Increasing Understanding of Restricted and Repetitive Behaviors in ASD
Lampi, A., Fitzpatrick, P., Romero, V., Amaral, J., & Schmidt, R. C. (2020). Understanding the influence of social and motor context on the co-occurring frequency of restricted and repetitive behaviors in autism. Journal of Autism and Developmental Disorders, 50(5), 1479-1496. doi: 10.1007/s10803-018-3698-3
Restricted and repetitive behaviors (RRBs) are a diagnostic component of ASD. These behaviors may involve repetitive motor movements, unusual non-word sounds, repeated touching or manipulation of objects, and repetitive words or statements. Research has attempted to assess what might cause these behaviors to occur, but the findings of such research are mixed. The study summarized in this post sought to determine if the level of social interaction and motor activity involved in tasks would change observed rates of RRBs. This study also sought to determine how RRBs were related to other social communication diagnostic indicators of ASD.
Who was involved?
Ninety-seven children between the ages of about 6-10 years old (50 ASD participants and 47 children without ASD) participated in the study. The research team also had caregivers familiar with the participants answer questions about development and complete symptom questionnaires. The researchers asked participants to engage in different tasks that were of different combinations of social attention and motor difficulty: low social/low motor, high social/low motor, low social/high motor, and high social/high motor. Video recordings of the sessions allowed the researchers to collect data on the rate of RRBs during each task and then compare those findings with questionnaires completed by caregivers.
What was the outcome?
As expected, the ASD group demonstrated significantly more RRBs than the comparison group without ASD. Repetitive motor movements and verbal statements were the most commonly observed RRBs in the study. RRBs were also found to occur more or less often depending on the type of task being used, with highest rates of RRBs during tasks with low social engagement and low motor effort. Also, the type of motor action did not have to match a similar pattern or style as the repetitive behavior to result in lower rates of RRBs. The researchers indicate that some of the differences observed between tasks may have less to do with the amount of social and motor engagement than with the attention required for the engagement to occur. However, tasks with more social interaction and more motor effort tended to correlate with fewer repetitive behaviors. The level of RRBs was also found to relate to the level of ASD severity overall and lower nonverbal intellectual ability. The relationship of RRBs to social communication ability appeared to be affected by the child’s nonverbal intellectual ability.
What are the strengths and limitations of the study?
Strengths: Direct evaluation of RRBs during various different types of tasks allowed for conclusions about what types of engagement might compete with RRBs without directly intervening with the interfering behavior.
Limitations: Due to the types of tasks used in this study, they took different lengths of time to complete by their nature. This may have resulted in some shifting of the rates of RRBs and made comparisons across the tasks less stable.
What are the implications?
If higher levels of social engagement and more motor requirements compete with RRBs, such information could be useful in the education and intervention supports for individuals with ASD. Although the level of ASD severity was found to correlate with more RRBs in this study, such findings have not been the case in some other research. This research highlights some potential considerations for ways to impact reduction of RRBs without directly intervening with the behavior, which is helpful for considering indirect impacts of enriched environments. However, each individual with ASD may have unique environmental variables that increase or decrease behavior. As such, functional assessments and determination of whether an RRB needs attention for reduction (i.e., is it interfering with that person’s functioning?) should be considered on a case-by-case basis as relevant to that individual’s needs.