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Frisch M, Coulter KL, Thomas RP, Barton ML, Robins DL, Fein DA. Categorizing and identifying preferred interests in autistic toddlers. Autism Res 2024; 17:1487-1500. [PMID: 38770793 DOI: 10.1002/aur.3169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Preferred interests are characteristic of autism spectrum disorder and are reported by parents starting at an early age. However, limited research has explored the presentation of preferred interests in toddlerhood. Previous literature suggests that both the intensity and type of preferred interests held by autistic individuals differ from those held by peers with developmental delay and no diagnosis and that autistic interests are more unusual in nature. While preferred interests are seen in typical child development, previous research suggests that the presence of preferred interests in children with no diagnosis declines with age. Literature also indicates that the sex and cognitive ability of autistic children influences preferred interests. Identification of early preferred interests commonly held by autistic toddlers could serve as a useful clinical indicator of future diagnosis. This article explored whether diagnostic group, age, sex, and cognitive ability predict the likelihood that parents reported preferred interests in children aged 12-36 months with diagnoses of autism, developmental delay, and those with no diagnosis. Additionally, we explored potential diagnostic group differences in interest type. Results suggest that diagnostic group, but not age, sex, or cognitive ability, predicts the likelihood that parents report preferred interests. No differences in the type of interests among diagnostic groups were identified. These results support the use of preferred interests as an early sign of autism but suggest that interest type may not be a helpful clinical indicator of autism in toddlerhood.
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Affiliation(s)
- MaryKate Frisch
- Department of Psychological Science, University of Connecticut, Storrs, Connecticut, USA
| | - Kirsty L Coulter
- Department of Psychological Science, University of Connecticut, Storrs, Connecticut, USA
| | - Rebecca P Thomas
- Department of Psychological Science, University of Connecticut, Storrs, Connecticut, USA
| | - Marianne L Barton
- Department of Psychological Science, University of Connecticut, Storrs, Connecticut, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Storrs, Connecticut, USA
| | - Deborah A Fein
- Department of Psychological Science, University of Connecticut, Storrs, Connecticut, USA
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2
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Patti MA, Croen LA, Dickerson AS, Joseph RM, Ames JL, Ladd-Acosta C, Ozonoff S, Schmidt RJ, Volk HE, Hipwell AE, Magee KE, Karagas M, McEvoy C, Landa R, Elliott MR, Mitchell DK, D'Sa V, Deoni S, Pievsky M, Wu PC, Barry F, Stanford JB, Bilder DA, Trasande L, Bush NR, Lyall K. Reproducibility between preschool and school-age Social Responsiveness Scale forms in the Environmental influences on Child Health Outcomes program. Autism Res 2024; 17:1187-1204. [PMID: 38794898 PMCID: PMC11186723 DOI: 10.1002/aur.3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/12/2024] [Indexed: 05/26/2024]
Abstract
Evidence suggests core autism trait consistency in older children, but development of these traits is variable in early childhood. The Social Responsiveness Scale (SRS) measures autism-related traits and broader autism phenotype, with two age-dependent forms in childhood (preschool, 2.5-4.5 years; school age, 4-18 years). Score consistency has been observed within forms, though reliability across forms has not been evaluated. Using data from the Environmental Influences on Child Health Outcomes (ECHO) program (n = 853), preschool, and school-age SRS scores were collected via maternal report when children were an average of 3.0 and 5.8 years, respectively. We compared reproducibility of SRS total scores (T-scores) and agreement above a clinically meaningful cutoff (T-scores ≥ 60) and examined predictors of discordance in cutoff scores across forms. Participant scores across forms were similar (mean difference: 3.3 points; standard deviation: 7), though preschool scores were on average lower than school-age scores. Most children (88%) were classified below the cutoff on both forms, and overall concordance was high (92%). However, discordance was higher in cohorts following younger siblings of autistic children (16%). Proportions of children with an autism diagnoses were also higher among those with discordant scores (27%) than among those with concordant scores (4%). Our findings indicate SRS scores are broadly reproducible across preschool and school-age forms, particularly for capturing broader, nonclinical traits, but also suggest that greater variability of autism-related traits in preschool-age children may reduce reliability with later school-age scores for those in the clinical range.
