Is it OCD… or autism? And how do you actually treat both?
In this episode of The OCD Whisperer Podcast, Kristina Orlova speaks with Jenna Stone, Licensed Clinical Social Worker and founder of SideQuest Psychotherapy. Together, they explore the complex overlap between OCD and autism, and how proper evaluation and therapy can change everything.
Jenna opens up about:
• Her personal journey with OCD and lived experience in the mental health field
• How autism and OCD can overlap—and why they’re often misunderstood
• The differences between OCD rumination and autistic processing
• How therapy needs to adapt when working with neurodivergent clients
If you’ve ever questioned whether symptoms are OCD, autism, or both—this episode will give you clarity, direction, and a more compassionate understanding of your experience.
Whether you’re navigating OCD yourself or supporting someone, this episode offers practical insight, validation, and hope for a more personalized path to recovery.
📲 About Jenna Stone (guest):
• Clinical Director at SideQuest psychotherapy, lcsw-c
[00:00] – Is It OCD… or Autism? (Why This Topic Matters)
[00:45] – What Got You Into This Work? (Jenna’s Personal Story)
[02:42] – What Does an Autism + OCD Evaluation Actually Look Like?
[04:32] – What Do You Mean by “Nervous System”? (Explained Simply)
[06:02] – Can ERP Work for Autism + OCD? (Or Is It Different?)
[08:22] – OCD Rumination vs Autistic Thinking (Key Difference)
[10:32] – Why Do Autistic People Overthink Social Situations?
[13:02] – Is This OCD… or Just How the Brain Works?
[15:02] – What If Someone Can’t Communicate What They Feel?
[17:32] – How Should Parents Handle OCD Behaviors in Kids?
[20:32] – Are You Helping… or Making OCD Worse? (Hard Truth)
[22:32] – Which Therapy Works Best: ERP, ICBT, or ACT?
[25:02] – Why Therapy Takes Longer for Neurodivergent Clients
[27:02] – How Do You Actually Build Trust With These Clients?
[29:02] – What Does GOOD Therapy Look Like for OCD + Autism?
[30:32] – Final Takeaway: What People Still Get Wrong
Welcome to OCD Whisperer! Each episode shares tools and insights for OCD recovery, managing intrusive thoughts, ERP therapy, CBT techniques, anxiety relief, and mindfulness practices. Join me for expert interviews and personal insights into overcoming OCD. Subscribe to find support, strategies, and hope for your OCD journey.
⚠️ Disclaimer: Please note while the host is a licensed marriage and family therapist specializing in OCD and anxiety disorders in the state of California, this podcast is for educational purposes only and should not be considered a substitute for therapy.
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I have Jenna stone and we're gonna be talking about autism and OCD
But not just that, but I think one of the common things I heard from you guys is you know
What would the evaluation process even look like for that?
How would you how would you do therapy for that?
So Jenna is gonna talk about that with us. Welcome to the show Jenna
Hi, thank you so much for having me
Absolutely if you don't mind just to give our audience a little background and a little bit about kind of what you do who you are that would be great
So I am a licensed clinical social worker in Maryland
I'm also licensed in Virginia and Florida and I have a private practice called side-class psychotherapy here and
And I
Primarily specialized in OCD and eating disorders with neurodiverment hopes
So I also will offer
ADHD and autism assessments
Amazing in my work with OCD
Hi, I'm Christina Arlova host of the OCD Whisperer podcast as someone who lives with OCD
I understand the struggles firsthand if you're here. You're not alone
Before we start grab your free OCD survival kit at
www.coreresults.com to help you take control
That's K-O-R results dot com now. Let's dive into today's episode
Okay, well, let's dive right in I mean
I guess one of the things I always like to know from my guess is kind of what got you into this work
What got you interested like do you there a little piece of a story about you that you want to share?
Yeah, sure
So I actually became a therapist because I recovered from an eating disorder
I was struggling with OCD in graduate school and thought I would never get into OCD as a provider because it hit too close to home
and then I met other lived experience
clinicians learned iCBT got involved in that community and the rest is kind of history
Okay, God I love it. So you have like a personal connection to this. Yeah
I get that
Yeah, I mean, yeah, like I have OCD partially why this podcast even exists at this point is really because of clients and
Kind of you know realizing like God it took so long for me to even find treatment
That you know, like okay, let's let's let's keep talking about this and not make it so taboo and weird
Um, well, okay, so let's talk about autism in OCD. So what does that evaluation even look like?
