Restricted and Repetitive Behaviors In Children and Adolescents with ASDs Who Have Achieved Optimal Outcomes

Background: A study is currently following children and adolescents who have a history of autism spectrum disorders (ASDs), but who no longer meet diagnostic criteria for such a disorder. These individuals have achieved social and language skills within the average range for their ages and receive little or no school support. Several recent studies suggest that this small subset of individuals, once diagnosed with ASDs, achieve "optimal outcomes" (OO, Sutera et al., 2007; Kelley, Naigles & Fein, 2010; Helt et al., 2008).

Objectives: This study examines parent report of past and present restricted and repetitive behaviors (RRBs) of children and adolescents who achieved OO.

Methods: Parents of 30 individuals who achieved OO (M(age) =13.1) completed the Autism Diagnostic Interview-Revised (ADI-R) and their past and present ratings of items relating to RRBs were compared to parent responses of 27 high functioning individuals with a current ASD diagnosis (HFA, M(age) = 12.8).  Codes for items on the ADI-R range from 0 to 3; higher scores indicate the presence of more severe or frequent behaviors.  Additionally, 22 individuals in the OO group, 21 individuals in the HFA group and 21 typically-developing (TD) peers (M(age) = 13.4) were compared on the number of items endorsed by parents on subtests of the Repetitive Behavior Scale-Revised (RBS-R).  The RBS-R measures current RRBs and consists of six subtests: Stereotyped Behavior (6 items), Self-Injurious Behavior (8 items), Compulsive Behavior (8 items), Ritualistic Behavior (6 items), Sameness Behavior (11 items), and Restricted Behavior (4 items).  The groups were matched on age, gender and nonverbal IQ; however the groups differed significantly on verbal IQ (M(HFA)=103.7, M(OO)=113.2, M(TD)=113.7, p<.05).

Results: Parent responses to ADI-R items indicated that individuals in the HFA group exhibited significantly more circumscribed interests (current: M(HFA)=1.33, M(OO)=0.43, p<.05; past: M(HFA)=1.81, M(OO)=1.20, p<.05) and insistence on sameness behaviors (current: M(HFA)=0.59, M(OO)=0.20, p<.05; past: M(HFA)=1.22, M(OO)=0.53, p<.05) than did individuals in the OO group both currently and in the past.  When comparing the number of items endorsed by parents on subtests of the RBS-R, the OO group exhibited significantly more ritualistic behaviors, insistence on sameness behaviors and restricted behaviors than did the TD group.  Parents of the individuals in the HFA group endorsed significantly more items on each subtest of the RBS-R than did the individuals in the OO and TD groups (all p’s<.05; Stereotyped Behavior: M(HFA)=2.35, M(OO)=0.52, M(TD)=0.11; Self-Injurious Behavior: M(HFA)=0.91, M(OO)=0.15, M(TD)=0.05; Compulsive Behavior: M(HFA)=1.48, M(OO)=0.50, M(TD)=0.05; Ritualistic Behavior: M(HFA)=2.69, M(OO)=1.23, M(TD)=0.01; Sameness Behavior: M(HFA)=3.77, M(OO)=1.05, M(TD)=0.01; Restricted Behavior: M(HFA)=1.61, M(OO)=0.50, M(TD)=0.05).

Conclusions: The results of this study suggest that individuals who achieved OO exhibited fewer RRBs throughout development than did individuals who retained their ASD diagnosis.  Individuals who achieved OO continue to exhibit mild symptoms of RRBs more frequently than is seen in typical development.  However, further research is needed to support these conclusions, including studies that involve larger samples and RRB ratings that are not based exclusively on parent report.