Adaptive and maladaptive correlates of repetitive behavior and restricted interests in persons with down syndrome and developmentally-matched typical children: a two-year longitudinal sequential design

Characterising repetitive behaviours in children and adolescents with Down syndrome

BACKGROUND

Individuals with intellectual disability, including people with Down syndrome (DS), often exhibit restricted and repetitive behaviours (RRBs). However, RRBs have not been deeply characterised in children and adolescents with DS.

METHOD

The study encompassed a cohort of 151 participants aged 4 to 18 years with DS. RRBs were assessed utilising the Repetitive Behaviour Scale-Revised. Additionally, data pertaining to cognitive and adaptive functioning, linguistic abilities, sleep patterns and emotional/behavioural issues were gathered.

RESULTS

Self-injurious behaviours were reported less frequently whereas parents most commonly endorsed items related to behaviours associated with the need for sameness and ritualistic behaviours. We observed very few gender differences, whereas some age-related differences emerged, with adolescents exhibiting higher scores in items related with higher-level RRBs. The analysis of the association between RRBs and clinical features revealed that RRBs were associated with parent-reported sleep difficulties, as well as with internalising and externalising problems. We also observed a negative correlation with IQ whereas associations with adaptive skills emerged mainly for lower-level RRBs, such as motor stereotypies. Finally, RRBs were negatively associated with linguistic abilities, both expressive and receptive.

CONCLUSIONS

RRBs in children and adolescents with DS are of significant clinical interest due to their associations with various clinical dimensions. Therefore, psychological and neuropsychiatric assessment should include an accurate evaluation of RRBs for young people with DS.

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

In this paper, we investigated the psychometric properties of the Child Communication Checklist-Revised (CCC-R) for the first time with an English-speaking sample. We used a confirmatory application of exploratory structural equation modeling (ESEM) to re-evaluate the CCC-R's psychometric properties. We found strong support for its use as an assessment for pragmatic and structural language. Our second main aim was to explore associations between pragmatic and structural language and restricted and repetitive behaviors (RRBs), two hallmark characteristics of autism. We used the CCC-R and Repetitive Behavior Questionnaire (RBQ-2) to investigate these associations in a diverse non-clinical sample of children, taking a transdiagnostic approach. We intentionally excluded autism and other neurodevelopmental diagnoses to test, (1) the CCC-R in a broad sample and (2) the association between pragmatic language and RRB in children not already selected for that association. The sample comprised two groups of children, one was community sampled (n = 123) and the other (n = 143) included children with non-specific behavioral, emotional and/or cognitive difficulties referred to an assessment unit by schools. We found clear associations between pragmatic language difficulties and RRBs in both groups. Regression analysis showed that pragmatic language was the only significant contributor to RRBs even after Grammatical-Semantic score, age, sex, and socioeconomic status were controlled. The pattern was the same for both recruitment groups. However, the effects were stronger for the school-referred group which also had more pragmatic difficulties, grammatical-semantic difficulties and RRBs. A robust link between pragmatic language and RRBs, established in autism, has continuity across the broader non-clinical population.

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

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.

Repetitive Behavior Scale for Early Childhood (RBS-EC): Psychometrics and Developmental Effects with a Community Sample

Restricted, repetitive behaviors and interests (RRBIs) occur commonly in young children in the course of typical development, but too frequent or persistent RRBIs have been linked to a variety of psychosocial and neurodevelopmental disorders. Unfortunately, a lack of psychometrically sound, feasible instruments stymies RRBI study and intervention in early childhood. Therefore, this study validated an extant RRBI measure (i.e., Repetitive Behavior Scale for Early Childhood; RBS-EC) for predominately neurotypical community children ages 2-7 years via an MTurk survey of 300 caregivers. Confirmatory factor analyses best supported a 4-factor model for the RBS-EC (i.e., repetitive motor, rituals and routines, restricted interests, self-directed behaviors). RBS-EC scores varied significantly with age and gender; namely, RRBIs were typically (1) less frequent but more problematic with older versus younger children and (2) more frequent and problematic with boys versus girls. Findings extend the RBS-EC's utility in RRBI assessment and treatment during early childhood.

Latent profiles of autism symptoms in children and adolescents with Down syndrome

BACKGROUND

Down syndrome (DS) is associated with elevated rates of autism spectrum disorder (ASD) and autism symptomatology. To better characterise heterogeneity in ASD symptomatology in DS, profiles of caregiver-reported ASD symptoms were modelled for children and adolescents with DS.