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Grants
- UH3OD023285 NIH ECHO Program, funded by the office of the Director, NIH
- UG3 OD023342 NIH HHS
- UH3OD023288 NIH ECHO Program, funded by the office of the Director, NIH
- U24OD023319 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023244 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023313 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023305 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023275 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023328 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023342 NIH ECHO Program, funded by the office of the Director, NIH
- U2C OD023375 NIH HHS
- UH3OD023271 NIH ECHO Program, funded by the office of the Director, NIH
- U24OD023382 NIH ECHO Program, funded by the office of the Director, NIH
- UH3OD023249 NIH ECHO Program, funded by the office of the Director, NIH
- U2COD023375 NIH ECHO Program, funded by the office of the Director, NIH
- UH3 OD023342 NIH HHS
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Affiliation(s)
- Marisa A Patti
- AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis, Sacramento, California, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, MIND Institute, University of California Davis, Sacramento, California, USA
| | - Heather E Volk
- Wendy Klag Center for Autism and Developmental Disabilities Research, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelsey E Magee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Cindy McEvoy
- Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Rebecca Landa
- Center for Autism Services, Science and Innovation, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael R Elliott
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Daphne Koinis Mitchell
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Viren D'Sa
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sean Deoni
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michelle Pievsky
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Pei-Chi Wu
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fatoumata Barry
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deborah A Bilder
- Department of Psychiatry, University of Utah Huntsman Mental Health Institute, Salt Lake City, Utah, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Spackman E, Geng A, Smillie LD, Frazier TW, Hardan AY, Alvarez GA, Whitehouse A, Schuck RK, Leekam SR, Uljarević M. Characterising Insistence on Sameness and Circumscribed Interests: A Qualitative Study of Parent Perspectives. J Autism Dev Disord 2024:10.1007/s10803-024-06404-4. [PMID: 38809473 DOI: 10.1007/s10803-024-06404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Manifestations of insistence on sameness (IS) and circumscribed interests (CI) are complex, with individuals varying considerably, not only in the types of behaviours they express, but also in terms of a behaviour's frequency, intensity, trajectory, adaptive benefits, and impacts. However, current quantitative RRB instruments capture only certain aspects of these behaviours (e.g., mostly frequency or general "severity"). Thus, the current study utilised a semi-structured caregiver interview to provide an in-depth, qualitative characterization of different aspects of IS and CI presentation. Caregivers of 27 autistic children and adolescents displaying IS and/or CI behaviours (3-16 years; 18 males; 9 females) participated in a semi-structured interview. Responses were analysed using thematic framework analysis. Framework analysis identified nine different aspects of IS and CI presentation: (1) intensity, (2) frequency, (3) emergence of behaviour, (4) changes over time, (5) day-to-day fluctuations, (6) purpose/adaptive benefit, (7) experiences of distress, (8) challenges for the individual, their family, and their socialisation, and (9) management strategies and their effectiveness. Autistic children and adolescents were reported to vary greatly on each of these dimensions. Findings demonstrate the complexity of IS and CI presentations and highlight the need for more comprehensive quantitative assessments that independently assess the frequency, intensity, and impact of behaviours. Further, findings reported here emphasize the need for ecologically valid measures that assess the contexts in which these behaviours occur and how their presentations can change within and across days.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA.
| | - Alicia Geng
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
| | - Luke D Smillie
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, OH, USA
| | - Antonio Y Hardan
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
| | | | | | | | - Sue R Leekam
- School of Psychology, Cardiff University, Cardiff, UK
| | - Mirko Uljarević
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
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Stoyell SM, Elison JT, Graupmann E, Miller NC, Emerick J, Ramey E, Sandness K, Schleiss MR, Osterholm EA. Neurobehavioral outcomes of neonatal asymptomatic congenital cytomegalovirus infection at 12-months. J Neurodev Disord 2024; 16:19. [PMID: 38637762 PMCID: PMC11025208 DOI: 10.1186/s11689-024-09533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) is the most common congenital viral infection in the United States. Symptomatic infections can cause severe hearing loss and neurological disability, although ~ 90% of cCMV infections are asymptomatic at birth. Despite its prevalence, the long-term neurobehavioral risks of asymptomatic cCMV infections are not fully understood. The objective of this work was to evaluate for potential long-term neurobehavioral sequelae in infants with asymptomatic cCMV. METHODS Infants with cCMV were identified from a universal newborn cCMV screening study in a metropolitan area in the midwestern United States. Asymptomatic infants with cCMV were enrolled in a longitudinal neurodevelopmental study (N = 29). Age- and sex-matched healthy control infants (N = 193) were identified from the Baby Connectome Project (BCP), a longitudinal study of brain and behavioral development. The BCP sample supplemented an additional group of healthy control infants (N = 30), recruited from the same participant registry as the BCP specifically for comparison with infants with asymptomatic cCMV. Neurobehavioral assessments and parent questionnaires, including the Mullen Scales of Early Learning, the Repetitive Behavior Scales for Early Childhood (RBS-EC), and the Infant Toddler Social Emotional Assessment (ITSEA) were administered at 12 months of age. Neurobehavioral scores were compared between infants with asymptomatic cCMV and all identified healthy control infants. RESULTS Infants with asymptomatic cCMV performed equivalently compared to healthy control infants on the neurobehavioral measures tested at 12 months of age. CONCLUSIONS These results indicate that at 12 months of age, infants with asymptomatic cCMV are not statistically different from controls in a number of neurobehavioral domains. Although follow-up is ongoing, these observations provide reassurance about neurobehavioral outcomes for infants with asymptomatic cCMV and inform the ongoing discussion around universal screening. Additional follow-up will be necessary to understand the longer-term outcomes of these children.