Yeah, so sometimes so I um
People will reach out to me either just coming to me specifically for evaluation
Or they will be in like eating disorder OCD treatment with me like as a therapist and I recommend it to go through that process
Because it actually gives us a lot of insight about what's happening for them. So um as a social worker
I provide what we call like neuro-affirming
evaluation
So they're a little bit different than what a you would get from a neuropsych
So we don't touch like IQ testing or anything like that
We're not looking at that
We're actually looking at the social differences in autism the sensory domains how emotions um
Are experienced and expressed and things like that through this assessment to call it the MIG does too
um and that's um
Dr. Montero's model which is based on this triangle of how autism
um is basically
Uh, when these the amount of demands kind of on your nervous system are going to kind of bring out some of these um
Uh, autism symptoms and what I see with OCD is OCD if you have OCD
It's going to place a lot of demands on your nervous system like oh you have to wash your hands
You have to what you know do things over and over again and that can really just regulate someone even more
They are um autistic
Yeah, so let's let's talk about this because I've heard on you know on the internet
Let's say you know more conversations about the nervous system and
Of course like everything on the internet, you know, there's these intense polarities and
You know, what are we talking about nervous system like no that's not even that's not even a thing to discuss
We're dealing with you know OCD stuff or and I'll be honest
I'm a little it's a little Adam a wheelhouse way for talking about autism because I I'm not as
While verse or trained in that I know some basics, but like what do you mean when you say that when you're talking about the nervous system?
So um, I'm not sure if you are following but like poly bagel theory was just a bump um
However, when I'm talking about the nervous system
I'm really talking about what a lot of us who are trained in CBT models are talking about staying within your window of tolerance
And so for me as a therapist I'd like to explore
What are the things that really toss someone out of that window of tolerance for some people?
It's sensory
struggles um
And that could just be like motherhood and all the noises of children things like that can really make someone
Struggle more with their mental health overall and of course OCD can kind of sneak in and create stories for people
That they then kind of get sucked into
So we just want to kind of get people more at their baseline
We know like learning happens when we are in the window of tolerance
So when we're doing therapy with autistic clients specifically we want to make sure like if we're doing the exposure therapy
The exposure in that moment right like it could change moment to moment depending on what's going on for that client
If they're able to access the learning that they're going to get through the exposure
Okay, so since we're naturally talking about that
Let's let's let's dive a little deeper so
When you're working with somebody who has autism and OCD like is there a certain degree of autism or you would say
It might not be helpful to do exposure and response prevention
Is there some some because people talk about high functioning lower functioning where things like that so
I think we need to do away with the functioning labels honestly
Um because a lot of and in this back to the assessment that I use which is the MIG does
um the MIG does is looking at how people experience um like they're we take in a lot of consideration for masking presentations
And how much um that can lead to like what we call autistic burnout and
Just really people are walking around they appear functional on the outside
But internally they're really struggling they might um do a social
Like a podcast for instance right and then after that podcast to ruminate or something like that
Just because like oh was I appropriate there's kind of things because they're also living usually with a lot of complex trauma
About maybe you know being not picking up on social cues saying things that are inappropriate
Whatever that is and that can kind of trigger anxiety um post
Speaking spirals whatever they want to call it um it kind of looks like OCD, but it's it's not um
Unless it turns into more of like a story where there's like a consequence and they're like
Mental compulsions because autistic brains like to ruminate and I think that's one of the things are therapies that we're trained in
Don't really acknowledge that much is that the autistic brain really wants to make sense of things to feel safe
To even have that experience of felt safety people need to understand
You know what if I'm going to um, I don't know some networking event
What are we wearing what are we supposed to wear how are we supposed to talk to each other in all these little social rules
Those details are so so important for autistic people
So if they're ruminating about that that makes sense um from that kind of
Understanding and I think sometimes what looks like OCD or anxiety like generalizing anxiety is actually what we call distinct
Autistic anxiety is a very distinct form of anxiety experienced by autistic folks
Okay, so let me be sure I'm I'm tracking this correctly. So you're saying like okay, so if somebody
Let's say with OCD we know people well people in general can ruminate and and do but we're talking about that people with
Autism tend to ruminate really in a specific way part of it is understanding
Um, whatever the situation is understanding also social cues. There's also a history of of course socially if
That isn't something that's known and then there can be some
You know consequences for a negative feedback that they've gotten and they can
You know trying to understand what that is or why or they can maybe figure it out and so
Basically, they will tend to ruminate a lot because they're really kind of the purpose of that
It's just to try to understand what's going on or what's the right thing to do or how to be
From a small detail to you like okay. What's how should I address then for this
Or best way to come and connect
Etc. And like that's going to be different than you know cd for example when you start to feel this urge like I have to keep
Figuring something out because otherwise something horrible is going to happen and catastrophic or whatever
Yeah, this is more kind of like the way I would explain this um is if you're a vegetarian and you're going out to dinner with a bunch of friends
Who are restaurant that you've never been to before it's going to make sense that you're going to check that menu to see if you can actually order all of that
That's kind of how it is for autistic people
Is to just kind of like need to know what to expect so
You know, they can get their most basic needs met whatever that is
um could also be something more around
Like the sensory a lot of like the sensory sensitivities. Is it going to be too loud? Do I need to bring my loops or something like that
These are all very reasonable things for an autistic person navigating a nerd
That was not designed for them and so a lot of the rumination that I think we see in clients actually does make sense
And we want to get curious about what they're worrying about and is this worry um I did that of the metacognitive therapy training
So I really use that language a lot too is you know, what is the metacognitive belief?
