Associations Between Repetitive Behaviours, Play and Development in Pre-School Autism

Background: Repetitive and restricted behaviours (RRBs) represent a key diagnostic feature of autism (DSM-IV, APA). However there is relatively little research into the incidence of these behaviours using observational methods rather than parent reports. Likewise little known about the relationships between RRBs and other areas of the autism triad and development.  Previous research has found an inverse relationship between advanced play behaviours and restricted object use (Bruckner and Yoder, 2007). Similarly RRBs have been found to negatively associate with language and non-verbal development (Militerni et al, 2002).

Objectives: We used a systematic observation methodology to investigate the presence of RRBs in a standardised free play session between preschool children with autism and their caregivers; and related these to other measures of development and autism symptomology. We hypothesised that a higher incidence of RRBs would associate negatively with advanced play behaviours, language and non-verbal development, but positively with simple play and autism severity.

Methods: 51 children (mean age = 44.5 months, SD = 8.53) with autism played with their caregiver with a standardised set of toys. Coding for RRBs were modified from items used in the Repetitive Behaviour Questionnaire (Turner, 1999), DISCO (Wing et al, 2002) and Watt et al (2008). Coding of Play levels were similar to those described previously by Naber et al (2008), Belsky and Most (1981) and Leslie (1987). All coding was standaradised using The Observer (Noldus, 1991). Children also completed the Pre-School Language Scales (Zimmerman et al, 1997), Mullen Scale of Early Learning (Mullen, 1995) and the Autism Diagnostic Observation Schedule (ADOS; Lord et al, 2000). These measures formed part of the baseline assessment for the Pre-School Autism Communication Trial (PACT; www.medicine.manchester.ac.uk/pact).

Results: During a 10 minute free play sequence, children on average displayed 6.76 RRBs (SD = 7.84). The most common behaviour was “fiddling with toys” followed by “throwing and kicking.” Total RRBs negatively correlated with mean language scores (r_s = -.294, p = .04) and positively with ADOS stereotyped behaviours and restricted interests (r_s = 302, p = .035). Negative associations were found between the total number of RRBs and time spent in functional (r_s = -.349, p = .014) and advanced functional play (r_s = -.287, p = .045). Total RRBs positively correlated with simple exploratory play (r_s = .326, p = .022).

Conclusions: Results suggest an inverse relationship between RRBs and advanced forms of play and development; consistent with the small amount of existing research in this area (e.g. Bruckner and Yoder, 2007). No associations were found between autism severity and RRBs, but a marginal correlation with ADOS stereotyped behaviours and restricted interests. Future work aims to explore the incidence of RRBs over time and their expression in non-verbally matched controls.