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Uljarević M, Spackman EK, Whitehouse AJO, Frazier TW, Billingham W, Condron P, Hardan A, Leekam SR. Arriving at the empirically based conceptualization of restricted and repetitive behaviors: A systematic review and meta-analytic examination of factor analyses. Clin Psychol Rev 2023; 103:102286. [PMID: 37269778 DOI: 10.1016/j.cpr.2023.102286] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
An empirically based understanding of the factor structure of the restricted and repetitive behaviors (RRB) domain is a prerequisite for interpreting studies attempting to understand the correlates and mechanisms underpinning RRB and for measurement development. Therefore, this study aimed to conduct a systematic review and meta-analysis of RRB factor analytic studies. Sets of meta-analyses were performed to examine (a) the factor structure of individual RRB instruments, (b) associations between RRB subdomains across instruments, and (c) the association between RRB factors and other variables. Searches for peer-reviewed articles evaluating the factor structure of the RRB domain were performed in PsycINFO (Ovid), Medline (Ovid), and Embase (Ovid). No age, measurement, or informant-type limits were imposed. Quality and risk of bias for individual studies were assessed using relevant COSMIN sections. Among the 53 studies retained for review, 41 examined RRB factor structures among individuals with autism spectrum disorder (ASD) and 12 among non-ASD samples. Meta-analysis of factor correlations provided evidence that the RRB domain encompasses the following eight specific factors: repetitive motor behaviors, insistence on sameness, restricted interests, unusual interests, sensory sensitivity, and repetitive, stereotyped language. Although interrelated, RRB factors were distinct, showing a unique pattern of associations with demographic, cognitive, and clinical correlates. Meta-analyses of the associations between RRB factors and specific correlates, specifically adaptive functioning and communication impairments, should be considered preliminary due to the limited number of studies. Despite limitations, this review provides important insights into the factor structure of the RRB domain and highlights critical conceptual, measurement, and methodological limitations of the current research that will need to be addressed in order to improve our understanding of RRB.
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Affiliation(s)
- Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States.
| | - Emily K Spackman
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, OH, USA
| | - Wesley Billingham
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Vic 3010, Australia
| | - Antonio Hardan
- University Library, The University of Melbourne, Parkville, Vic 3010, Australia
| | - Susan R Leekam
- School of Psychology, Cardiff University, Cardiff, Wales, UK
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2
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Selten I, Boerma T, Everaert E, Gerrits E, Houben M, Wijnen F, Vorstman J. Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2023; 8:23969415231179844. [PMID: 37362238 PMCID: PMC10286206 DOI: 10.1177/23969415231179844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background and Aim Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD). Method 44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children's expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning. Results Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD. Conclusion Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later. Implications Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.
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Affiliation(s)
- Iris Selten
- Program in Genetics and Genome Biology, Research Institute, and Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Emma Everaert
- Institute for Language Sciences, Utrecht University, Utrecht, The Netherlands; Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen Gerrits
- Institute for Language Sciences, Utrecht University, Utrecht, The Netherlands; Research group Speech and Language Therapy – Participation is Communication, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Michiel Houben
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Wijnen
- Institute for Language Sciences, Utrecht University, Utrecht, The Netherlands
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Chaxiong P, Dimian AF, Wolff JJ. Restricted and repetitive behavior in children with autism during the first three years of life: A systematic review. Front Psychol 2022; 13:986876. [PMID: 36389482 PMCID: PMC9661964 DOI: 10.3389/fpsyg.2022.986876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/06/2022] [Indexed: 09/19/2023] Open
Abstract
Restricted and repetitive behavior (RRB) is a core diagnostic feature of autism spectrum disorder (ASD). Previous research shows that RRB is prevalent early in life and observed in neurotypical development as well. Less is known, however, about early RRB patterns, developmental trajectories, and the relation to outcomes for autistic children. The purpose of this systematic review was to synthesize findings from studies examining RRB in autistic children from birth through age 3. A detailed protocol was designed a priori based on PRISMA guidelines for systematic reviews. From the published literature, 41 peer reviewed journal articles were identified and included in this review. Our synthesis of the literature suggests that differences in RRB are evident prior to age 2 in children with or who go onto be diagnosed with autism. These differences were evident for both frequency and intensity of RRB across multiple topographies. There were mixed results regarding functional outcomes associated with early RRB, such as cognitive and adaptive behavior, though relations appeared to become stronger as children aged beyond toddlerhood. Notably, level of RRB appears unrelated to autism severity in young autistic children. A wide range of RRB have been reported to be elevated in autistic children during the first years of life, including repetitive motor behaviors, atypical sensory behaviors, insistence on sameness (IS), and self-injurious behaviors (SIBs). In contrast to studies of older children, RRB in very young autistic children do not appear to be associated with functional outcomes but may be valuable to include in early screening efforts. Systematic review registration https://osf.io/huzf3, unique identifier: doi: 10.17605/OSF.IO/HUZF3.
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Affiliation(s)
- Pang Chaxiong
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, MN, United States
| | - Jason J. Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
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4
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Uljarević M, Carrington SJ, Hardan AY, Leekam SR. Subdomains of restricted and repetitive behaviors within autism: Exploratory structural equation modeling using the diagnostic interview for social and communication disorders. Autism Res 2022; 15:861-869. [PMID: 35178885 PMCID: PMC9306942 DOI: 10.1002/aur.2687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/16/2021] [Accepted: 01/15/2022] [Indexed: 01/21/2023]
Abstract
The current study aimed to explore the factor structure of a broad range of restricted and repetitive behaviors (RRB) within the autism spectrum. Exploratory structural equation modeling was conducted using individual item‐level data from the Diagnostic Interview for Social and Communication Disorders (DISCO). DISCO is a comprehensive semi‐structured interview used by clinicians to elicit information from caregivers about the individual's profile of development and behavior. Data from a sample of 226 individuals with a clinical diagnosis of autism spectrum disorder (ASD) (189 males; Mage = 11.82 years, SDage = 7.87) were analyzed. The six‐factor structure provided the most optimal and interpretable fit (comparative fit index = 0.944, Tucker–Lewis index = 0.923, root mean square error of approximation = 0.018). Derived factors were interpreted as repetitive motor behaviors (RMB), unusual sensory and object focused interests (USOI), sensory sensitivity (SS), insistence on sameness (IS), circumscribed interests (CI) and stereotyped language (SL). Age was significantly negatively associated with RMB, USOI and SL but not with SS, IS or CI factor scores. None of the factors were associated with sex. ASD individuals with intellectual disability (ID) had the highest RMB, USOI, SS and SL scores while those without ID had the highest IS and CI scores. Our findings provide preliminary evidence for the utility of the DISCO as a comprehensive measure of several distinct RRB domains in both research and clinical contexts. Importantly, the current investigation highlights crucial areas for measurement development.