METHODS

Participants (n = 125) were recruited through several multi-site research studies on cognition and language in DS. Using the Social Responsiveness Scale-2 (SRS-2; Constantino and Gruber 2012), two latent profile analyses (LPA) were performed, one on the broad composite scores of social communication and interaction and restricted interests and repetitive behaviour, and a second on the four social dimensions of social communication, social motivation, social awareness, and social cognition.

RESULTS

A three-profile model was the best fit for both analyses, with each analysis yielding a low ASD symptom profile, an elevated or mixed ASD symptom profile and a high ASD symptom profile. Associations were observed between profile probability scores and IQ, the number of co-occurring biomedical conditions reported, sex, and SRS-2 form.

CONCLUSIONS

Characterising heterogeneity in ASD symptom profiles can inform more personalised supports in this population, and implications for potential therapeutic approaches for individuals with DS are discussed.

[Formula: see text] The role of distinct executive functions on adaptive behavior in children and adolescents with Down syndrome

Difficulties in executive function are a relatively well-characterized feature of the neuropsychological profile in Down syndrome (DS), yet the impact of these challenges on aspects of daily functioning remain poorly understood. We examined the role of specific executive functions on domains of adaptive behavior in children and adolescents with DS. Participants included 68 children and adolescents with DS between 6-17 years old (mean chronological age = 12.56 years; SD = 3.22) and their caregivers. Parent reported executive function skills were measured using the BRIEF-2 and adaptive behavior was measured using the Vineland Adaptive Behavior Scales-III. Results identified working memory as a significant predictor of Communication, Daily Living, and Socialization skills, and Shifting significantly predicted Daily Living and Socialization. Findings demonstrate the relation between executive functions and adaptive behavior and highlight the effects of working memory on aspects of daily functioning for individuals with DS.

Behavioral Inflexibility Across Two Neurogenetic Conditions: Down Syndrome and Fragile X Syndrome

Behavioral inflexibility (BI) has been highlighted to occur across genetic and neurodevelopmental disorders. This study characterized BI in two common neurogenetic conditions: Fragile X syndrome (FXS) and Down syndrome (DS). Caregivers of children with FXS (N = 56; with ASD = 28; FXS only = 28) and DS (N = 146) completed the Behavioral Inflexibility Scale (BIS) via an online survey. Total BIS scores were higher in FXS+ASD than both FXS only and DS (p <.001). Most endorsed items were similar across the three groups, but scores were higher in the FXS+ASD group. In all groups, BI associated with other clinical variables (receptive behaviors, anxiety, social communication). The current data suggest that BI is variable across neurogenetic conditions and higher in individuals with comorbid ASD.

Toward better characterization of restricted and repetitive behaviors in individuals with germline heterozygous PTEN mutations

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 (M_age  = 8.93 years, SD_age  = 4.75), 25 Macro-ASD (M_age  = 11.99 years; SD_age  = 5.15), and 23 PTEN-No ASD (M_age  = 8.94 years; SD_age  = 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.

The science of humanity and the humanity of science: Perspectives on Ed Zigler's contributions to developmental psychopathology and the study of all children

We present this article as a testament to Ed Zigler's commitment to science in the service of humanity and to policy based on conceptually compelling theory and methodologically rigorous science. In doing so, we highlight ways that Ed's universal and inclusive developmental world view, early training as a behaviorist, exacting scientific standards, concern for others, and appreciation of his own roots and upbringing all transformed the way that many different groups of people of all ages and backgrounds are studied, viewed, and intervened with by researchers, policy makers, and society at large. Ed's narrative of development rather than defect, universality rather than difference, and holistic rather than reductionist continues to compel us in the quest for a kinder, more inclusive, and enabling society. Conversely, Ed's behaviorist training as a graduate student also influenced him throughout his career and was essential to his career-long commitment to systemic action in the service of improving the lives of others. We cite the lessons that we, as his descendants, learned from Ed and apply them to our own areas of research with populations that Ed did not study, but had considerable interest in - persons with autism spectrum disorder and Indigenous youth.

Systematic Review of Recent Pediatric Down Syndrome Neuropsychology Literature: Considerations for Regression Assessment and Monitoring

OBJECTIVES

To conduct a systematic review of recent pediatric Down syndrome (DS) neuropsychology research that may be useful to clinicians and researchers examining regression in this population.

METHODS

We reviewed original peer-reviewed articles published between 2013 and 2018 studying neuropsychological profiles in DS.

RESULTS

Thirty-one articles (of 1231 included in the original search) passed all inclusion criteria, were evaluated for bias, and were included in the analysis.

CONCLUSION

Findings argued against a single "DS profile" and revealed multiple within-group differences as well as expected and unexpected differences relative to typically developing children and children with other intellectual and developmental disabilities. Areas identified as most germane to regression monitoring included working memory, inhibition, letter and word identification, navigational route learning, motor skills (when strong at baseline), single word receptive/expressive vocabulary, and adaptive function.

