Restricted and Repetitive Behaviors as Predictors of Outcome in Autism Spectrum Disorders

Abstract

Restricted and Repetitive Behaviors (RRBs) are core features of Autism Spectrum Disorders (ASDs). Efforts to understand the purpose of RRBs have raised questions about the significance of the presence of RRBs in the long-term outcome of children with ASDs. Some studies have reported that the presence of RRBs during preschool years is a negative prognostic indicator for later childhood (e.g., Charman et al., 2005), while others have failed to replicate this finding (e.g., Bopp et al., 2009). This study examined the effect of RRBs on later functioning in 40 children with ASDs. RRBs were examined at ages 1-2 and 3-5 years using direct observation and parent report. These scores were used to predict cognitive functioning, adaptive abilities, and ASD symptomatology at age 8-10 years. The results suggest that RRBs observed early in the preschool period do not predict later functioning. However, when RRBs are observed at age 3-5 years, they appear to be useful prognostic indicators. Specifically, more severe preoccupations with parts of objects, sensory interests and stereotyped motor movements observed between 3-5 years of age predicted less developed cognitive and adaptive skills, as well as greater ASD symptom severity at age 8-10 years. The relationship between RRBs in the late preschool period and school age outcome is not as strong as the relationship between cognitive functioning in the late preschool period and school age outcome. However, overall, these findings indicate that exhibiting RRBs in the late preschool period does appear to be a negative prognostic indicator for school-age outcome.

Preschool predictors of school-age academic achievement in autism spectrum disorder

“…Analyses of variance revealed no significant differences on gender, race, cognitive ability, adaptive functioning, or ASD symptom severity at T1 and T2 evaluations between children who participated in T3 testing and those who did not (Knoch, 2014; Troyb et al, 2016). …”

Conceptualization of a Heuristic to Predict Increase in Restricted and Repetitive Behaviour in ASD across the Short to Medium Term

“…Impaired communication and social skills were clustered as one part of the dyad and RRBs form the second part of the dyad in the latest version. Despite the centrality of RRBs to diagnosis there is a paucity of research in this domain [3][4][5]. Little is known of how RRBs change over time as people with ASD move through childhood into adolescence and adulthood [6,7].…”

“…Little is known of how RRBs change over time as people with ASD move through childhood into adolescence and adulthood [6,7]. Longitudinal studies are sparse and findings varied [5]. What is clear is that RRBs present extreme challenges to people with ASD, their parents and caregivers [3,8].…”

“…What is clear is that RRBs present extreme challenges to people with ASD, their parents and caregivers [3,8]. This challenge is not only manifested in the present, but may also be projected into future development, as RRBs not only inhibit adaptation in the present but through impaired flexibility and openness to environmental cues also impact on development of future capabilities [3,5,9,10].…”

“…The relationship between RRBs and anxiety has been discussed for some time [5,9,10,13,[29][30][31]. This relationship is particular to the cluster of obsessions, rituals and insistence on sameness [31].…”