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Affiliation(s)
- Mirko Uljarević
- Faculty of Medicine, Dentistry, and Health Sciences, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Sarah J Carrington
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Susan R Leekam
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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5
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Uljarević M, Frazier TW, Rached G, Busch RM, Klaas P, Srivastava S, Martinez-Agosto JA, Sahin M, Eng C, Hardan AY. Toward better characterization of restricted and repetitive behaviors in individuals with germline heterozygous PTEN mutations. Am J Med Genet A 2021; 185:3401-3410. [PMID: 34423884 DOI: 10.1002/ajmg.a.62458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Abstract
This study aimed to further our understanding of restricted and repetitive behaviors (RRB) among individuals with germline pathogenic mutations in PTEN by providing multimethod characterization and comparison of key RRB subdomains across individuals with PTEN mutations with autism spectrum disorder (ASD) (PTEN-ASD), with PTEN mutations without ASD (PTEN-No ASD) and with ASD and macrocephaly but without PTEN mutations (Macro-ASD). Of 86 total research participants, 38 had PTEN-ASD (Mage = 8.93 years, SDage = 4.75), 25 Macro-ASD (Mage = 11.99 years; SDage = 5.15), and 23 PTEN-No ASD (Mage = 8.94 years; SDage = 4.85). The Repetitive Behavior Scale-Revised (RBS-R) and the Autism Diagnostic Interview-Revised (ADI-R) were used as measures of distinct RRB domains. There were significant group differences in the RBS-R repetitive motor behaviors (RMB; F = 4.52, p = 0.014, ω2 = 0.08), insistence on sameness (IS; F = 4.11, p = 0.02, ω2 = 0.05), and circumscribed interests (CI; F = 7.80, p = 0.001, ω2 = 0.14) scales. Post hoc comparisons showed that the PTEN-No ASD group had significantly lower RMB, IS, and CI scores compared to both PTEN-ASD and Macro-ASD groups. Importantly, PTEN-No ASD group still showed elevated RRB levels. Furthermore, there was a portion of individuals in PTEN-No ASD group whose Full-Scale Intelligence Quotient (FSIQ) was >70 that did not show floor level scores in the RMB domain. After adjusting for age and FSIQ scores, group differences were no longer statistically significant. RMB, IS, and CI domains showed distinct association patterns with sex, age, and FSIQ. This investigation provides the largest and most comprehensive characterization of distinct RRB domains in individuals with PTEN mutations to date. Despite the limitations, our findings have important assessment and treatment implications.
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Affiliation(s)
- Mirko Uljarević
- Faculty of Medicine, Dentistry, and Health Sciences, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,La Trobe University, Bundoora, Victoria, Australia
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, Ohio, USA.,Autism Speaks, New York, New York, USA
| | | | - Robyn M Busch
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Klaas
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Siddharth Srivastava
- Department of Neurology, Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julian A Martinez-Agosto
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Division of Medical Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Mustafa Sahin
- Department of Neurology, Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Harrop C, Sterrett K, Shih W, Landa R, Kaiser A, Kasari C. Short-term trajectories of restricted and repetitive behaviors in minimally verbal children with autism spectrum disorder. Autism Res 2021; 14:1789-1799. [PMID: 33960125 PMCID: PMC11045260 DOI: 10.1002/aur.2528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/12/2022]
Abstract
Very little is known about the 30% of children with Autism Spectrum Disorder (ASD) who remain minimally verbal when they enter school. Restricted and repetitive behaviors (RRBs) are well-characterized in younger, preschool, and toddler samples. However, the prevalence and impact of RRBs has not been characterized in older, minimally verbal children. The goal of this study was to characterize this core diagnostic feature in minimally verbal children with ASD ages 5-8 years over a 9-month period to better understand how these behaviors manifest in this crucially understudied population. RRBs were coded from caregiver-child interactions (CCX) at four timepoints. Upon entry into the study, children demonstrated an average of 17 RRBs during a 10-min CCX. The most common category was Verbal. RRBs remained constant over 6 months; however, a slight reduction was observed at the final timepoint. Compared to prior literature on younger samples, minimally verbal children with ASD demonstrated higher rates of RRBs and higher rates of verbal RRBs. Further work is required to understand the function and impact of RRBs in minimally verbal children. LAY ABSTRACT: Approximately one-third of children with autism spectrum disorder (ASD) remain minimally verbal at the time of school entry. In this study, we sought to characterize the presence of restricted and repetitive behaviors (RRBs) in school-aged children (5-8) who were minimally verbal. Compared to prior studies, minimally verbal children with ASD had higher frequencies of RRBs and demonstrated a different profile of behaviors, including more verbal RRBs.
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Affiliation(s)
- Clare Harrop
- University of North Carolina at Chapel Hill, Allied Health Sciences, Carr Mill, Mall Carrboro, NC, 27510
| | - Kyle Sterrett
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90024
| | - Wendy Shih
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90024
| | - Rebecca Landa
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, 21211
| | - Ann Kaiser
- Vanderbilt University, Department of Special Education, Nashville, TN, 37203
| | - Connie Kasari
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90024
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Supekar K, Ryali S, Mistry P, Menon V. Aberrant dynamics of cognitive control and motor circuits predict distinct restricted and repetitive behaviors in children with autism. Nat Commun 2021; 12:3537. [PMID: 34112791 PMCID: PMC8192778 DOI: 10.1038/s41467-021-23822-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/19/2021] [Indexed: 11/08/2022] Open
Abstract
Restricted and repetitive behaviors (RRBs) are a defining clinical feature of autism spectrum disorders (ASD). RRBs are highly heterogeneous with variable expression of circumscribed interests (CI), insistence of sameness (IS) and repetitive motor actions (RM), which are major impediments to effective functioning in individuals with ASD; yet, the neurobiological basis of CI, IS and RM is unknown. Here we evaluate a unified functional brain circuit model of RRBs and test the hypothesis that CI and IS are associated with aberrant cognitive control circuit dynamics, whereas RM is associated with aberrant motor circuit dynamics. Using task-free fMRI data from 96 children, we first demonstrate that time-varying cross-network interactions in cognitive control circuit are significantly reduced and inflexible in children with ASD, and predict CI and IS symptoms, but not RM symptoms. Furthermore, we show that time-varying cross-network interactions in motor circuit are significantly greater in children with ASD, and predict RM symptoms, but not CI or IS symptoms. We confirmed these results using cross-validation analyses. Moreover, we show that brain-clinical symptom relations are not detected with time-averaged functional connectivity analysis. Our findings provide neurobiological support for the validity of RRB subtypes and identify dissociable brain circuit dynamics as a candidate biomarker for a key clinical feature of ASD.