Adaptive Behavior in Youth with Autism Spectrum Disorder: The Role of Flexibility

Cognitive and behavioral flexibility are important predictors of adaptive behavior in school-age autistic youth. While prior research has utilized broad measures of flexibility, the current study uses the multi-dimensional Flexibility Scale-Revised to examine which specific flexibility skills relate to adaptive functioning. Through parent-report measures on 216 autistic youth, flexibility explained 22.2% of variance in adaptive socialization skills (p < 0.001). Specifically, Social Flexibility accounted for significant variance in adaptive socialization skills, while Transitions/Change approached significance. In exploratory analyses, flexibility explained 11.5% of variance in Communication skills (p < 0.001). This pattern remained after controlling for co-occurring ADHD symptoms. The current study helps to refine the relationship between flexibility and adaptive behavior, which may ultimately help to inform more targeted interventions.

The Social Responsiveness Scale (SRS-2) in school-age children with Down syndrome at low risk for autism spectrum disorder

BACKGROUND AND AIMS

Little is known about how autism spectrum disorder (ASD) symptoms present in individuals with Down syndrome (DS). Some behaviors may be symptomatic of comorbid ASD or more broadly representative of the DS phenotype. A prior research study documented elevated ASD-like symptoms in adolescents and young adults with DS without comorbid ASD, using a common ASD risk screening tool-the Social Responsiveness Scale (SRS). The current study applied a similar approach to younger children with DS using the SRS-2. The primary aim was to document patterns of ASD-like symptoms in children with DS at low risk of comorbid ASD to distinguish the symptoms that may be present across DS in general.

METHODS

SRS-2 standard scores were analyzed in a sample of 40 children with DS, 6-11 years old, who were considered to be at low risk for ASD based on the Social Communication Questionnaire (SCQ) screener. Other developmental characteristics (i.e., age, nonverbal IQ, expressive language), social skills, and problem behaviors were also examined across the sample.

RESULTS

SRS-2 scores were significantly elevated in this sample compared to the normative population sample. A pattern of ASD-like symptomatology was observed across SRS-2 subdomains. These findings were similar to the findings of the prior study. However, nuanced differences were observed across the two samples that may represent developmental differences across different ages in this population.

CONCLUSIONS

Replicating and extending a prior study's findings, certain ASD-like behaviors may occur in individuals with DS who are at low risk for comorbid ASD.

IMPLICATIONS

Understanding the pattern of ASD-like behaviors that occur in children with DS who are at low risk for comorbid ASD will help clinicians in screening and identification efforts. In particular, it will lead to better specification of the behaviors or symptoms that are not characteristic of the DS phenotype and thus are red flags for comorbid ASD in this population.

Sensory Processing and Maladaptive Behavior: Profiles Within the Down Syndrome Phenotype

Aim: Sensory processing impairments are well characterized in children with neurodevelopmental disorders, particularly autism, and have been associated with maladaptive behaviors. However, little is known regarding sensory processing difficulties within Down syndrome, or how these difficulties may influence maladaptive behavior. This study aims to characterize sensory processing difficulties within the Down syndrome phenotype and determine the influence of processing difficulties on maladaptive behavior. Methods: To explore this issue, we administered the Short Sensory Profile and the Developmental Behavior Checklist to parents or primary caregivers of young children with DS (N = 49; M nonverbal mental age (NVMA) = 30.92 months (SD = 12.30); M chronological age (CA) = 67.04 (SD = 25.13). Results: Results indicated that Low Energy/Weak, Under-responsive/Seeks Sensation, and Auditory Filtering were the areas of greatest sensory regulation difficulty, and that Self-Absorbed behavior and Disruptive/Antisocial behavior were elevated areas of maladaptive behavior. Multivariate regression analyses indicated that Under-responsive/Seeks Sensation was the only sensory regulation domain significantly associated with Self-Absorbed and Disruptive/Antisocial behavior. Conclusion: Findings indicate a consistent pattern of sensory processing impairments and associations with maladaptive behavior in children with DS. Implications for interventions are discussed.

Largely Typical Electrophysiological Affective Responses to Special Interest Stimuli in Adolescents with Autism Spectrum Disorder

Circumscribed interests are a symptom of autism spectrum disorder (ASD) that may be related to exaggerated affective neural responses. However, the use of generic ASD-interest image stimuli has left an open question as to whether affective responses towards individual interests are greater in ASD compared to typically developing (TD) controls. We compared amplitudes of the late positive potential (LPP), an affective electroencephalographic response, between adolescents with ASD (N = 19) and TD adolescents (N = 20), using images tailored to individual likes and dislikes. We found an LPP response for liked and disliked images, relative to neutral, with no difference in amplitude between groups. This suggests that the LPP is not atypical in adolescents with ASD towards images of individual interests.