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Affiliation(s)
- Sally M Stoyell
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA.
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Emily Graupmann
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Neely C Miller
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Jessica Emerick
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Ramey
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kristen Sandness
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Mark R Schleiss
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Erin A Osterholm
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
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Chung H, Wilkinson CL, Job Said A, Tager-Flusberg H, Nelson CA. Evaluating early EEG correlates of restricted and repetitive behaviors for toddlers with or without autism. RESEARCH SQUARE 2024:rs.3.rs-3871138. [PMID: 38313269 PMCID: PMC10836096 DOI: 10.21203/rs.3.rs-3871138/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background Restricted and repetitive behaviors (RRB) are among the primary characteristics of autism spectrum disorder (ASD). Despite the potential impact on later developmental outcomes, our understanding of the neural underpinnings of RRBs is limited. Alterations in EEG alpha activity have been observed in ASD and implicated in RRBs, however, developmental changes within the alpha band requires careful methodological considerations when studying its role in brain-behavior relationships during infancy and early childhood. Novel approaches now enable the parameterization of the power spectrum into periodic and aperiodic components. This study aimed to characterize the neural correlates of RRBs in infancy by (1) comparing infant resting-state measures (periodic alpha and aperiodic activity) between infants who develop ASD, elevated likelihood infants without ASD, and low likelihood infants without ASD, and (2) evaluate whether these infant EEG measures are associated with frequency of RRBs measured at 24 months. Methods Baseline non-task related EEG data were collected from 12-to-14-month-old infants with and without elevated likelihood of autism (N=160), and periodic alpha activity (periodic alpha power, individual peak alpha frequency and amplitude), and aperiodic activity measures (aperiodic exponent) were calculated. Parent-reported RRBs were obtained at 24 months using the Repetitive Behavior Scale-Revised questionnaire. Group differences in EEG measures were evaluated using ANCOVA, and multiple linear regressions were conducted to assess relationships between EEG and RRB measures. Results No group-level differences in infant EEG measures were observed. Marginal effects analysis of linear regressions revealed significant associations within the ASD group, such that higher periodic alpha power, lower peak alpha frequency, and lower aperiodic exponent, were associated with elevated RRBs at 24 months. No significant associations were observed for non-ASD outcome groups. Limitations The sample size for ASD (N=19) was modest for examining brain-behavior relations. Larger sample sizes are needed to increase statistical power. Conclusion For infants with later ASD diagnoses, measures of alpha and aperiodic activity measured at 1-year of age were associated with later manifestation of RRBs at 2-years. Longitudinal studies are needed to elucidate whether the early trajectory of these EEG measures and their dynamic relations in development influence manifestations of RRBs in ASD.