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Affiliation(s)
- Kaustubh Supekar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Srikanth Ryali
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Percy Mistry
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Vinod Menon
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
- Stanford Neuroscience Institute, Stanford University, Stanford, CA, USA.
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8
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Uljarević M, Jo B, Frazier TW, Scahill L, Youngstrom EA, Hardan AY. Using the big data approach to clarify the structure of restricted and repetitive behaviors across the most commonly used autism spectrum disorder measures. Mol Autism 2021; 12:39. [PMID: 34044873 PMCID: PMC8162018 DOI: 10.1186/s13229-021-00419-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/26/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Restricted and repetitive behaviors (RRB) in autism spectrum disorder (ASD) encompass several distinct domains. However, commonly used general ASD measures provide broad RRB scores rather than assessing separate RRB domains. The main objective of the current investigation was to conduct a psychometric evaluation of the ability of the Social Responsiveness Scale (SRS-2), the Social Communication Questionnaire (SCQ), the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) to capture different RRB constructs. METHODS Exploratory Structural Equation Modeling (ESEM) was conducted using individual item-level data from the SRS-2, SCQ, ADI-R and the ADOS. Data were obtained from five existing publicly available databases. For the SRS-2, the final sample consisted of N = 16,761 individuals (Mage = 9.43, SD = 3.73; 18.5% female); for the SCQ, of N = 15,840 (Mage = 7.99, SD = 4.06; 18.1% female); for the ADI-R, of N = 8985 (Mage = 8.86, SD = 4.68; 19.4% female); and for the ADOS, of N = 6314 (Mage = 12.29, SD = 6.79; 17.7% female). RESULTS The three-factor structure provided the most optimal and interpretable fit to data for all measures (comparative fit index ≥ .983, Tucker Lewis index ≥ .966, root mean square error of approximation ≤ .028). Repetitive-motor behaviors, insistence on sameness and unusual or circumscribed interests factors emerged across all instruments. No acceptable fit was identified for the ADOS. LIMITATIONS The five datasets used here afforded a large as well as wide distribution of the RRB item scores. However, measures used for establishing convergent and divergent validity were only available for a portion of the sample. CONCLUSIONS Reported findings offer promise for capturing important RRB domains using general ASD measures and highlight the need for measurement development.
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Affiliation(s)
- Mirko Uljarević
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Thomas W. Frazier
- Department of Psychology, John Carroll University, University Heights, OH USA
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA USA
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Davie Hall, Chapel Hill, NC USA
| | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
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A Distinct Three-Factor Structure of Restricted and Repetitive Behaviors in an Epidemiologically Sound Sample of Preschool-Age Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 51:3456-3468. [PMID: 33387232 DOI: 10.1007/s10803-020-04776-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
Prior studies investigating restricted and repetitive behavior (RRB) subtypes within autism spectrum disorder (ASD) have found varied factor structures for symptom groupings, in part, due to variation in symptom measurement and broad sample age ranges. This study examined RRBs among 827 preschool-age children, ages 35 to 71 months, through an exploratory factor analysis of RRB items from the Autism Diagnostic Interview-Revised (ADI-R) collected through the Study to Explore Early Development. The factor structures of RRBs among children with confirmed ASD versus those with non-autism developmental concerns were qualitatively compared. Correlations between RRB factors and participant characteristics were examined in the ASD group. Three conceptually well-defined factors characterized as repetitive sensorimotor behaviors (RSMB), insistence on sameness (IS), and a novel stereotyped speech (SPEECH) factor emerged for the ASD group only. Distinct factors were supported by different clinical correlates. Findings have implications for improving differential diagnosis and understanding of ASD symptomatology in this age range.
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Jansen R, Maljaars J, Zink I, Steyaert J, Noens I. The complexity of early diagnostic decision making: A follow-up study of young children with language difficulties. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:2396941520984894. [PMID: 36381531 PMCID: PMC9620700 DOI: 10.1177/2396941520984894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background & aims Due to the complexity of early diagnostic decision making, we examined the predictive value of an early diagnostic classification and early abilities on later best estimate diagnosis for 22 clinically referred children with language difficulties. Methods and procedures Four years after initial evaluation (Time 1), the clinical files of these children were reviewed. A best-estimate (BE) diagnosis of language disorder (LD), intellectual disability (ID), or autism spectrum disorder (ASD) was established, with ASD being most common. Outcomes and results Early clinical classifications were relatively unstable or difficult to establish at a young age. The magnitude of children's cognitive and receptive language delay was a significant predictor of a later BE diagnosis of ID and LD respectively. A BE diagnosis of ASD, by contrast, could not be predicted from children's early social communication problems nor the presence of restricted and repetitive behaviors and interests. Conclusions Taken together, the results of this study suggest that language difficulties can be an early marker of a neurodevelopmental disorder which is often not identified at the age of first referral. Implications Eligibility for treatment should, therefore, be based on biopsychosocial case formulation rather than DSM or ICD diagnostic classification. What this paper adds? In this study a dimensional approach was used to characterize the abilities of young children referred with mild to profound receptive and/or expressive language difficulties. Later on, a categorical approach was adopted to establish best estimate diagnoses. Our clinical, broadly defined sample reflects the heterogeneous intake of young children referred for diagnostic assessment. Other studies on diagnostic stability often only focus on one diagnostic category (and are explicitly excluding children with specific other diagnoses), not taking into account the difficulties of early differential diagnostic decision making and stability across different categories over time. Investigations of differential diagnosis within a clinical group, instead of only differentiating children with a specific diagnosis from typically developing children, may be more informative for clinicians.
