Subcategories of Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorders

Research suggests that restricted and repetitive behaviors (RRBs) can be subdivided into Repetitive Sensory Motor (RSM) and Insistence on Sameness (IS) behaviors. However, because the majority of previous studies have used the Autism Diagnostic Interview-Revised (ADI-R), it is not clear whether these subcategories reflect the actual organization of RRBs in ASD. Using data from the Simons Simplex Collection (n = 1,825), we examined the association between scores on the ADI-R and the Repetitive Behavior Scale-Revised. Analyses supported the construct validity of RSM and IS subcategories. As in previous studies, IS behaviors showed no relationship with IQ. These findings support the continued use of RRB subcategories, particularly IS behaviors, as a means of creating more behaviorally homogeneous subgroups of children with ASD.     

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence

BackgroundChallenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood.MethodAdolescents with typical cognitive development (TD, n = 84), intellectual disability (ID, n = 30), or ASD (n = 45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors.ResultsAll domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS.ConclusionsDLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.     

Application of the Repetitive Behavior Scale-Revised – Italian version – in preschoolers with autism spectrum disorder

Restricted repetitive and stereotyped patterns of behavior, interests, and activities (RRB) are mandatory features for a diagnosis of Autism Spectrum Disorder (ASD) according to the Diagnostic and Statistical Manual of mental disorders-fifth edition (DSM-5). Despite the strong diagnostic role of RRB, their expressiveness and their relationship with other clinical/demographic features in ASD is not fully elucidated.The Italian version of the Repetitive Behavior Scale-Revised (RBS-R) was applied to a relatively large sample of preschool-aged children with ASD who underwent a comprehensive clinical assessment. The relationship between RRB and sex, age, non-verbal IQ, autism severity, as well as the diagnostic accuracy of the RBS-R were explored.Stereotyped and Ritualistic/Sameness behaviors were the most common RRB in preschoolers with ASD, without widespread differences between males and females. No significant correlations between RRB and chronological age, or non-verbal IQ were detected. The expressiveness of ritualistic/sameness behaviors positively correlated with autism severity, assessed through the Calibrated Severity Score (CSS) derived from the Autism Diagnostic Observation Schedule (ADOS). Receiver Operator Characteristic (ROC) analysis showed high diagnostic accuracy using the Global Rating Score, which represents the judgment of the parents of as the RRB affect the child's life. However, while the Global Rating Score performed well, the remaining subscales did not.This investigation extends the limited research on early pattern and associated features of RRB in young children with ASD. The use of the RBS-R may increase the knowledge of the RRB complexity and variability and in turn improve the diagnostic and therapeutic procedures within the autistic spectrum.     

Validating the Repetitive Behavior Scale-Revised in Young Children with Autism Spectrum Disorder

This study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 287 preschool-aged children with autism spectrum disorder (ASD). A confirmatory factor analysis was used to examine six competing structural models. Spearman’s rank order correlations were calculated to examine the associations between factor scores and variables of interest. The 3- and 5-factor models were selected as preferable on the basis of fit statistics and parsimony. For both models, the strongest correlations were with problem behavior scores on the Child Behavior Checklist and repetitive behavior scores on the ADI-R. Developmental index standard scores were not correlated with factors in either model. The results confirm the utility of the RBS-R as a measure of repetitive behaviors in young children with ASD.     

Is there a relationship between restricted, repetitive, stereotyped behaviors and interests and abnormal sensory response in children with autism spectrum disorders?

This study examined the relation between restricted, repetitive, and stereotyped behaviors and interests (RBs) and sensory responses in a group of 70 children and adolescents diagnosed with an autism spectrum disorder (ASD). Caregivers completed the Repetitive Behavior Scale-Revised (RBS-R) and the Sensory Profile. Controlling for IQ and age, total RBS-R and Sensory Profile scores revealed significant correlations both prior to and after removing overlapping items. Examination of the co-occurrence of RBs and atypical sensory responses in this population suggests a subgroup has consistently high rates of problems in both RBs and sensory processing. In addition, this subgroup has high rates of prescribed psychoactive medications and co-morbid psychiatric diagnoses. The IQ and age of this subgroup did not differ significantly from the rest of the participants. Results are consistent with previous research describing the co-occurrence of RBs and sensory response abnormalities in the ASD population. Further investigation of the subset of individuals with ASD who have high rates of RBs and abnormal sensory responses may lead to a more comprehensive understanding of their clinical picture and improve interventions. Additionally, research with this subgroup may have significance for identifying a specific phenotype in ASD.     