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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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Keating J, Van Goozen S, Uljarevic M, Hay D, Leekam SR. Restricted and repetitive behaviors and their developmental and demographic correlates in 4-8-year-old children: A transdiagnostic approach. Front Behav Neurosci 2023; 17:1085404. [PMID: 36935892 PMCID: PMC10014551 DOI: 10.3389/fnbeh.2023.1085404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Restricted and repetitive behaviors (RRBs) are a broad class of behaviors characterized by frequent action repetition and intense preference for sameness. Research has predominantly focused on RRBs in diagnosed clinical groups, particularly in autism spectrum disorder and genetic disorders. Using a transdiagnostic approach, the current study examined RRBs in a diverse sample of children in relation to developmental and demographic correlates (age, language, non-verbal ability, child anxiety, sex, and socioeconomic status). Separate analyses examined two RRB subtypes; repetitive sensory and motor behaviors (RSMB) and insistence on sameness (IS). Method: Children (N = 260, age 4-8 years, 174 male, 86 female) in mainstream schools identified by teachers as having behavioral, emotional, and/or cognitive difficulties, were assessed using the Repetitive Behavior Questionnaire-2 (RBQ-2), the British Picture Vocabulary Scale (BPVS), Lucid Ability Scale, the Welsh Index of Multiple Deprivation (WIMD) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Recruitment excluded diagnosed clinical conditions. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children's difficulties. Results: RRB scores were of high frequency and the scores for the IS were higher than for RSMB. The severity of anxiety symptoms and male sex were significantly associated with both RRB subtypes, and younger age and SES scores were associated with IS. Elevated RRB total and subtype scores were significantly related to SDQ scores for emotion, conduct, hyperactivity, and peer-relations. Discussion: The study provides the first evidence of RRBs in a diverse sample of young children with emerging difficulties in behavior, cognition, and/or emotion. The results contribute to proposals about psychological development in RRB and indicate that RRBs are best represented on a continuum of severity found across children in the early school years. The results support previous findings of a relation between RRB and anxiety reported in clinical samples and importantly, they indicate that it is time to move beyond the study of categorically defined groups and consider correlates of RRBs that include broad indices of mental health and well-being.
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Affiliation(s)
- Jennifer Keating
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Stephanie Van Goozen
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Mirko Uljarevic
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Dale Hay
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Susan R. Leekam
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
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Melo C, Ribeiro TP, Prior C, Gesta C, Martins V, Oliveira G, Temudo T. Motor stereotypies in autism spectrum disorder: Clinical randomized study and classification proposal. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:456-471. [PMID: 35762643 DOI: 10.1177/13623613221105479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Motor stereotypies are one of the most frequent features in children with a diagnosis of autism spectrum disorder. They may disrupt children's functioning and development and be a potential source of stress for families. Several factors, including sex, age, cognitive ability, and severity of autism spectrum disorder, may influence the presence and intensity of stereotypies. The present study aimed to identify the prevalence of motor stereotypies in a group of children with autism spectrum disorder. In addition, it sought to investigate whether sex, age, cognitive ability, verbal language, neurological comorbidities, and severity of autism spectrum disorder were associated with an increased probability and higher number, duration, and variability of stereotypies. A total of 134 participants aged 2.3-17.6 years underwent a clinical protocol with standardized video-recorded sessions. Stereotypies were identified and classified by two independent evaluators. The prevalence of stereotypies was 56.7%, and a total of 1198 motor stereotypies were captured. Children who were younger, nonverbal, and had higher severity of autism spectrum disorder had an increased probability of presenting stereotypies. Being nonverbal or having higher severity of autism spectrum disorder was also associated with presenting a higher number of stereotypies. Children with developmental delay, intellectual disability, or epilepsy displayed longer stereotypies, and children with developmental delay or intellectual disability additionally presented more diverse stereotypies. As part of the study, the authors present a clinical classification model, a glossary, and video samples of motor stereotypies. The findings of this study suggest that children who are younger, nonverbal, have lower cognitive ability, and have higher severity of autism spectrum disorder may have a higher burden of stereotypies. Earlier intervention and monitoring of these children have the potential to improve their long-term outcomes.
