How mental health disorders such as obsessive compulsive disorder (OCD) manifest in high ability youth has received little empirical attention, and differentiating OCD from other diagnoses like autism spectrum disorder (ASD) can be challenging. The purpose of this study was to examine clinical profiles among OCD, ASD, or no diagnosis for those of high ability and not high ability. Results indicated those with high ability only tended to obtain higher ability and achievement scores than those with a co-occurring disability. Youth in the high ability/OCD and high ability/ASD groups had lower working memory and processing speed scores than the high ability alone group, but also had frequent comorbid attention-deficit hyperactivity disorder diagnoses. The high ability/OCD and high ability/ASD groups were the most divergent on the anxiety and atypicality Behavioral and Emotional Screening System (BASC) subtests, but an anxiety disorder was often comorbid with OCD.