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Affiliation(s)
- Rianne Jansen
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Jarymke Maljaars
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Inge Zink
- Department of Neurosciences, ExpORL, KU Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Belgium
| | - Jean Steyaert
- Department of Neurosciences, Developmental Psychiatry, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
| | - Ilse Noens
- Parenting and Special Education Research Unit, KU Leuven, Belgium; Leuven Autism Research (LAuRes), KU Leuven, Belgium
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Bury SM, Hedley D, Uljarević M, Gal E. The autism advantage at work: A critical and systematic review of current evidence. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 105:103750. [PMID: 32810716 DOI: 10.1016/j.ridd.2020.103750] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/28/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite difficulties entering the workforce, people on the autism spectrum are often successful. Furthermore, they are suggested to bring unique abilities (e.g., attention to detail, tolerance for repetitive tasks) related to the repetitive and restrictive behaviours and interests (RRBI) diagnostic domain, that may be advantageous in employment. AIMS This critical and systematic review examined evidence supporting the superior workplace performance of employees on the autism spectrum, particularly regarding the RRBI domain. METHOD AND PROCEDURES A systematic review (PRISMA guidelines) evaluated empirical peer-reviewed studies that assess employees on the autism spectrum's performance in the workplace or on work-specific tasks. Nine databases were searched, with additional papers identified from reference lists and consultation. OUTCOMES AND RESULTS Two quantitative and four qualitative papers met criteria. Results reflect themes; attention to detail, tolerance of repetitive tasks, special/circumscribed interests, other RRBI related advantages/concerns. CONCLUSIONS AND IMPLICATIONS Due to the nature and quality of the identified studies there is currently no strong evidence supporting or negating a workplace autism advantage. This review highlights the need for more research and urges constraint in utilising stereotypes that may not apply to all on the autism spectrum, arguing an individual differences approach to supporting autism strengths at work.
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Affiliation(s)
- Simon M Bury
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, VIC, Australia.
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, VIC, Australia
| | - Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, USA; University of Melbourne, VIC, Australia
| | - Eynat Gal
- University of Haifa, Department of Occupational Therapy, Haifa, Israel
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12
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Uljarević M, Cooper MN, Bebbington K, Glasson EJ, Maybery MT, Varcin K, Alvares GA, Wray J, Leekam SR, Whitehouse AJO. Deconstructing the repetitive behaviour phenotype in autism spectrum disorder through a large population-based analysis. J Child Psychol Psychiatry 2020; 61:1030-1042. [PMID: 32037582 DOI: 10.1111/jcpp.13203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Restricted and repetitive pattern of behaviours and interests (RRB) are a cardinal feature of autism spectrum disorder (ASD), but there remains uncertainty about how these diverse behaviours vary according to individual characteristics. This study provided the largest exploration to date of the relationship between Repetitive Motor Behaviours, Rigidity/Insistence on Sameness and Circumscribed Interests with other individual characteristics in newly diagnosed individuals with ASD. METHOD Participants (N = 3,647; 17.7% females; Mage = 6.6 years [SD = 4.7]) were part of the Western Australian (WA) Register for ASD, an independent, prospective collection of demographic and diagnostic data of newly diagnosed cases of ASD in WA. Diagnosticians rated each of the DSM-IV-TR criteria on a 4-point Likert severity scale, and here we focused on the Repetitive Motor Behaviours, Insistence on Sameness and Circumscribed Interests symptoms. RESULTS The associations between RRB domains, indexed by Kendall's Tau, were weak, ranging from non-significant for both Circumscribed Interests and Repetitive Motor Behaviours to significant (.20) for Insistence on Sameness and Repetitive Motor Behaviours. Older age at diagnosis was significantly associated with lower Circumscribed Interests and significantly associated with higher Insistence on Sameness and Repetitive Motor Behaviours. Male sex was significantly associated with higher Repetitive Motor Behaviours but not Insistence on Sameness or Circumscribed Interests. CONCLUSIONS The pattern of associations identified in this study provides suggestive evidence for the distinctiveness of Repetitive Motor Behaviours, Insistence on Sameness and Circumscribed Interests, highlighting the potential utility of RRB domains for stratifying the larger ASD population into smaller, more phenotypically homogeneous subgroups that can help to facilitate efforts to understand diverse ASD aetiology and inform design of future interventions.
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Affiliation(s)
- Mirko Uljarević
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry and Behavioural Sciences, School of Medicine, Stanford Autism Center, Stanford University, Stanford, CA, USA
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Keely Bebbington
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Murray T Maybery
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Kandice Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Gail A Alvares
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - John Wray
- Child Development Service, WA Department of Health, Perth, WA, Australia
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
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13
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The relation between normative rituals/routines and obsessive-compulsive symptoms at a young age: A systematic review. DEVELOPMENTAL REVIEW 2020. [DOI: 10.1016/j.dr.2020.100913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Barrett SL, Uljarević M, Jones CRG, Leekam SR. Assessing subtypes of restricted and repetitive behaviour using the Adult Repetitive Behaviour Questionnaire-2 in autistic adults. Mol Autism 2018; 9:58. [PMID: 30505424 PMCID: PMC6258483 DOI: 10.1186/s13229-018-0242-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/07/2018] [Indexed: 02/03/2023] Open
Abstract
Background The majority of previous research into restricted and repetitive behaviours (RRBs) has focussed on children, partly due to a lack of suitable measures for RRBs in adults. This study aimed to explore the psychometric properties of the Adult Repetitive Behaviour Questionnaire-2 (RBQ-2A) in a large sample of autistic adults using a self-report questionnaire method. Methods The RBQ-2A and Autism-Spectrum Quotient (AQ) were administered online. Data from 275 autistic adults aged 18-66 (M = 36.56, SD = 12.24; 100 men and 171 women) were analysed using polychoric principal components analysis (PCA). Reliability and validity were assessed using Cronbach's alpha and correlation analyses. Results PCA resulted in two components of the RBQ-2A, interpretable as repetitive sensory and motor behaviours (RSMB) and insistence on sameness (IS). Both components showed acceptable internal consistency (α = .70 and .81 respectively) and were significantly moderately correlated with scores on the AQ (r s = .25 and .42). Participants' scores on IS were higher than their scores on RSMB. RSMB, but not IS, was negatively associated with age, particularly in older adults (≥ 50 years). There were no gender differences. Conclusions The RBQ-2A is a reliable and valid self-report measure of RRBs in the present sample of autistic adults. As one of the few measures of RRBs aimed at adults, it is suitable for adults with the ability to read and complete a self-report questionnaire. Results build on previous work with children using the Repetitive Behaviour Questionnaire-2 (RBQ-2).