um
You know that you a lot of the times people think well I have to worry to feel safe and
Sometimes yes and sometimes most of time know like where it turns into more of like this and like this
Presentation that we would want to treat and I think sometimes as a therapist
I'm just helping people make more sense of their experience so they can actually be more prepared and
Um confident that like yeah, it's okay. I'm autistic. I'm sitting here with my
My fidget toy and this is totally valid
I'm not avoiding uncomfortable emotions. I'm using it to stay engaged
Um here tonight, right? So it's kind of like that where we don't have to um, you know
um, I don't know apologize fidgets or whatever because we're not leaning into the discomfort that kind of language
So they think a lot of us were trained in when we got into this work
Well, I think too the if I may even be on language is just really understanding the different ways that things show up
Right because like you said to your point like look like right now like if if we're doing with autism like me fidgeting
Has nothing to do with me avoiding a feeling. It's actually serving more as a as a thing to kind of make sure
I'm really here right versus somebody with OCD like they're doing everything they're doing is to try to avoid and get rid of
Any and all discomfort. So like when you're having both
I mean, it seems pretty important to be able to slow down and kind of discern and figure out what's going on. So
Yeah, and like the really have language right like language for what's happening and I think really slowing things down and doing that
Functional analysis like what is
What is the purpose of this behavior in this moment and that can look very different
So when we do have clients that have both autism and OCD
They can start to tell um
You know, this is my OCD or no. This is this is an autistic need. I actually need
um, you know, I'm not going to go to this event because
Uh, it has bright lights and I'm prone to headaches and I really um, I'm beyond my window of tolerance for the day or whatever kind of language
They want to use. I'm out of spoons things like that a lot of us with autism
We also have a lot of chronic illnesses. So there's that big overlap with some major chronic illnesses
And it's just taking care of yourself and knowing what are my limits and being okay with that
So would you say like what happened? Yeah, so my question is okay
I know you said we want to do a way with a like high level of functioning low level of functioning
I don't know better words or language
So, you know, let me know what that is, but but I am curious about because I like I have some people who've come and reached out of people
I know where um being able to really communicate and and have this kind of conversation to understand or figure it out
Sometimes it's challenged and so
How do you how do you what do you do there? How would you work with that?
Yeah, so that is actually I would say um one of the hardest parts of my um as as someone who is late diagnosed with autism and ADHD
I didn't believe it when it was first presented to me that I could have these things because I've went my entire life masking
And so I think you want to have that trust that good like for core in the therapeutic relationship to start to breach that like hey
Have you ever thought that maybe these things um
Are coming from sensory issues or whatever it is or hmm. I'm curious why um
In relation late especially with relationship about CB. I see this all the time and autism because there's the social differences
A lot of the times our clients are just trying to understand social situations
And that can spend an OCD story right like that can absolutely trigger OCD
um and
Sometimes it's just a matter of like
Hmm, I wonder if the way that you're expecting relationships to work just isn't how
Relationships are and just getting curious about those kind of things and kind of sneaking in some autism
Language because sometimes people just aren't open to it and um and I think it's it's more about really check
In and being attuned with our clients and they're like are they ready to explore this and if you know
If you're trained to kind of explore it with them and that neuroperman way. Yeah
Well, let me pivot for a second because we're talking about if you're a therapist and you're working with clients
Right like I mean and I think that's a that's that's fear and that's its own category
But I'm also thinking about like I actually have some friends as parents and and they have kids who are autistic and you know
Like I'm thinking of somebody where you know one of the kids struggles a little more than the other and
You know trying to be as patient as possible and this is a kid that has autism and OCD and it's it's a little bit again harder to communicate and
Get that clarity and I mean a lot of work has gone into you know
Understanding and doing some of the behavioral things and also, you know trying different ways to
Communicate and also listen and kind of translate a little bit of what's being said and what what is being meant
So like you know when you're thinking about families and parents and dynamics like that like what's something that
You know parents can do with with how to kind of navigate when you're seeing your kiddo and it's pretty clear like okay
We're now doing OCD behaviors like I don't know lining certain cups and feeling like it has to have excellent of water because
In their mind with autism to maybe like oh water equals something, you know or I have to use X amount of
clean access or tissues or papers or whatever it is
Yeah, so that's a great um
You know example is that you know really my my whole question is is this lining up of object springing that person joy or distressed