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Affiliation(s)
- Cláudia Melo
- Centro Hospitalar do São João, Portugal.,University of Porto, Portugal
| | - Tiago Pinto Ribeiro
- Centro Hospitalar Universitário do Porto, Portugal.,PIN-Progresso infantil, Portugal
| | | | - Camila Gesta
- Centro Hospitalar Universitário do Porto, Portugal
| | | | - Guiomar Oliveira
- Centro Hospitalar e Universitário de Coimbra, Portugal.,University of Coimbra, Portugal
| | - Teresa Temudo
- Centro Hospitalar Universitário do Porto, Portugal.,Instituto de Ciências Biomédicas de Abel Salazar, Portugal
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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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10
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Sadeghi S, Pouretemad HR. Executive functions predict restricted and repetitive behaviors in toddlers under 36 months old with autism spectrum disorder. Infant Behav Dev 2022; 67:101721. [DOI: 10.1016/j.infbeh.2022.101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
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11
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Tian J, Gao X, Yang L. Repetitive Restricted Behaviors in Autism Spectrum Disorder: From Mechanism to Development of Therapeutics. Front Neurosci 2022; 16:780407. [PMID: 35310097 PMCID: PMC8924045 DOI: 10.3389/fnins.2022.780407] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/09/2022] [Indexed: 01/28/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social communication, social interaction, and repetitive restricted behaviors (RRBs). It is usually detected in early childhood. RRBs are behavioral patterns characterized by repetition, inflexibility, invariance, inappropriateness, and frequent lack of obvious function or specific purpose. To date, the classification of RRBs is contentious. Understanding the potential mechanisms of RRBs in children with ASD, such as neural connectivity disorders and abnormal immune functions, will contribute to finding new therapeutic targets. Although behavioral intervention remains the most effective and safe strategy for RRBs treatment, some promising drugs and new treatment options (e.g., supplementary and cell therapy) have shown positive effects on RRBs in recent studies. In this review, we summarize the latest advances of RRBs from mechanistic to therapeutic approaches and propose potential future directions in research on RRBs.
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Affiliation(s)
| | | | - Li Yang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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Zhang A, Liu L, Chang S, Shi L, Li P, Shi J, Lu L, Bao Y, Liu J. Connectivity-Based Brain Network Supports Restricted and Repetitive Behaviors in Autism Spectrum Disorder Across Development. Front Psychiatry 2022; 13:874090. [PMID: 35401246 PMCID: PMC8989843 DOI: 10.3389/fpsyt.2022.874090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a lifelong condition. Autistic symptoms can persist into adulthood. Studies have reported that autistic symptoms generally improved in adulthood, especially restricted and repetitive behaviors and interests (RRBIs). We explored brain networks that are related to differences in RRBIs in individuals with ASDs among different ages. METHODS We enrolled 147 ASD patients from the Autism Brain Imaging Data Exchange II (ABIDEII) database. The participants were divided into four age groups: children (6-9 years old), younger adolescents (10-14 years old), older adolescents (15-19 years old), and adults (≥20 years old). RRBIs were evaluated using the Repetitive Behaviors Scale-Revised 6. We first explored differences in RRBIs between age groups using the Kruskal-Wallis test. Associations between improvements in RRBIs and age were analyzed using a general linear model. We then analyzed RRBIs associated functional connectivity (FC) links using the network-based statistic method by adjusting covariates. The association of the identified FC with age group, and mediation function of the FC on the association of age-group and RRBI were further analyzed. RESULTS Most subtypes of RRBIs improved with age, especially stereotyped behaviors, ritualistic behaviors, and restricted behaviors (p = 0.012, 0.014, and 0.012, respectively). Results showed that 12 FC links were closely related to overall RRBIs, 17 FC links were related to stereotyped behaviors. Among the identified 29 FC links, 15 were negatively related to age-groups. The mostly reported core brain regions included superior occipital gyrus, insula, rolandic operculum, angular, caudate, and cingulum. The decrease in FC between the left superior occipital lobe and right angular (effect = -0.125 and -0.693, respectively) and between the left insula and left caudate (effect = -0.116 and -0.664, respectively) might contribute to improvements in multiple RRBIs with age. CONCLUSION We identified improvements in RRBIs with age in ASD patients, especially stereotyped behaviors, ritualistic behaviors, and restricted behaviors. The decrease in FC between left superior occipital lobe and right angular and between left insula and left caudate might contribute to these improvements. Our findings improve our understanding of the pathogenesis of RRBIs and suggest potential intervention targets to improve prognosis in adulthood.
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Affiliation(s)
- Anyi Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Suhua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Peng Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.,Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing, China
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13
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Luo X, Xiong Y, Gu M, Huang L, Lu Z, Zhong X, Zou S. Reliability and validity of the repetitive behavior scale-revised for young Chinese children with autism spectrum disorder in Jiangxi Province. Front Pediatr 2022; 10:939841. [PMID: 36160810 PMCID: PMC9492994 DOI: 10.3389/fped.2022.939841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Restricted and repetitive behaviors (RRBs) are one of the two main diagnostic features of autism spectrum disorder (ASD). To date, a growing body of research on RRB in children with ASD has recently attracted academic attention. The Repetitive Behavior Scale-Revised (RBS-R) was primarily intended for use in evaluating RRBs observed in ASD. This study recruited 381 Chinese children with ASD aged 2-4 years to measure the reliability and validity of the RBS-R. Confirmatory factor analysis (CFA) was applied to the structuring models of the four proposed structural models, indicating that a 6-factor model demonstrated good internal consistency and the best fit based on common overall fit indices. These findings suggest the utility of the Chinese version of RBS-R.