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Affiliation(s)
- Sarah L Barrett
- 1Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Mirko Uljarević
- 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California USA
| | - Catherine R G Jones
- 1Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Susan R Leekam
- 1Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
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Restricted and Repetitive Behaviors in Autism Spectrum Disorder: a Review of Associated Features and Presentation Across Clinical Populations. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0139-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Schertz HH, Odom SL, Baggett KM, Sideris JH. Parent-Reported Repetitive Behavior in Toddlers on the Autism Spectrum. J Autism Dev Disord 2017; 46:3308-16. [PMID: 27460002 DOI: 10.1007/s10803-016-2870-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Toddlers with autism spectrum disorder (ASD) were assessed on the Repetitive Behavior Scale-Revised (RBS-R), which we found to have acceptable internal consistency. Stereotypical subscale scores showed a negligible association with cognitive level, but correlated more strongly with adaptive and social indicators. Relative to earlier reported RBS-R scores for older age groups, toddlers' scores trended toward higher stereotyped behavior and lower ritualistic/sameness behavior. Our findings on associations with developmental indicators align with those of researchers who used more resource-intensive repetitive behavior measures. The convergence of these findings with those derived from other measurement methods suggests that the RBS-R, a cost effective parent-report measure, is a viable means of assessing repetitive behavior in toddlers with autism.
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Affiliation(s)
- Hannah H Schertz
- Department of Curriculum and Instruction, Indiana University School of Education, 201 N Rose Ave., Bloomington, IN, 47405, USA.
| | - Samuel L Odom
- Frank Porter Graham Child Development Institute, University of North Carolina, 105 Smith Level Road, Chapel Hill, NC, 27599, USA
| | - Kathleen M Baggett
- Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave., Kansas, KS, 66101, USA
| | - John H Sideris
- Frank Porter Graham Child Development Institute, University of North Carolina, 105 Smith Level Road, Chapel Hill, NC, 27599, USA
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Repetitive Behaviours and Restricted Interests in Individuals with Down Syndrome-One Way of Managing Their World? Brain Sci 2017; 7:brainsci7060066. [PMID: 28617347 PMCID: PMC5483639 DOI: 10.3390/brainsci7060066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 01/11/2023] Open
Abstract
This paper argues that the repetitive behaviour and restrictive interests (RBRI) displayed by individuals with Down syndrome have mostly positive functions. However, as research has developed from interests in Obsessional Compulsive Disorder or Autistic Spectrum Disorder, unfortunately a view has arisen that RBRI in individuals with Down syndrome are also likely to be pathological. This is particularly the case in adults. The paper reviews: (a) measures employed and the perspectives that have been used; (b) the development in typically developing individuals, those with Down syndrome, and those with other conditions associated with intellectual disability; (c) positive and possible negative effects of RBRI; and (d) the need for more research. The conclusion is that, for their level of development, RBRI are helpful for most individuals with Down syndrome.
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Harrop C, Gulsrud A, Shih W, Hovsepyan L, Kasari C. The impact of caregiver-mediated JASPER on child restricted and repetitive behaviors and caregiver responses. Autism Res 2017; 10:983-992. [PMID: 27910235 PMCID: PMC11385810 DOI: 10.1002/aur.1732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/07/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Abstract
Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorder (ASD). Compared to the social-communication impairments, we know considerably less about why children engage in RRBs and if and how to intervene with these behaviors. As a result, early intervention has typically focused on social-communication. In this study, we were interested in understanding how child RRBs changed following an intervention targeting social-communication behaviors and if caregiver training changed how they responded to their child's RRBs. Eighty-six toddlers with ASD and their caregivers received one of two interventions: caregivers were either actively coached while playing with their child (JASPER) or attended information sessions about ASD. On three different occasions (when they entered the study, following 10 weeks of intervention and 6-months after) caregivers were filmed playing with their child. From these recordings, we coded child RRBs and caregiver responses to these behaviors. Child RRBs remained relatively stable following intervention in both groups, but increased when the children returned at 6-months. Caregivers who received one-on-one coaching (JASPER) responded to a greater number of their child's RRBs and their responses were rated as more successful. Our study showed that a short-term social-communication intervention delivered through caregivers had "spillover effects" on how they also responded to their child's RRBs. Interventions targeting social-communication behaviors should also examine how these treatments affect child RRBs and how caregiver responses to these behaviors may change following training. Autism Res 2017, 10: 983-992. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Clare Harrop
- Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda Gulsrud
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
| | - Wendy Shih
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
| | - Lilit Hovsepyan
- School of Behavioral Health - Psychology, Loma Linda University, Loma Linda, California
| | - Connie Kasari
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
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Zachor DA, Vardi S, Baron-Eitan S, Brodai-Meir I, Ginossar N, Ben-Itzchak E. The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: a controlled study. Dev Med Child Neurol 2017; 59:550-556. [PMID: 27911014 DOI: 10.1111/dmcn.13337] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
Abstract
AIM Outdoor adventure programmes aim to improve interpersonal relationships using adventurous activities. The current study examined the effectiveness of an outdoor adventure programme in children with autism spectrum disorders (ASD). METHOD The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Only the intervention group (n=30) participated in the outdoor adventure programme for 13 weeks, completing challenging physical activities that required cooperation and communication with peers and instructors. The control group (n=21) was not significantly different from the research group in age, sex, cognitive, and adaptive behaviour measures. RESULTS Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms subdomains of the Social Responsiveness Scale. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite (p<0.010). INTERPRETATION The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD. Future studies should examine the outcome of outdoor adventure programmes delivered for longer periods of time and maintenance of the achievements over time.
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Affiliation(s)
- Ditza A Zachor
- Department of Pediatrics, The Autism Center, Assaf Harofeh Medical Center, The Sackler School of Medicine, Tel Aviv University, Zerifin, Israel
| | - Shira Vardi
- Department of Human Services, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Shani Baron-Eitan
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Inbal Brodai-Meir
- The Israeli National Association for Children with Autism (ALUT), Givataim, Israel
| | - Noa Ginossar
- The Israeli National Association for Children with Autism (ALUT), Givataim, Israel
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20
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Restricted and Repetitive Behaviors as Predictors of Outcome in Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:1282-96. [PMID: 26676629 DOI: 10.1007/s10803-015-2668-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Questions have been raised about the significance of restricted and repetitive behaviors (RRBs) in predicting outcomes of children with Autism Spectrum Disorders (ASDs). Previous studies have yielded mixed findings, but some suggest that the presence of RRBs during preschool years is a negative prognostic indicator for later childhood. This study examined the effect of RRBs at ages 1-2 and 3-5 years on cognitive functioning, adaptive abilities, and ASD symptomatology at age 8-10 years in 40 children with ASDs. At 1-2 years, RRBs did not predict later functioning. However, at 3-5 years, more severe preoccupations with parts of objects, sensory interests, and stereotyped motor movements predicted less developed cognitive and adaptive skills, and greater ASD symptom severity at age 8-10 years.