Relationship between the social functioning of children with autism spectrum disorders and their siblings’ competencies/problem behaviors

There is very little known about how sibling characteristics may influence the social functioning of a child with an autism spectrum disorder (ASD). The current study utilized data from the Simons Simplex Collection (SSC; n = 1355 children with ASD and 1351 siblings) to investigate this relationship. Phenotypic measures included (a) the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and the Vineland Adaptive Behavior Scales-II (VABS-II) for the probands with ASD and (b) the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale (SRS), the Child Behavior Checklist (CBCL), and the VABS-II for siblings. Sibling data were first analyzed collectively, then analyzed by “older” and “younger” groups, relative to the age of the proband with ASD. Significant correlations were observed between probands’ and siblings’ VABS-II socialization domain scores; additional associations were noted between (a) probands’ VABS-II socialization domain scores and siblings’ CBCL internalizing subscale scores when only younger siblings were analyzed, and (b) probands’ ADOS Reciprocal Social Interaction (RSI) domain scores and the sibling SCQ scores when only older siblings were analyzed. These findings suggest that typically developing children may have a small yet meaningful influence on the prosocial development of their siblings with ASD. Limitations and future directions are discussed.     

Changes in Restricted Repetitive Behaviors with age: A study of high-functioning adults with Autism Spectrum Disorders

The existing literature suggests that while impairments in Autism Spectrum Disorders (ASDs) continue into adulthood, some behavioral symptoms tend to abate with age. However, there is a dearth of research examining changes in ASD symptoms from childhood to adulthood, especially for Restricted Repetitive Behaviors (RRBs). We examined age-related changes in RRBs in a sample of 34 high-functioning adults with ASDs at current age and retrospectively at age 4–5 years using the Autism Diagnostic Interview—Revised, and the Repetitive Behavior Scale—Revised. We found significant changes in all RRBs over time with the exception of the Self-injurious Behavior subscale of the RBS-R. In addition, the degree of change also differed for RRB subtypes. Based on the RBS-R, the highest proportion of participants showed improvements on the Compulsive Behavior subscale (75%), and the lowest proportion showed improvement on the Restricted Behavior subscale (44.1%). We also found a low base rate for certain symptoms (e.g., self-injurious behavior, unusual preoccupations, and unusual sensory interests) in this sample of higher-functioning individuals with ASDs. Future research should examine further changes in RRBs in late adulthood and also evaluate contextual variables that are likely to be related to symptom abatement over time.     

State and Trait Anxiety of Adolescents with Autism Spectrum Disorders

Objective This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. Methods A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants’ parents completed the Child Behavior Checklist (CBCL). Pearson’s correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson’s correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants’ age and IQ. Results The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. Conclusion Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.     

The Behavioral Assessment of Social Interactions in Young Children: An examination of convergent and incremental validity

Many treatment programs for individuals with an autism spectrum disorder (ASD) target social skills, and there is growing attention directed toward the development of specific interventions to improve social skills and social interactions in this population (Hestenes and Carroll, 2000, Strain and Hoyson, 2000). However, there are limited tools available to assess social skills in children with ASD. Furthermore, there are even fewer designed to assess response to intervention. The focus of the current study was to examine the convergent, criterion, and incremental validity of a new measure designed to assess the development of social interaction skills in individuals with ASD; namely, the Behavioral Assessment of Social Interactions in Young Children (BASYC; Gillis, Callahan, & Romanczyk, 2010). A total of 44 individuals with ASD participated in this study (mean age was 7 years 11 months; range was 2–12 years old). The BASYC demonstrated convergent validity with the Social Approach subscale of the Pervasive Developmental Disorders Behavior Inventory (PDDBI; Cohen & Sudhalter, 2005) and criterion-related validity with the Socialization domain of the Vineland Adaptive Behavior Scales-II (VABS-II; Sparrow, Cicchetti, & Balla, 2005). One of the two BASYC subscales demonstrated incremental validity over the PDDBI in predicting variability in the VABS-II Socialization domain. The results of this research provide further support for the clinical utility of the BASYC as a measure of social interaction skills in individuals with ASD.     

Level of Functioning in Autism Spectrum Disorders: Phenotypic Congruence Among Affected Siblings

Little evidence supports that siblings with autism exhibit the same behaviors; however, some findings suggest that level of functioning shows familial aggregation. We tested this notion among multiplex families participating with the Autism Genetic Resource Exchange (AGRE) Consortium, using scores on the Peabody Picture Vocabulary Test-Third Edition (N = 204 families), the Ravens Colored Progressive Matrices (N = 226 families), and the Vineland Adaptive Behavior Scales (N = 348 families). Intraclass Correlation Coefficients revealed that siblings with autism/autism spectrum disorders (ASD) were more similar on measures of verbal and nonverbal IQ and adaptive functioning than were unrelated children with autism/ASD. Preliminary twin correlations indicated strong genetic effects for some skill domains and the influence of shared environmental factors for others.     

