Felt but not seen: Observed restricted repetitive behaviors are associated with self-report-but not parent-report-obsessive-compulsive disorder symptoms in youth with autism spectrum disorder.

The study measured associations at assessment points, not over time, so it cannot show that OCD symptoms caused repetitive behaviors or that repetitive behaviors caused distress. Participants were recruited from research studies rather than clinical clinics, so the sample may differ from clinic-referred youth. The sample was verbally fluent and excluded youth with IQ below 70, so findings may not apply to youth with intellectual disability or limited verbal ability. There was no comparison group of youth with OCD without ASD, so the study cannot separate ASD-related repetitive behaviors from OCD-related behaviors. Youth did not receive a thorough clinical evaluation for OCD or anxiety, so the findings are based on questionnaire symptom scores, not diagnosed disorders. The measures did not directly ask children about their subjective distress while performing the specific observed repetitive behaviors, so the link between self-report and observation may reflect measurement overlap or misunderstanding. ASD classification was based on ADOS-2 research criteria, and clinicians in community settings often do not rely on ADOS-2 alone, so ecological validity may be limited.

No author conflict-of-interest statement is included in the supplied text. The listed publication types include NIH extramural and non-U.S. government research support.

Do not conclude that child self-reported OCD symptoms diagnose OCD or cause observed repetitive behaviors. The study only showed associations in verbally fluent autistic youth with IQ above 70, and none received a full clinical OCD evaluation.