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How Are Child Restricted and Repetitive Behaviors Associated with Caregiver Stress Over Time? A Parallel Process Multilevel Growth Model. J Autism Dev Disord 2016; 46:1773-83. [PMID: 26801776 DOI: 10.1007/s10803-016-2707-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The impact of raising a child with autism spectrum disorder (ASD) is frequently accompanied by elevated caregiver stress. Examining the variables that predict these elevated rates will help us understand how caregiver stress is impacted by and impacts child behaviors. This study explored how restricted and repetitive behaviors (RRBs) contributed concurrently and longitudinally to caregiver stress in a large sample of preschoolers with ASD using parallel process multilevel growth models. Results indicated that initial rates of and change in RRBs predicted fluctuations in caregiver stress over time. When caregivers reported increased child RRBs, this was mirrored by increases in caregiver stress. Our data support the importance of targeted treatments for RRBs as change in this domain may lead to improvements in caregiver wellbeing.
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22
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Barrett SL, Uljarević M, Baker EK, Richdale AL, Jones CRG, Leekam SR. The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A): A Self-Report Measure of Restricted and Repetitive Behaviours. J Autism Dev Disord 2015; 45:3680-92. [PMID: 26155763 PMCID: PMC4608982 DOI: 10.1007/s10803-015-2514-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In two studies we developed and tested a new self-report measure of restricted and repetitive behaviours (RRB) suitable for adults. In Study 1, The Repetitive Behaviours Questionnaire-2 for adults (RBQ-2A) was completed by a sample of 163 neurotypical adults. Principal components analysis revealed two components: Repetitive Motor Behaviours and Insistence on Sameness. In Study 2, the mean RBQ-2A scores of a group of adults with autism spectrum disorder (ASD; N = 29) were compared to an adult neurotypical group (N = 37). The ASD sample had significantly higher total and subscale scores. These results indicate that the RBQ-2A has utility as a self-report questionnaire measure of RRBs suitable for adults, with potential clinical application.
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Affiliation(s)
- Sarah L Barrett
- Wales Autism Research Centre, School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff, CF10 3AT, UK.
| | - Mirko Uljarević
- Olga Tennison Autism Research Centre, Cooperative Research Centre for Living with Autism Spectrum Disorders (Autism CRC), School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Australia
| | - Emma K Baker
- Olga Tennsion Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Amanda L Richdale
- Olga Tennsion Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Catherine R G Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff, CF10 3AT, UK
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Tower Building, Park Place, Cardiff, CF10 3AT, UK
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23
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McConachie H, Parr JR, Glod M, Hanratty J, Livingstone N, Oono IP, Robalino S, Baird G, Beresford B, Charman T, Garland D, Green J, Gringras P, Jones G, Law J, Le Couteur AS, Macdonald G, McColl EM, Morris C, Rodgers J, Simonoff E, Terwee CB, Williams K. Systematic review of tools to measure outcomes for young children with autism spectrum disorder. Health Technol Assess 2015; 19:1-506. [PMID: 26065374 PMCID: PMC4781156 DOI: 10.3310/hta19410] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact. OBJECTIVES To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. METHODS The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. RESULTS The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). CONCLUSIONS This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. FUTURE WORK Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002223. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Magdalena Glod
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hanratty
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Inalegwu P Oono
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Baird
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deborah Garland
- National Autistic Society North East Autism Resource Centre, Newcastle upon Tyne, UK
| | - Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Paul Gringras
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Glenys Jones
- School of Education, University of Birmingham, Birmingham, UK
| | - James Law
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann S Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Elaine M McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- PenCRU, Child Health Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jacqueline Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrina Williams
- University of Melbourne, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
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Harrop C, McConachie H, Emsley R, Leadbitter K, Green J. Restricted and repetitive behaviors in autism spectrum disorders and typical development: cross-sectional and longitudinal comparisons. J Autism Dev Disord 2014; 44:1207-19. [PMID: 24234675 DOI: 10.1007/s10803-013-1986-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Restricted and repetitive behaviors (RRBs) are characteristic of autism spectrum disorders (ASD). However, compared to social and communicative impairments, less is known about their development, trajectory and etiology. This study explored RRBs in young children with ASD matched to typically developing (TD) children on non-verbal development. RRBs were coded from direct observation at three time points within 13 months of development. Children with ASD displayed higher frequency and greater diversity of RRBs at all time points, however RRBs were not unique to ASD and evident in the TD control group albeit at a reduced frequency. RRBs did not correlate with social and communicative impairments in the ASD group, suggesting dissociation between these domains.
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25
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Shuster J, Perry A, Bebko J, Toplak ME. Review of factor analytic studies examining symptoms of autism spectrum disorders. J Autism Dev Disord 2014; 44:90-110. [PMID: 23729334 DOI: 10.1007/s10803-013-1854-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Factor analytic studies have been conducted to examine the inter-relationships and degree of overlap among symptoms in Autism Spectrum Disorder (ASD). This paper reviewed 36 factor analytic studies that have examined ASD symptoms, using 13 different instruments. Studies were grouped into three categories: Studies with all DSM-IV symptoms, studies with a subset of DSM-IV symptoms, and studies with symptoms that were not specifically based on the DSM-IV. There was consistent support for a common social/communication domain that is distinct from a restricted and repetitive behaviours and interests domain. Implications for symptom conceptualization and diagnosis in ASD are discussed.
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Affiliation(s)
- Jill Shuster
- LaMarsh Centre for Child and Youth Research, York University, Toronto, Canada,
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Abstract
This study investigated cognitive control of social and nonsocial information in autism using functional magnetic resonance imaging. Individuals with autism spectrum disorders (ASDs) and a neurotypical control group completed an oddball target detection task where target stimuli were either faces or nonsocial objects previously shown to be related to circumscribed interests in autism. The ASD group demonstrated relatively increased activation to social targets in right insular cortex and in left superior frontal gyrus and relatively decreased activation to nonsocial targets related to circumscribed interests in multiple frontostriatal brain regions. Findings suggest that frontostriatal recruitment during cognitive control in ASD is contingent on stimulus type, with increased activation for social stimuli and decreased activation for nonsocial stimuli related to circumscribed interests.