Brief Report: Repetitive Behaviours in Greek Individuals with Autism Spectrum Disorder

The main objective of this study was to examine the factor structure of restricted repetitive behaviours (RRBs) in a sample of 205 Greek individuals with Autism Spectrum Disorder (ASD), using the Repetitive Behavior Scale-Revised (RBS-R). Results show that the structure of RRBs in this Greek sample can be described using a 2-factor solution. The current study provides further, cross-cultural support for the distinction between a “high-order” factor reflecting compulsions, rituals, sameness, and restricted behaviours (CRSRB) and a “low-order” factor reflecting stereotyped movements and self-injurious behaviours (SSIB). These factors are most likely located at the top of the RRB structural hierarchy and represent general, independent constructs of ASD behaviours that can be identified not only across studies but also across cultures.     

Repetitive behavior profiles: Consistency across autism spectrum disorder cohorts and divergence from Prader�CWilli syndrome

Restricted and repetitive behavior (RRB) is a group of heterogeneous maladaptive behaviors. RRB is one of the key diagnostic features of autism spectrum disorders (ASDs) and also commonly observed in Prader–Willi syndrome (PWS). In this study, we assessed RRB using the Repetitive Behavior Scale-Revised (RBS-R) in two ASD samples (University of Illinois at Chicago [UIC] and University of Florida [UF]) and one PWS sample. We compared the RBS-R item endorsements across three ASD cohorts (UIC, UF and an ASD sample from Lam, The Repetitive Behavior Scale-Revised: independent validation and the effect of subject variables, PhD thesis, 2004), and a PWS sample. We also compared the mean RBS-R subscale/sum scores across the UIC, UF and PWS samples; across the combined ASD (UIC + UF), PWS-deletion and PWS-disomy groups; and across the combined ASD sample, PWS subgroup with a Social Communication Questionnaire (SCQ) score ≥15, and PWS subgroup with a SCQ score <15. Despite the highly heterogeneous nature, the three ASD samples (UIC, UF and Lam’s) showed a similar pattern of the RBS-R endorsements, and the mean RBS-R scores were not different between the UIC and UF samples. However, higher RRB was noted in the ASD sample compared with the PWS sample, as well as in the PWS subgroup with a SCQ score ≥15 compared with the PWS subgroup with a SCQ score <15. Study limitations include a small sample size, a wide age range of our participants, and not controlling for potential covariates. A future replication study using a larger sample and further investigation into the genetic bases of overlapping ASD and RRB phenomenology are needed, given the higher RRB in the PWS subgroup with a SCQ score ≥15.     

Age-Related Differences in Restricted Repetitive Behaviors in Autism Spectrum Disorders

Restricted repetitive behaviors (RRBs) were examined in a large group of children, adolescents and adults with ASD in order to describe age-related patterns of symptom change and association with specific contextual factors, and to examine if the patterns of change are different for the various types of RRBs. Over 700 individuals with ASD were rated on the Repetitive Behavior Scale-Revised. RRBs were less frequent and less severe among older than younger individuals, corroborating that autism symptoms abate with age. Our findings further suggest that repetitive behaviors are a heterogeneous group of behaviors, with the subtypes of RRBs having their own individual patterns across the lifespan, and in some cases, a differential association with age depending on intellectual functioning.     

A Comparison of Repetitive Behaviors in Aspergers Disorder and High Functioning Autism

In this study we compared 33 IQ and age matched pairs of individuals with Aspergers Disorder (ASP) and high functioning autism (HFA) on measures of repetitive behavior. On the Repetitive Behavior Scale-Revised (RBS-R), the ASP and HFA groups showed no differences in RBS-R Intensity score (severity) score or Frequency score (number of problems present). This suggests that the two groups are similar with respect to␣the intensity or severity of repetitive behaviors and the presence of repetitive behaviors. At the item level there were no differences on scales typically associated with autism (Stereotyped Behavior) and ASP (Restricted Interests). Similarly, there were no differences between the groups on the Aberrant Behavior Checklist Stereotypy scale. These findings add to the body of literature showing that HFA and ASP fail to differ with respect to repetitive behaviors. The implications of the findings for neurobiologic and genetic studies are discussed.     

Restricted and repetitive behaviors and psychiatric symptoms in youth with autism spectrum disorders

Children with autism spectrum disorders (ASD) are at high risk for co-occurring psychiatric disorders. Previous research has suggested that restricted and repetitive behaviors (RRB) are associated with symptoms of co-occurring psychiatric disorders in individuals with ASD, but this relationship is not well understood. The current study investigated the relationship between RRB and co-occurring psychiatric symptoms, including depressive, anxiety, attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms, while considering the role of level of functioning. Participants were 72 parents of youth diagnosed with an ASD (ages 5–17). They completed the Social Communication Questionnaire (SCQ), the Repetitive Behavior Scale-Revised (RBS-R), an abridged version of the Child Symptom Inventory-4 (CSI-4) and the Conceptual domain of the Adaptive Behavior Assessment System, 2nd Edition (ABAS-II). Results indicated that RRB do predict psychopathology. Ritualistic and sameness behavior is predictive of anxiety, depression and ODD while stereotypy is predictive of ADHD. Restricted interests were a negative predictor of depression. Level of functioning moderated the relationship between self-injurious behavior (SIB) and both anxiety and depressive symptoms as well as the relationship between ritualistic and sameness behavior and depressive symptoms. Understanding the relationship between RRB and psychiatric symptoms could help clarify the presentation of ASD phenotypes as well as etiological variables.     

