Developmental Course of Restricted and Repetitive Behaviors in Children with Autism Spectrum Disorde

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Developmental Course of Restricted and Repetitive
Behaviors in Children with Autism Spectrum
Disorders

• S. Bishop, M. Huerta, J. Richler, S. Qiu, C.
  Lord
• University of Michigan

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Restricted and Repetitive Behaviors in children
with ASD

• RRBs comprise one of the categories of behaviors
  required for a diagnosis of autism in the DSM-IV
  (American Psychiatric Association, 1994).
  Included in this category are
• Stereotyped and repetitive motor mannerisms (e.g.
  hand-flapping, finger-flicking)
• Persistent occupation with parts of objects
• Preoccupations/restricted patterns of interest
• Inflexible adherence to nonfunctional
  routines/rituals

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Background

• Studies examining RRBs in very young children
  with ASD have found mixed results
• Few children with clear RRBs at 20 months (Cox et
  al., 1999).
• Social and communicative impairments more
  prominent at age 2 than RRBs (Stone et al.,1999).
  
• Some RRBs more commonly reported at the age of 2
  than others (Moore Goodson, 2003).

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Background

• There is evidence to suggest that different RRBs
  may follow different developmental trajectories
• Increase seen in scores on some RRBs over time
  (Moore Goodson, 2003 Cox et al., 1999).

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Research Questions

• What is the frequency of each RRB at age 2 in
  children with ASD? In non-ASD?
• Is there an increase in RRB total score?
• Are certain RRBs more prevalent at age 9 than at
  age 2?
• How stable are different RRBs over time?

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Participant Demographics
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Measures

• Assessments at each time point included a battery
  of child tests and a parent interview
• Autism Diagnostic Interview - Revised (ADI-R
  Lord, Rutter LeCouteur, 1994 see also
  LeCouteur, Rutter, Lord 2003)
• Measures of cognitive and social functioning

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Results
Percentage of children with different RRBs on the
ADI-R
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Results
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Results

• Consistent with earlier work, RRB total scores at
  age 9 were significantly higher than those at age
  2.

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RRBs more common at age 9
ASD reporting behavior
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RRB more common at age 2
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Stability of RRBs over time

• In general, behaviors were not highly stable. In
  most cases, a slight majority of children stayed
  the same (i.e. continued to show or not show the
  behavior), but a significant minority either lost
  or gained the behavior.

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Conclusions

• Some RRBs are present in a large percentage of 2
  year olds with ASD, whereas other repetitive
  behaviors are much less common in children that
  young.
• Individual RRBs follow distinct developmental
  courses.
• RRBs at age 2 are not highly stable.

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Limitations

• Unique sample of 2 year olds
• Findings are based only on parent report and are
  not supplemented by any direct clinical
  observation.
• Focused on presence/absence of behaviors rather
  than severity.

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Future Directions

• Timing of losses/gains in RRBs
• Constellations of RRBs
• Relationship between RRB development and autism
  severity

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Thank you for your attention!

• Additional thanks to
• Families in the EDX study
• Staff at University of Chicago, University of
  North Carolina, TEACCH, and University of
  Michigan
• Andrew Pickles
• This study was funded by NIMH, NICHD (CPEA),
  NIAAA