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Changes in the development of striatum are involved in repetitive behavior in autism. Biol Psychiatry 2014; 76:405-11. [PMID: 24090791 DOI: 10.1016/j.biopsych.2013.08.013] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive behavior is a core feature of autism and has been linked to differences in striatum. In addition, the brain changes associated with autism appear to vary with age. However, most studies investigating striatal differences in autism are cross-sectional, limiting inferences on development. In this study, we set out to 1) investigate striatal development in autism, using a longitudinal design; and 2) examine the relationship between striatal development and repetitive behavior. METHODS We acquired longitudinal structural magnetic resonance imaging scans from 86 individuals (49 children with autism, 37 matched control subjects). Each individual was scanned twice, with a mean scan interval time of 2.4 years. Mean age was 9.9 years at time 1 and 12.3 years at time 2. Striatal structures were traced manually with high reliability. Multivariate analyses of variance were used to investigate differences in brain development between diagnostic groups. To examine the relationship with behavior, correlations between changes in brain volumes and clinical measures were calculated. RESULTS Our results showed an increase in the growth rate of striatal structures for individuals with autism compared with control subjects. The effect was specific to caudate nucleus, where growth rate was doubled. Second, faster striatal growth was correlated with more severe repetitive behavior (insistence on sameness) at the preschool age. CONCLUSIONS This longitudinal study of brain development in autism confirms the involvement of striatum in repetitive behavior. Furthermore, it underscores the significance of brain development in autism, as the severity of repetitive behavior was related to striatal growth, rather than volume per se.
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Bishop SL, Hus V, Duncan A, Huerta M, Gotham K, Pickles A, Kreiger A, Buja A, Lund S, Lord C. Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. J Autism Dev Disord 2014; 43:1287-97. [PMID: 23065116 DOI: 10.1007/s10803-012-1671-0] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Somer L Bishop
- Center for Autism and the Developing Brain, Weill Cornell Medical College, Bard House, 21 Bloomingdale Road, White Plains, NY 10605, USA.
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Valla JM, Belmonte MK. Detail-oriented cognitive style and social communicative deficits, within and beyond the autism spectrum: Independent traits that grow into developmental interdependence. DEVELOPMENTAL REVIEW 2013. [DOI: 10.1016/j.dr.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Joseph L, Thurm A, Farmer C, Shumway S. Repetitive behavior and restricted interests in young children with autism: comparisons with controls and stability over 2 years. Autism Res 2013; 6:584-95. [PMID: 23868881 DOI: 10.1002/aur.1316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/17/2013] [Indexed: 11/11/2022]
Abstract
Restricted, repetitive and stereotyped patterns of behavior, interests and activities [RRBs] are among the core symptoms of autism spectrum disorders (ASD). Previous studies have indicated that RRBs differentiate ASD from other developmental disorders and from typical development. This study examined the presentation of RRBs as reported on the Repetitive Behavior Scale-Revised, a caregiver report, in children with ASD [separated into autism and Pervasive Developmental Disorder-Not Otherwise Specified groups] compared with children with nonspectrum developmental delays or typical development. We examined the role of age, cognitive functioning, sex and social communication impairment as they relate to RRBs. The stability of RRBs in children with autism was also examined over the course of 2 years. Results of the study confirmed that the amount and type of RRBs differs by diagnosis. Age, cognitive functioning, sex and social-communication impairment were not significant correlates. Among children with autism, RRBs remained stable over time.
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Affiliation(s)
- Lisa Joseph
- Pediatrics and Developmental Neuroscience Branch, National Institute of Health, Bethesda, Maryland, USA
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31
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Zachor DA, Ben-Itzchak E. The Relationship Between Clinical Presentation and Unusual Sensory Interests in Autism Spectrum Disorders: A Preliminary Investigation. J Autism Dev Disord 2013; 44:229-235. [PMID: 23797714 DOI: 10.1007/s10803-013-1867-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Unusual responses to sensory stimuli have been described in autism spectrum disorder (ASD).The study examined the frequencies of 'unusual sensory interests' and 'negative sensory responses' and their relation to functioning in a large ASD population (n = 679). Having 'unusual sensory interests' was reported in 70.4 % and 'negative sensory responses' in 66.0 % of the ASD group. Having 'unusual sensory interests' was associated with more severe reported and observed autism symptoms, lower cognitive ability and lower adaptive skills. In contrast, having 'negative sensory responses' was only associated with more severe reported stereotyped behaviors. It is suggested that having 'unusual sensory interests' is a part of a primary more severe type of ASD involving numerous developmental domains that might have a unique neurobiological origin.
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Affiliation(s)
- Ditza A Zachor
- Department of Pediatrics, The Autism Center, Assaf Harofeh Medical Center, 70300, Zerifin, Israel,
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32
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Goldman S, Greene PE. Stereotypies in autism: a video demonstration of their clinical variability. Front Integr Neurosci 2013; 6:121. [PMID: 23316144 PMCID: PMC3539667 DOI: 10.3389/fnint.2012.00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/09/2012] [Indexed: 11/13/2022] Open
Abstract
In autism, stereotypies are frequent and disabling, and whether they correspond to a hyperkinetic movement disorder, a homeostatic response aiming at sensory modulation, or a regulator of arousal remains to be established. So far, it has been challenging to distinguish among these different possibilities, not only because of lack of objective and quantitative means to assess stereotypies, but in our opinion also because of the underappreciated diversity of their clinical presentations. Herein, we illustrate the broad spectrum of stereotypies and demonstrate the usefulness of video-assisted clinical observations of children with autism. The clips presented were extracted from play sessions of 129 children with autism disorder. We conclude that compared to widely used questionnaires and interviews, systematic video observations provide a unique means to classify and score precisely the clinical features of stereotypies. We believe this approach will prove useful to both clinicians and researchers as it offers the level of detail from retrievable images necessary to begin to assess effects of age and treatments on stereotypies, and to embark on the type of investigations required to unravel the physiological basis of motor behaviors in autism.
