Little consensus exists on whether repetitive behaviors that are topographically similar in obsessive–compulsive disorder (OCD) and autism spectrum disorder (ASD) are indicative of a comorbid diagnosis of OCD or overlapping symptoms subsumed under ASD. This ambiguity in the cause and/or function of the behavior often results in challenges for clinicians regarding conceptualization, assessment, and treatment of repetitive behavior, especially given the challenges young children and children with ASD may have with articulating thoughts, obsessions, or functions of behavior. To address this issue, this article proposes an approach that refrains from providing a comorbid diagnosis in most cases, instead focusing on overlapping symptom presentation. We present a conceptual framework for the often-complex role that behavioral function(s) of repetitive behavior serve for an individual based in Mowrer’s (1951) two-process theory. A second conceptual framework considers the presentation of obsessive–compulsive behaviors based in relational frame theory (Hayes, 1991). Clinical case examples illustrate the varied influence of respondent and operant learning and relational framing on repetitive behaviors in ASD. Methods of functional behavioral assessment are described, and recommendations for addressing function(s) in treatment based in applied behavior analysis, cognitive behavior therapy, and acceptance and commitment training are provided. Limitations and future directions for function-based treatment of obsessive–compulsive behaviors in persons with ASD are discussed in the context of the conceptual frameworks.