Like is there that fear attached to it and when usually what parents see when you have that overlap is that it's a bit of both
And to start to like ask um the child, you know
Um questions about like is this enjoyable for you and and see if they're actually like maybe they don't have the language a lot of autistic people are
Alexa thimic and they just may not know that they're in as much distressed as they are which is really heartbreaking actually
As a parent to neurodivergent kids that is just it's really hard to see your kids suffer like that when you know there's a problem maybe
Um and they're just not really able to see that yet
Because they have no words
So that's so what do you do how do you how do you help them in that moment the parent or the child
Well, how is it helped the parent to support them to help the child right like so is it am I hearing you like help to
Give language even even
Was it this or this or is it that or that? I'm just getting curious um with kids about you know what what their
Experiencing because to just like as a therapist we can see a behavior and get it wrong and that we really want to trust our clients
Just as his parents we run a trust our kids
Um to kind of give us feedback about what's actually going on and not falsely accused like oh it's is the OCD monster
And it might actually not be or it is and we just want to kind of figure out what's going on
So so we can get them connect them to the right kind of supports the the therapist that are actually trained to you know
Treat OCD if this is OCD
Um, and if there's also autism someone who's neuroaffirming and will pace their treatment based on their neuro type
And so if you well, so I'm getting I'm thinking of of course if you if you can because I'll be honest
I think I've seen a very small
Um amount of folks who really
Understand and I think are skilled
To treat both of the same time where you don't need to go to because for a long time
It was like you have to go to an OCD specialist or a separate autism specialist
And now we actually are seeing more where you know a person can actually hold both which is amazing
Um, but if
Let's say you know you're
Not there yet. What can the parent and the child do on their own? How can they
Start
With you know, okay, we've identified that this isn't necessarily just pleasure
This is I'm having some sort of a fear or something around it like
I kind of think I've drawn my I put on my space cap um for this one where I really go into you know
We don't want to as parents. We don't want to accommodate the the anxious driven behaviors, right?
And so usually what I see in these these family systems not all of them
But the parents are also very anxious too and working toward lowering those
Accommodations um when they see their kid in distress
The ones that are more even if your kiddo is autistic and has OCD
I mean, yeah, and then you kind of see and identify that okay
This is the most CD stuff
Then you want to kind of work with the parent or you'd want to see the parents try to learn how to step back a little bit and
Not going
Yeah, yeah, I mean for sure
Yeah, hard. It's it's really hard
Um, and I think uh space does a wonderful job
Um of really explaining like why accommodations over accommodation is actually going to make it worse
Um, and so the parents actually have a lot of power and helping their kids
um by lowering those um
Accommodations for the anxious behaviors and then maybe encouraging like you know if
Someone's kid likes to line up their cars or their Legos or put them in rainbow order just for for fun
Then like you know
Noticing that they're doing that and like and they know that it brings their child joy like oh
I really like what you're doing there with your Legos. That's really cool. You're so creative and giving those positive, you know
um feedback
Statements for the the autistic behaviors that will probably um
You know, I I have a very strengths-based approach with like looking at autism
I don't use the deficits like yes living with autism's very hard at the same time
There are things that our brains can do that are
Unique and different and and I think feeling like really affirmed and embraced in those ways those beautiful ways that autism can show up
Is a really great way to parent a child and then when they are struggling with OCD like hey
I love you and I know you don't have to go check
And I'm and I'm gonna you know stop driving you to school um every morning and whatever the accommodation is right and like I know you've got this
Because you know you're strong
I love that. Yeah, so still bringing back bringing that back in and and really like you said focusing on
Um the ways that the person is able to you know
Yeah, use some of those other things that they're actually interested in and just because it brings some joy or helps them
Go better what not and like yeah, that's awesome
That you you know what that is and you're doing it right now because that's actually a good thing to do
Um, yeah, is there anything else from your experience?
um you could think of that'll be valuable from folks to hear in terms of you know how else
Because I'm thinking also, you know, I've had several um kind of DMs and messages from parents about like gosh
I don't know what to expect like do it like is it europee is it i c b t is like
What are we doing what kind of therapy like is it better to
Maybe not sit and have to kind of do all those processing kind of thing not to be processing
But a lot of this kind of back and forth kind of high level cognitive stuff
If maybe sometimes it seems like we can't access sometimes maybe we don't access it as well
Like there's a more europee kind of based approach better
How do you augment it like what would you say?