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Affiliation(s)
- Xiu Luo
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yaoyao Xiong
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Mei Gu
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Liyun Huang
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Zhonghui Lu
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Xia Zhong
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Shipu Zou
- Department of Children Health, Jiangxi Provincial Children's Hospital, Nanchang, China
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14
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Burrows CA, Bodfish JW, Wolff JJ, Vollman EP, Altschuler MR, Botteron KN, Dager SR, Estes AM, Hazlett HC, Pruett JR, Schultz RT, Zwaigenbaum L, Piven J, Elison JT. Cataloguing and characterizing interests in typically developing toddlers and toddlers who develop ASD. Autism Res 2021; 14:1710-1723. [PMID: 34021722 PMCID: PMC8714188 DOI: 10.1002/aur.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
Abstract
Intense interests are common in children with and without autism spectrum disorder (ASD), and little research has characterized aspects of interests that are unique to or shared among children with and without ASD. We aimed to characterize interests in a sample of infants at high-familial-risk (HR) and low-familial-risk (LR) for ASD using a novel interview. Participants included HR siblings who were diagnosed with ASD at 24 months (HR-ASD, n = 56), HR siblings who did not receive an ASD diagnosis at 24 months (HR-Neg, n = 187), and a LR comparison group (n = 109). We developed and collected data with the Intense Interests Inventory at 18- and 24-months of age, a semi-structured interview that measures intensity and peculiarity of interests in toddlers and preschool-aged children. Intensity of interests differed by familial risk at 24 months, with HR-ASD and HR-Neg groups demonstrating equivalent intensity of interests that were higher than the LR group. By contrast, peculiarity of interest differed by ASD diagnosis, with the HR-ASD group showing more peculiar interests than the HR-Neg and LR groups at 24 months. At 18 months the HR-ASD group had more peculiar interests than the LR group, though no differences emerged in intensity of interests. This measure may be useful in identifying clinically-relevant features of interests in young children with ASD. We also replicated previous findings of males showing more intense interests at 18 months in our non-ASD sample. These results reveal new information about the nature of interests and preoccupations in the early autism phenotype. LAY SUMMARY: Intense interests are common in young children with autism and their family members. Intense interests are also prevalent among typically-developing children, and especially boys. Here we catalog interests and features of these interests in a large sample of toddlers enriched for autism risk. Children who had family members with autism had more intense interests, and those who developed autism themselves had more unusual interests at 24 months. These results highlight the importance of different aspects of interest in autism.
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Affiliation(s)
- Catherine A Burrows
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - James W Bodfish
- Department of Hearing & Speech Sciences, Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elayne P Vollman
- Department of Psychology and Comparative Human Development, University of Chicago, Chicago, Illinois, USA
| | - Melody R Altschuler
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kelly N Botteron
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Annette M Estes
- Center on Human Development and Disability, University of Washington, Seattle, Washington, USA
| | - Heather C Hazlett
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John R Pruett
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Robert T Schultz
- Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lonnie Zwaigenbaum
- Autism Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
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Coulter KL, Barton ML, Robins DL, Stone WL, Fein DA. DSM-5 symptom expression in toddlers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1653-1665. [PMID: 33779335 PMCID: PMC8324506 DOI: 10.1177/13623613211000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Children with autism show more social-communication symptoms and repetitive behaviors than children with typical development or those diagnosed with other developmental disorders; however, non-autistic children often show some behaviors that are associated with autism. We compared the behavioral reports from caregivers of children in these three groups to identify the behaviors that were specific to autism. Children with autism were found to show more of these behaviors, and behaviors that are particularly indicative of autism were identified. These behaviors included social symptoms (approaching others to interact, showing things, looking back while showing, responding to an approaching child, spontaneous imitation) and repetitive behavior symptoms (specific, inflexible play, unusual body movements, strong specific interest, carrying around an unusual object, sensory seeking, and sensory hyper-reactivity).These findings may aid professionals in determining the most appropriate diagnosis for a child between the ages of 12 and 36 months.
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