Ritualistic and Adaptive Behaviors in Children with and without Autism Spectrum Disorders

Background: In contrast to the widespread attention given to the social and communication deficits associated with autism spectrum disorders (ASD), little work has addressed the repetitive and ritualistic behaviors associated with autism. Less work has examined the adaptive and maladaptive correlates of repetitive behaviors in ASD.  

Objectives: This pilot study focused on the ritualistic and repetitive behaviors exhibited by children with and without autism, and identifies adaptive and maladaptive correlates of these behaviors.  We examined the continuities and discontinuities between normative rituals and routines observed in typically developing children and those with ASD. 

Methods: Parent report measures (Childhood Routines Inventory (CRI), Child Behavior Checklist (CBCL), Adaptive Behavioral Assessment Scales (ABAS)) assessed childhood behaviors in 10 children with autism (mean CA 15 years, mean MA=6.8) and a mental-aged matched, typically developing comparison group (n=10; mean CA 7.2 years, mean MA=6.1). The CRI measures normative compulsive-like behaviors, including “Just Right” (e.g., sensitivity to imperfections in toy/clothes) and Repetitive Behaviors. The CBCL measures internalizing and externalizing problem behavior, and the ABAS measures adaptive behavior.  

Results: Oneway ANOVA revealed significant differences between the two groups of children on all measures. The ASD and typical groups differed on all three subscales of the CRI: Mean Just Right subscale, Mean Repetitive Behavior subscale, and Mean CRI scale (p< .05). For all analyses the children with ASD were reported to engage in greater frequency/intensity than the typically developing children. As expected, the children with ASD exhibited more symptoms as measured by the CBCL than the comparison group. Differences emerged on Withdrawal, Social Problems, Thought Problems, Attention Problems, and Total Problems.

Next, we explored how adaptive and maladaptive behaviors serve as predictors of compulsive-like behaviors measured by the CRI, and whether adaptive/maladaptive behaviors differentially predict compulsive-like behavior for children with and without ASD.

A series of stepwise regressions were performed with CBCL internalizing and externalizing factors entered as predictor variables for each CRI subscale.  Externalizing Problems predicted 48% of the variance in repetitive behaviors in children with autism.

Each CRI scale was entered as the criterion variable with the ABAS subscales (ABAS Practical Composite, General Adaptive Composite Scores, Conceptual Composite Scores, Social Composite Scores) serving as predictor variables. For the ASD group, ABAS Practical Composite Score was a significant (and negative) predictor of CRI Repetitive Behavior (p<.01), accounting for 62.7% of the variance.  The ABAS Practical Composite Score predicted Mean CRI, (41% of the variance, again negative).  None of the adaptive/maladaptive variables predicted accounted for significant variance in the CRI for the typically developing children.

Conclusions: Though typically developing children engage in ritualistic behaviors in early childhood, when matched on developmental level, children with autism engage in more compulsive-like behaviors. Also, compulsive-like behaviors may serve different functions for children with and without autism. For children with ASD, externalizing behaviors predict compulsive-like behaviors, whereas for typically developing children, compulsive-like behaviors may not signify maladaptation – a hypothesis forwarded in previous work. Future research is called for to elucidate the nature of compulsive-like behavior in children with and without ASD.