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Affiliation(s)
- Sylvie Goldman
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine Bronx, NY, USA ; Department of Pediatrics, Albert Einstein College of Medicine Bronx, NY, USA ; Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine Bronx, NY, USA
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33
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Boyd BA, McDonough SG, Bodfish JW. Evidence-based behavioral interventions for repetitive behaviors in autism. J Autism Dev Disord 2012; 42:1236-48. [PMID: 21584849 PMCID: PMC3709868 DOI: 10.1007/s10803-011-1284-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat "lower order" RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for "higher order" behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research.
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Affiliation(s)
- Brian A Boyd
- Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, CB# 7122, Bondurant Hall, Chapel Hill, NC 27599-7120, USA.
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Autism Spectrum Disorders: Information for Pediatricians Supporting Families of Young Children on the Spectrum. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 724:51-60. [DOI: 10.1007/978-1-4614-0653-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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35
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Sofronoff K, Jahnel D, Sanders M. Stepping Stones Triple P seminars for parents of a child with a disability: a randomized controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2253-2262. [PMID: 21871779 DOI: 10.1016/j.ridd.2011.07.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 05/31/2023]
Abstract
Parents of children with a developmental disability require tailored parenting support, as their families have special needs and are at risk of increased burden. The aim of this study was to evaluate the efficacy of the Stepping Stones Triple P seminars, a brief group intervention for parents of a child with a disability. There were two seminars that presented parenting strategies to improve both child behavior and parenting variables implicated in the development and maintenance of child problem behavior. Fifty-three parents participated in this randomized controlled trial. Each had a child, aged two to ten, with a disability. The results indicated significant reductions in child behavior problems, the use of dysfunctional parenting styles, and parental conflict reported by parents in the intervention group compared to a waitlist group. The results were maintained at 3-month follow-up and there was evidence of a sleeper effect for parenting confidence. This study demonstrated that the seminars provide a promising intervention for parents of children with a disability. Limitations and implications for future research are also discussed.
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Affiliation(s)
- Kate Sofronoff
- School of Psychology, University of Queensland, St Lucia 4072, Australia.
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36
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Boyd BA, McDonough SG, Rupp B, Khan F, Bodfish JW. Effects of a family-implemented treatment on the repetitive behaviors of children with autism. J Autism Dev Disord 2011; 41:1330-41. [PMID: 21161576 PMCID: PMC3709848 DOI: 10.1007/s10803-010-1156-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The restricted and repetitive behaviors of children with autism can interfere with family functioning as well as learning and socialization opportunities for the child. To date, neither pharmacological nor comprehensive behavioral treatments have been found to be consistently effective at significantly reducing children's engagement in repetitive behaviors. We developed Family-Implemented Treatment for Behavioral Inflexibility (FITBI) to target the full variety of repetitive behaviors found in autism. For the current study, a therapist and parents of five children with autism (mean age = 48 months) co-implemented FITBI in a clinic setting over a 12-week treatment period. Using single case design methodology, significant reductions in repetitive behaviors were found for all participants and maintenance of treatment effects for 4 of 5 participants.
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Affiliation(s)
- Brian A Boyd
- Division of Occupational Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7120, USA.
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37
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Validating the Repetitive Behavior Scale-Revised in Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2010; 40:1521-30. [DOI: 10.1007/s10803-010-1012-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wilson CE, Palermo R, Schmalzl L, Brock J. Specificity of impaired facial identity recognition in children with suspected developmental prosopagnosia. Cogn Neuropsychol 2010; 27:30-45. [DOI: 10.1080/02643294.2010.490207] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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39
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Mooney EL, Gray KM, Tonge BJ, Sweeney DJ, Taffe JR. Factor analytic study of repetitive behaviours in young children with Pervasive Developmental Disorders. J Autism Dev Disord 2009; 39:765-74. [PMID: 19148740 DOI: 10.1007/s10803-008-0680-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 12/10/2008] [Indexed: 11/28/2022]
Abstract
The aim of the current study was to investigate the manifestation of repetitive behaviour profiles in young children with a Pervasive Developmental Disorder. The sample consisted of 137 developmentally delayed children with a DSM-IV-TR Pervasive Developmental Disorder (PDD) and 61 developmentally delayed children without a PDD. An exploratory factor analytic investigation using 12 ADI-R repetitive behaviour items from parent report of children with a PDD reported the emergence of two factors. The first factor consisted of higher-level, "insistence on sameness" behaviours, and the second of lower-level, repetitive "sensory-motor" behaviours. This factor structure was also applicable to a more general group of young children with developmental delay, regardless of their diagnosis. Correlational analyses highlighted contrasting relationships between developmental variables and the different repetitive behaviour factors. These relationships were different for children with a PDD and those without a PDD. The findings have potential implications for the early assessment and diagnosis of PDDs in young children.
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Affiliation(s)
- Erin L Mooney
- Centre for Developmental Psychiatry and Psychology, School of Psychology, Psychiatry & Psychological Medicine, Monash University, VIC, Australia.
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40
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Watt N, Wetherby AM, Barber A, Morgan L. Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. J Autism Dev Disord 2008; 38:1518-33. [PMID: 18266099 PMCID: PMC2637365 DOI: 10.1007/s10803-007-0532-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 12/26/2007] [Indexed: 10/22/2022]
Abstract
This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.
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Affiliation(s)
- Nola Watt
- Discipline of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, 1 Jan Smuts Avenue, Private Bag 3, WITS, Johannesburg, Gauteng, 2050, South Africa.
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41
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Le Couteur A, Haden G, Hammal D, McConachie H. Diagnosing autism spectrum disorders in pre-school children using two standardised assessment instruments: the ADI-R and the ADOS. J Autism Dev Disord 2007; 38:362-72. [PMID: 17605097 DOI: 10.1007/s10803-007-0403-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 05/24/2007] [Indexed: 02/04/2023]
Abstract
The reliable diagnosis of Autism/Autism Spectrum Disorder in pre-school children is important for access to early intervention and for accurate ascertainment for research. This paper explores the combined use of two standardised assessment instruments--the Autism Diagnostic Interview Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS)--in a large sample of pre-school children. The children were recruited to research studies, and a 'best estimate' clinical diagnosis reached. The findings show good agreement between the instruments especially for children with core Autism. The instruments appear to have a complementary effect in aiding diagnosis and confirm the importance of a multidisciplinary assessment process with access to information from different sources and settings. The presence of repetitive behaviours during the ADOS appeared of diagnostic significance.
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Affiliation(s)
- Ann Le Couteur
- School of Clinical Medical Sciences, Child Health, University of Newcastle, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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