Targeting Restricted and Repetitive Patterns of Behavior in Children with Autism and Asperger Syndrome

Background: The domain of restricted and repetitive patterns of behaviors (RRB) is one of the core diagnostic features of autism and Asperger syndrome. RRB comprise a heterogeneous group of behaviors, but appear to share a common quality of rigidity or “inflexibility.” Furthermore, two main sub-categories of RRB have been delineated into lower-order RRB (i.e. motor-sensory behaviors) and higher order RRB (i.e., complex behavioral rigidity). Research on the developmental course of these symptoms highlight the pervasiveness of RRB, especially higher-order behaviors (i.e. restricted interests, insistence on sameness and ritualistic behaviors); the negative impact RRB pose for the individual and family; and reduced symptom improvement in this area in comparison to social and communication gains. Therefore, further research on interventions addressing RRB is warranted and there is evidence that self-management is an effective component of behavioral intervention in improving a variety of core ASD symptoms.

Objectives: To examine the effects of implementing an individualized self-management program to reduce behavioral inflexibility observed in targeted higher-order RRB, generalization of these behavioral gains and child affect.

Methods: A non-concurrent multiple baseline across participants time series research design was implemented with measures collected longitudinally. Following systematically staggered baselines, each participant (age 5-7), diagnosed with Autism Spectrum Disorder (ASD), was provided with a manualized self-management program in an attempt to increase behavioral flexibility.

Results: Application of a self-management program was effective in improving RRB as evidenced by increased percentages of behavioral flexibility following intervention.  All participants demonstrated increased flexibility in comparison to baseline and these gains generalized to a variety of settings and activities. Improvements in child affect ratings were also observed.   

Conclusions: Self-management is an effective intervention to improve behavioral flexibility related to RRB among children with ASD and has implications for future theoretical, behavioral and neurobiological research in this area.