I think uh first we want to find out like where is the child um when kids are in burnout
I don't recommend ERP it places way too many demands on their nervous system
Um, though it can be done. I'm not going to say it can't um
I have to make sure like at least the way I work like my clients are totally on board like they have full
The our hierarchy doesn't look like a hierarchy. It kind of changes every week whatever we're working on
Because we're really just like kind of like where are you at today? What what do you want to work on?
Progress just isn't linear with this population and that's okay and we have to be okay with that
And I think that's actually like a big thing to tell parents is that this expectation that your kids going to start ERP
And just kind of work up this hierarchy and it's it's you know, it's not like that. It's a longer process
Um for kids with these kind of brains and I think just being okay with that um and then
um sitting in the grief of that right like it's so hard
Especially when you are a parent and your kid has all these issues and then maybe your friend your friend group their kids are like
Doing normal stuff or whatever and it's and you're you're like taking your kid to their occupational therapist and they're mental health therapist
They're psychiatrist and just running around to all these different appointments
That can be really hard and so like you know sitting in the parents grateful with them
We're not there to just fix it and make the feelings go away. That's not how
You know being human works. We have life can be really uncomfortable. Um, I think like I love at
Um, that's another like good approach. Um, just like for the parents sometimes who are struggling
Uh along this journey with their kid
Um, but like I have seen now I work as young as 10 and up. Um, I don't do I CBT with kids that young
Um, but I have seen other therapists that have done it successfully
Um, but I do overall I do like I CBT a lot
It's just really depends on the kid I think and
cognitively where they're at like if this makes sense um
Sometimes I will just do just neuro affirming treatment um
Just kind of like a lot of
Plain Lego
Whatever it is my naturals, you know, just kind of like really connecting with them and establishing that
I spend more time on the rapport building before we can start to even talk about exposures
That's what I mean when I say like
It takes longer. I'll sometimes that you're just
Building that rapport that so they feel safe and attuned in um
With you and you're not just this scary person like you have to you know, do these exposures to get better
You're never going to get better. That's not going to work and we really just collaborate like wow like I wonder
You know, do you think you know
You know, you want to go out and try this exposure or something like that and then get their buy-in that way
Just by building that connection
While we play Lego or something like that. Yeah, so a lot of that's playing that's really cool to hear
Yeah, that like you you really like what this population you take your time to build and create that sense of safety
And like that there's a mutual understanding
There's no rush. There's no
Kind of goal like in the same way you might work with somebody else and that and then when you kind of built more of that and that
Kind of bond and connection then like you said to your point
Kind of the hierarchy or whatnot. Well, it'll change because it's whatever is in that moment
Okay, so the way I explain it to a lot of my clients is so I grew up doing figure skating and when you know
We would go out there and try um like double axles or whatever
They would put us on a harness right the coach would like hold me on a harness on the ice and I as a therapist
I feel like a coach when I'm doing this kind of
Oh, yeah, and like I'm not going to let you fall on that we're never going to do an exposure that I know you can't handle in this moment
And that you know, we're really
Creating like the safety so that they can access this learning that happens from wow the bad thing didn't happen
I can do. Yeah, even if you do like little increments. That's like that's the the name of the game is to
Build some of those wins and successes so they can feel like okay. I'm getting some confidence around this
Yeah, yeah
Love it. I love that
Thank you so much for sharing all this and I super appreciate you being open about
Yourself you've included yourself in this sharing process and
I love it. I mean, I think it's great to hear directly, you know from somebody who's actually living the experience
You know and kind of what that's like um
Yeah, so for anybody who would like to find you how can they find you
Um, yeah, so I am like I said, I'm based in Maryland on Instagram. I'm
My practice name is side quest psychotherapy and then my actual count is side quest with Jenna
I don't know what my tip-knock user name is to be honest. I think it's one of the same but
But I'm out there you can find me. I'm also on sub stack under genostone um
So yeah, awesome. Well, thank you so much for coming on the show
Yeah, absolutely
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