Parental education accounts for variability in the IQs of probands with Down syndrome: A longitudinal study

Recent work has demonstrated that variability in probands' phenotypes, including physical features, cognitive abilities, social functioning, and other developmental domains, is influenced by parental traits. Here we examine the role of parental education as a factor contributing to the variability of intelligence quotient (IQ) of offspring with trisomy 21. Participants were 43 probands with trisomy 21, aged 4-21 years of age, and their parents. Data were collected on parental education, and a bi-parental mean education score (BMES) was calculated. Probands' cognitive abilities were assessed by the Stanford-Binet 4th edition at baseline (T1), and again 24 months later (T2). Probands were placed into one of two age groups: 4-12 years and 13-21 years. Results indicated higher parent-proband correlations in Age Group 2 (mean r = .47) relative to Age Group 1 (mean r = .33) and increasing parent-proband correlations across time, with mean correlations of Age Group 1, T1: r = .26, T2: 39; Age Group 2 T1: r = .49, T2: r = 46. Despite the expected IQ deficits observed in trisomy 21 probands, parental education may still contribute to the variability of probands' cognitive abilities. These findings are consistent with the literature noting increasing heritability of IQ with development.

Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD)

BACKGROUND

Both self-regulation and insistence on sameness (IS) are related to anxiety, which is a common feature of individuals with autism spectrum disorder (ASD). Here, we aimed to characterise the IS-self-regulation-anxiety interrelationship by investigating the potential contribution made by self-regulation, assessed via effortful control (EC), to the IS-anxiety relationship in a sample of adolescents and young adults with ASD.

METHOD

Seventy-one older adolescents and younger adults with ASD (49 males, 22 females; Mage = 18.71 years, SD = 2.51, range 14.42-24.81) completed the Adult Repetitive Behaviour Questionnaire-2, Effortful Control Scale of the Adult Temperament Questionnaire and the DSM-5 Dimensional Anxiety Scales.

RESULTS

IS was associated with both EC (r = -.39, p = .001) and anxiety (r = .45, p < .001), and anxiety was in turn associated with EC (r = -.44, p < .001). To characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of EC on anxiety, through IS (b = -.06; BCa 95% CI [-.13, -.02]), and indirect effect on anxiety through EC (b = 1.62; BCa 95% CI [.59, 3.24]) with the mediators accounting for 29.07 and 26.04% of the total effect, respectively.

CONCLUSIONS

Our study provides the first exploration of the IS-anxiety-self-regulation link in ASD. The finding that lower levels of self-regulation are related both to anxiety and IS behaviours points to self-regulation as a viable intervention target for both anxiety and IS behaviours.

Repetitive Behaviours and Restricted Interests in Individuals with Down Syndrome-One Way of Managing Their World?

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.

Relationship between early motor milestones and severity of restricted and repetitive behaviors in children and adolescents with autism spectrum disorder

This study explored the relationships between the later age of achievement of early motor milestones, current motor atypicalities (toe walking), and the severity of restricted and repetitive behaviors (RRBs) in individuals with autism spectrum disorder (ASD). Parents of 147 children and adolescents with ASD (M_age  = 8.09 years, SD = 4.28; 119 males) completed an early developmental milestones questionnaire and the Social Responsiveness Scale as a measure of Insistence on Sameness (IS) and Repetitive Mannerisms (RM). Two hierarchical regression analyses were conducted to test whether RM and IS behaviors were predicted by early motor milestones, or current toe walking. The final model predicting RM accounted for 15% of the variance (F = 3.02, p = .009), with toe walking as a unique and independent predictor of RM scores (t = 3.568, p = .001). The final model predicting IS accounted for 19.1% of variance in IS scores (F = 4.045, p = .001), with chronological age (CA) (t = 2.92, p = .004), age when first standing (t = 2.09, p = .038), and toe walking (t = 2.53, p = .013) as unique independent predictors. Toe walking (t = 2.4, p = .018) and age when first sitting (t = 2.08, p = .04) predicted the severity of RRBs on the Autism Diagnostic Observation Schedule (F = 2.334, p = .036). Our study replicates previous findings on the relationship between concurrent motor impairments and RRBs, and provides the first evidence for the association between RRBs and age of attainment of early motor milestones. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1163-1168. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

A quantitative measure of restricted and repetitive behaviors for early childhood

Background

Restricted and repetitive behaviors are characteristic phenotypic features of many neurodevelopmental, psychiatric, and neurological conditions. During early childhood, such behaviors are considered normative. More research is needed to delineate the dimensions of restricted and repetitive behavior across typical and atypical development during this period.

