ASD were rated as
experiencing significantly more difficulty than typically developing children
on the inhibit, shift, emotional control, working memory, and planning and
organization scales, p < 0.01. On each of these scales, children with ASD

Table 3 Group means for BRIEF index scores (mean (SD))

ASD (n = 18)a OCD (n = 17) Control (n = 18)

Behavioural regulation 72.61 (9.94)b 69.94 (10.10)b 47.55 (8.08)

Metacognition 68.11 (6.17)b 61.53 (12.26)b 51.61 (6.64)
Global executive composite 71.67 (7.01)b, c 64.24 (11.09)b, d 61.92 (12.36)
a One parent did not complete the majority of items on the BRIEF; hence subscale and index scores

could not be calculated.

b p < 0.01, different from control.
c p < 0.05, different from OCD.
d p < 0.05, different from ASD.

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AU T I S M 13(1)
80

70

60

50 OCD

ASD

40 Control
In

Sh

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M
In

Pl

O
rg
hi

iti

on
a
or
i
ft

n/
ot

at
bi

an
ki

ito
or
io
t

iz

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na

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e
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Figure 1 Mean subscale scores on the BRIEF

and OCD did not significantly differ from each other. Children with ASD
were rated as experiencing significantly more difficulty on the initiate scale
than typically developing children and those with OCD, F(2, 50) = 12.80,
p = 0.00, with no significant difference between the latter two groups.
Children with ASD experienced more difficulty on the monitor scale than
children with OCD, U = 84.50, p = 0.02, and typically developing children,
U = 20.50, p = 0.00 (see Figure 1).
Correlations between the parent rated BRIEF and psychometric tests of
executive functioning tended to be in the expected direction, such that
more problematic behaviour was related to lower scores on neuropsycho-
logical tests. However, these relationships were most commonly small, with
most failing to reach significance, p > 0.05, and varied between and within
groups, with no clear patterns emerging.
Table 4 presents the correlations between repetitive behaviour and BRIEF
results for each of the groups. For the ASD and control groups, higher rates
of difficulty in the areas of behavioural regulation and general executive
functioning were related to higher rates of repetitive behaviour and com-
pulsions; however, relationships between BRIEF measures and repetitive
behaviour in the OCD group were predominantly small, with none reaching
significance.
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 ZANDT ET AL.: ASD AND OCD
Table 4 Correlations between executive functioning as assessed by the BRIEF
and repetitive behaviour

Executive functioning

Behavioural regulation Metacognition Global executive composite

ASD (n = 18)
Compulsions 0.38 0.35 0.47*
Obsessions –0.08 0.17 0.04
Repetitive behaviour 0.52* 0.15 0.43

OCD (n = 17)
Compulsions 0.09 –0.36 –0.06
Obsessions –0.08 0.04 –0.09
Repetitive behaviour 0.10 –0.24 –0.09

Control (n = 18)
Compulsions 0.09 0.32 0.26
Repetitive behaviour 0.47* 0.25 0.38

* p < 0.05.

The relationships between repetitive behaviour and tests of executive

functioning were also assessed, with the only significant relationship being
for the ASD group, with better performance on Walk, Don’t Walk related to
lower levels of obsessions, r(16) = –0.54, p = 0.03.