Predictors and Correlates of Adaptive Functioning in Children with Developmental Disorders

Autism is a developmental disorder marked by impairments in socialization, communication, and perseverative behavior and is associated with cognitive impairment and deficits in adaptive functioning. Research has consistently demonstrated that children with autism have deficits in adaptive functioning more severe than their cognitive deficits. This study investigates the correlates and predictors of adaptive functioning as measured by the Vineland Adaptive Behavior Scales in high- and low-functioning children with autism and their age and nonverbal IQ matched controls. Thirty-five 9-year-old children with high-functioning autism (HAD) were compared with 31 age-matched children with developmental language disorder (DLD), and 40 9-year-old children with low-functioning autism (LAD) were compared with 17 age-matched children with low IQ on adaptive functioning, IQ, autistic symptomology, and tests of language and verbal memory. Results indicate that both groups with autism were significantly impaired compared to their matched controls on Socialization and Daily Living, but not Communication and that these impairments were more pronounced in the HAD group than in the LAD group. Adaptive behavior was strongly correlated with autistic symptomology only in the HAD group. Regression analyses indicated that IQ was strongly predictive of adaptive behavior in both low-functioning groups, but tests of language and verbal memory predicted adaptive behavior in the higher functioning groups. Results suggest that IQ may act as a limiting factor for lower functioning children but higher functioning children are impaired by specific deficits, including autistic symptomology and impaired language and verbal memory.     

Validation of the Repetitive Behavior Scale-Revised in Spanish-Speakers Participants with Autism Spectrum Disorder

Restricted and repetitive behavior (RRB) is one of the two key diagnostic features of autism spectrum disorder (ASD). DSM-5 highlights the importance of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. Therefore, there is a need for available measures that assess the severity of RRB. The repetitive behavior scale-revised (RBS-R) is probably the most used informant-based rating scale for the assessment of RRB and interests observed in ASD. The present study examined the psychometric properties of the Spanish version of the RBS-R in a sample of 233 participants with ASD, aged 3 to 63 years. Results revealed a six-factor model, good internal consistency, and concurrent-divergent validity. These findings suggest the utility of the Spanish version of RBS-R.     

Adaptive Behavior Ratings Correlate With Symptomatology and IQ Among Individuals With High-Functioning Autism Spectrum Disorders

Caregiver report on the Adaptive Behavior Assessment System-II (ABAS) for 40 high-functioning individuals with Autism Spectrum Disorders (ASD) and 30 typically developing (TD) individuals matched for age, IQ, and sex ratio revealed global adaptive behavior deficits in ASD, with social skills impairments particularly prominent. Within the ASD group, adaptive communication skills were positively related to IQ while global adaptive functioning was negatively associated with autism symptomatology. Autistic behavior ratings related negatively to ABAS scores in the TD but not the ASD group. This investigation demonstrates: the utility of an adaptive functioning checklist for capturing impairments, even in high-functioning individuals with ASD; and that a relationship between social abilities and autism exists independently of intelligence.     

Concurrent Validity of the ABAS-II Questionnaire with the Vineland II Interview for Adaptive Behavior in a Pediatric ASD Sample: High Correspondence Despite Systematically Lower Scores

Journal of Autism and Developmental Disorders - We examined the correlation between interviewer-administered Vineland Adaptive Behavior Scale II (VABS-II) and the parent-rated Adaptive Behavior...     

The Repetitive Behavior Scale-Revised: Independent Validation in Individuals with Autism Spectrum Disorders

A key feature of autism is restricted repetitive behavior (RRB). Despite the significance of RRBs, little is known about their phenomenology, assessment, and treatment. The Repetitive Behavior Scale-Revised (RBS-R) is a recently-developed questionnaire that captures the breadth of RRB in autism. To validate the RBS-R in an independent sample, we conducted a survey within the South Carolina Autism Society. A total of 320 caregivers (32%) responded. Factor analysis produced a five-factor solution that was clinically meaningful and statistically sound. The factors were labeled “Ritualistic/Sameness Behavior,” “Stereotypic Behavior,” “Self-injurious Behavior,” “Compulsive Behavior,” and “Restricted Interests.” Measures of internal consistency were high for this solution, and interrater reliability data suggested that the RBS-R performs well in outpatient settings.