Restricted and repetitive behaviors and their developmental and demographic correlates in 4–8-year-old children: A transdiagnostic approach

Abstract

Background: Restricted and repetitive behaviors (RRBs) are a broad class of behaviors characterized by frequent action repetition and intense preference for sameness. Research has predominantly focused on RRBs in diagnosed clinical groups, particularly in autism spectrum disorder and genetic disorders. Using a transdiagnostic approach, the current study examined RRBs in a diverse sample of children in relation to developmental and demographic correlates (age, language, non-verbal ability, child anxiety, sex, and socioeconomic status). Separate analyses examined two RRB subtypes; repetitive sensory and motor behaviors (RSMB) and insistence on sameness (IS).Method: Children (N = 260, age 4–8 years, 174 male, 86 female) in mainstream schools identified by teachers as having behavioral, emotional, and/or cognitive difficulties, were assessed using the Repetitive Behavior Questionnaire-2 (RBQ-2), the British Picture Vocabulary Scale (BPVS), Lucid Ability Scale, the Welsh Index of Multiple Deprivation (WIMD) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Recruitment excluded diagnosed clinical conditions. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children’s difficulties.Results: RRB scores were of high frequency and the scores for the IS were higher than for RSMB. The severity of anxiety symptoms and male sex were significantly associated with both RRB subtypes, and younger age and SES scores were associated with IS. Elevated RRB total and subtype scores were significantly related to SDQ scores for emotion, conduct, hyperactivity, and peer-relations.Discussion: The study provides the first evidence of RRBs in a diverse sample of young children with emerging difficulties in behavior, cognition, and/or emotion. The results contribute to proposals about psychological development in RRB and indicate that RRBs are best represented on a continuum of severity found across children in the early school years. The results support previous findings of a relation between RRB and anxiety reported in clinical samples and importantly, they indicate that it is time to move beyond the study of categorically defined groups and consider correlates of RRBs that include broad indices of mental health and well-being.

Assessing pragmatic language difficulties using the Revised Children's Communication Checklist‐2. Exploratory structural equation modeling and associations with restricted and repetitive behaviors

“…No data are collected on whether children eventually receive a clinical diagnosis because the NDAU is concerned with identifying patterns of psychological functioning and behavior to help schools understand each child's profile. Language data for these children have previously been reported (Keating et al, 2023;Paine et al, 2021) showing that most children have verbal and non-verbal ability in the average range within 1 SD from the mean (see Keating et al, 2023, Table 1 and Figure S1). Among 4-to 7 year-olds olds, 20.9% had below average BPVS scores (1 SD below mean), 6.4% had below average Lucid Verbal Reasoning scores (Singleton, 2001) Data for children aged 6 and 7 years were selected for this study, to facilitate the same age range across the two samples.…”

“…Evidence on the association between language and RRBs in non-autistic children is sparse. While one study with two-year-olds found that semantic language (vocabulary comprehension) was associated with one subtype of RRB (RSMB) (Larkin et al, 2017), another study with older children found no association (Keating et al, 2023). Pragmatic language was not tested in either of these studies.…”

“…In the current study, we would expect that the school-referred group with behavioral and emotional difficulties would show a stronger association between RRB and pragmatic language difficulties compared with the community-sampled group. The study used the Repetitive Behavior Questionnaire-2 (RBQ-2) to measure RRBs, a questionnaire widely validated across clinical and non-clinical populations (Keating et al, 2023;Leekam et al, 2007;Lidstone et al, 2014;Uljarevi c et al, 2017) with a robust two-factor structure.…”

Are restricted and repetitive behaviours in two- and six-year-olds associated with emotional and behavioural difficulties?

“…The study did not, however, directly compare the broad constructs of IS and RSM RRBs, nor did it examine internalising behaviours more generally, or include any measure of externalising behaviours. More recently, Keating, Van Goozen, Uljarević, Hay, & Leekam et al (2023) recruited 4-to 8-year-old children with non-specific behavioural and emotional difficulties manifested in school. In this cross-sectional study, they found that both RSM and IS (measured by the RBQ-2) were significantly associated with both broad internalising and externalising scores on the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997), as well as with the specific emotion, conduct, hyperactivity, and peer-relations subscales.…”

“…Previous research indicates that RRBs are associated with socio-economic status (SES) in community samples (Larkin et al, 2017;Leekam et al, 2007); SES was therefore measured and controlled for in all analyses. Moreover, although evidence of sex differences in RRBs is somewhat limited (for review, see Uljarević et al, 2023), a recent study with 4-to 8-year-old children referred for assessment of emotional or behavioural difficulties reported that boys had significantly higher rates of both IS and RSM RRBs than girls (Keating et al, 2023).…”