Visual Stereotypies in Young Children with Autism Spectrum Disorders

Background: Repetitive and stereotyped behaviors are one of the diagnostic criteria for Autism Spectrum Disorders (ASD). Visual Stereotypies (VIS) including lateral glances, close inspection and tracing are particularly disruptive to learning activities and social interaction. These visual behaviors are not systematically identified or described, are often grouped with other stereotyped behaviors and are poorly understood.

Objectives: The first goal of this study was to identify, describe, and categorize Visual Stereotypies in young children with ASD. The second goal was to analyze the relationship of VIS to age at referral, cognitive, language and social functioning.

Methods: Based on retrospective chart review and Autism Diagnostic Observation Schedule (ADOS) videos and protocols, 2 groups of ASD children matched on gender and chronological age were included. One group exhibited Visual Stereotypies (VIS) and one group did not (NoVIS). The VIS group was comprised of 10 ASD children: 7 boys, 3 girls; mean age 30 months (range: 20-42). The NoVIS comparison group was comprised of 14 ASD children: 10 boys, 3 girls; mean age 31 months (range: 16-49). Using the total scores from the subscales of the ADOS protocol, we assessed and compared communication, socialization, play and repetitive behaviors. We compared group means for age at referral and IQ levels.

Results: First, we identified five subtypes of VIS. The most frequent was lateral glances; the least frequent was tracing. We found no statistical differences between the groups in regard to language, play, or social interaction, based on the ADOS scores. However, the analysis showed that compared to the NoVIS group, the VIS group presented with significantly earlier age at referral (p< .04), higher cognitive scores (p< .05), and higher prevalence of stereotyped behaviors and restricted interests (p< .01) from the ADOS.

Conclusions: Visual Stereotypies in preschool children with ASD are brief and relatively rare. The identification and characterization of these stereotypical behaviors through videos analysis can be challenging. This preliminary study identified five specific subtypes of VIS. It revealed that children with VIS, despite their higher cognitive functioning, are recognized and, therefore, referred earlier for diagnostic assessment. Limitations of this study included a relatively small sample and variable quality of the video recording. However, these findings highlight the need to examine repetitive behaviors in greater detail and the potential of visual stereotypies as a phenotypical marker for autism. Further analysis will examine the long-range outcomes of this subgroup of children.