Methods

We developed the 34-item parent-rated Repetitive Behavior Scale for Early Childhood (RBS-EC) to capture quantitative, dimensional features across a broad range of behaviors contributing to this domain. We evaluated its psychometric properties and factor structure in a community sample of 914 toddlers.

Results

The RBS-EC showed excellent overall internal consistency (α = 0.90), strong test-retest reliability (ICC = 0.87 for topographies and 0.90 for frequency) and evidence of convergent and discriminative validity. Using a split-half approach to factor analysis, we identified that a three- or four-factor structure best fit the data and confirmatory factor analysis indicated acceptable fit for both models. The empirically derived four-factor model was consistent with our conceptual model and included repetitive motor, restricted interests and behavior, ritual and routine, and self-directed behavior.

Conclusions

This initial study indicates that the RBS-EC is a reliable and valid instrument for characterizing quantitative, dimensional aspects of restricted and repetitive behaviors in young children.

Electronic supplementary material

The online version of this article (doi:10.1186/s11689-016-9161-x) contains supplementary material, which is available to authorized users.

Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and down syndrome

The present study had two aims: first to compare levels of restricted and repetitive behaviours (RRB) across two groups of typically developing (TD) children, and two disorders: Autism Spectrum Disorder (ASD) and Down syndrome (DS), and second to explore the relationship between fear and repetitive behaviours in these four groups. Parents of 41 offspring with ASD (M_age  = 123.39 months, SD_age  = 27.67), 38 offspring with DS (M_age  = 125.37 months, SD_age  = 45.71), 45 typically developing children matched to the mental age (MA) of the DS group (TD MA; M_age  = 51.13 months, SD_age  = 22.1), and 42 chronological age (TD CA; M_age  = 117.93 months, SD_age  = 22.91) matched TD children, completed measures of RRB and fear. ANOVAs revealed differences across the four groups on the RRB subscale scores: "Just Right" F(3,162) = 16.62, P < 0.001; Rigid Routines F(3,162) = 52.76, P < 0.001; Sensory behaviours F(3,162) = 23.26, P < 0.001. Post-hoc comparisons revealed that children with ASD had the highest RRB levels followed by DS, TD MA, and TD CA children. In children with ASD, higher levels of fear were related to higher RRB levels. Similar, albeit less strong, patterns of associations was found among DS and TD MA children but not in older TD CA children. This study provided evidence of a fear-RRB association in children with ASD, DS, and two groups of TD children. Autism Res 2017, 10: 502-507. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Characterizing caregiver responses to restricted and repetitive behaviors in toddlers with autism spectrum disorder

Restricted and repetitive behaviors are a core feature of autism spectrum disorder. This descriptive study documented the presence of restricted and repetitive behaviors in 85 toddlers with autism spectrum disorder as they interacted with their caregiver in a play interaction. For each child restricted and repetitive behavior, a caregiver response/non-response was coded. Caregiver responses were rated as successful or unsuccessful. In all, 83 toddlers demonstrated at least one restricted and repetitive behavior in 10 min. The most common child restricted and repetitive behavior was repetitive object use with 72 children displaying at least one instance of this category of restricted and repetitive behavior. Overall, caregivers responded to fewer than half of their child's restricted and repetitive behaviors, and caregiver response varied by child restricted and repetitive behavior type. The most common response was redirection. Success varied by child restricted and repetitive behavior type and caregiver response--redirections were most successful for child verbal and motor restricted and repetitive behaviors, whereas physical or verbal responses were rated more successful for repetitive object use and visual restricted and repetitive behaviors. This study represents the first attempt to characterize how caregivers respond to restricted and repetitive behaviors. Toddlers with autism spectrum disorder are already demonstrating a variety of restricted and repetitive behaviors within the context of a free play sessions, and caregivers differentially and naturally respond to them.

Excitatory/Inhibitory Balance and Circuit Homeostasis in Autism Spectrum Disorders

Autism spectrum disorders (ASDs) and related neurological disorders are associated with mutations in many genes affecting the ratio between neuronal excitation and inhibition. However, understanding the impact of these mutations on network activity is complicated by the plasticity of these networks, making it difficult in many cases to separate initial deficits from homeostatic compensation. Here we explore the contrasting evidence for primary defects in inhibition or excitation in ASDs and attempt to integrate the findings in terms of the brain's ability to maintain functional homeostasis.