Discussion
The major finding was that children with ASD and OCD did not differ from
a control group of equivalent intelligence on the majority of executive func-
tioning tasks, suggesting that neither group is globally impaired. There was
a trend for children with ASD to demonstrate impairments on tasks that
require them to generate multiple responses, as also reported by Ambery
et al. (2006) with adults, while children with OCD tended to have impaired
inhibition. Some limited support was found for a relationship between
repetitive behaviour and executive functioning, although relationships were
generally small and varied across groups.
Children with ASD tended to do more poorly on the Verbal Fluency
Task and the Concept Generation Task, both of which required the gener-
ation of multiple responses. These findings are consistent with the results
reported by Turner (1999) who demonstrated that both high and low
functioning individuals with ASD were impaired in generative ability. The
finding that children with ASD were not impaired on the Walk, Don’t Walk
task is consistent with previous reports using similar tasks. Taken together,
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AU T I S M 13(1)
the findings confirm that inhibition, as assessed on formal tasks under test
conditions, is generally unimpaired in children with ASD. The contribu-
tion of intelligence to performance on executive functioning tasks has been
noted (V. Anderson et al., 2001), with this contribution also being apparent
in the present study. Hence, these results may not be applicable to lower-
functioning children with ASD.
Children with OCD performed similarly to typically developing children
on the majority of tasks, but tended to demonstrate impairments in inhi-
bition, as assessed by the Walk, Don’t Walk task. This latter finding is in
contrast to those of Beers et al. (1999) who reported that children with
OCD performed better than controls on two tasks of inhibition, the Stroop
and the Go-No-Go task, which are similar to the Walk, Don’t Walk task. The
limited number of studies into executive functioning in children with OCD
precludes firm conclusions, but suggests that children with OCD are not
notably impaired. This contrasts with the adult literature where, although
inconsistencies exist, some executive functioning impairment is typically
reported (Griesberg and McKay, 2003). It is possible that anxiety may have
a greater impact on the test results of adults with OCD, or that the impair-
ments in children are more subtle and cannot be detected by the available
tests, or that the impairments may result from living with OCD for an
extended period.
Children with OCD and ASD were both rated by their parents as experi-
encing significantly more difficulty with executive functioning skills in
everyday life, compared with typically developing children, consistent with
previous research with a range of psychological disorders (Gioia et al.,
2000). However, the relationships between the BRIEF and the psychometric
measures of executive functioning were generally weak. Two recent studies
with different clinical populations have reported similar results (V. Anderson
et al., 2002; Vriezen and Pigott, 2002). The lack of support for a relation-
ship could be conceived as undermining the concept of executive function-
ing, especially in terms of reported everyday functioning. However, these
findings also raise the possibility that the BRIEF may assess something other
than executive functioning, for example non-specific impairment, adaptive
behaviour, or levels of parental concern.
Relationships between executive functioning as assessed by psychometric
tests and repetitive behaviour were generally small, with association between
inhibition and obsessions in the ASD group being the only significant
finding. Both Turner (1999) and Lopez et al. (2005) reported relationships
between repetitive behaviour and other executive functions, such as gener-
ative ability and cognitive flexibility. The present study, however, did not
replicate these latter findings. The use of different samples and measures may
have contributed to this discrepancy.
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 ZANDT ET AL.: ASD AND OCD
Relationships between repetitive behaviour and parental ratings of exec-
utive functioning were also explored. Greater executive function impair-
ment, as assessed by the BRIEF, was related to repetitive behaviour in the
ASD and in the typically developing group, but not in the OCD group,
providing some limited support for Turner’s (1999) theory. Parental reports
of executive functioning explained more of the variance in repetitive beha-
viour for children with ASD than for children with OCD. The OCD group
acknowledged significantly more obsessions, which were only weakly if
at all related to executive functioning measures, but were strongly related
to compulsions (Zandt et al., 2007). As noted earlier, repetitive behaviour
in the two disorders may be derived from different cognitive processes,
with anxiety (and obsessions) providing a better explanation for repetitive
behaviour in OCD, and executive functioning accounts being better suited
to ASD.
Further exploration of the relationship between executive functioning
and repetitive behaviour in OCD and ASD is warranted, with larger samples
and a range of severity and ages. Exploration of the developmental trajectory
of repetitive behaviour and executive functioning in each of these disorders
should be helpful. Performance and questionnaire measures of executive
functioning are likely to yield differing results, with further research
required to determine the construct and discriminant validity of question-
naire measures. Addressing the question of underlying processes requires
researchers to include measures that adequately assess children’s feelings
of anxiety, sadness, and distress as well as adaptive impairments.

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