The Childhood Routines Inventory in Children with Autism Spectrum Disorders

Background:  Until recently, the study of restricted, repetitive behavior (RRB) in autism spectrum disorders (ASD) has been largely neglected relative to the research on the language and social deficits associated with ASD.  This may be due in part to the high prevalence of repetitive behavior that presents in other, non-ASD neurodevelopmental disorders, which might obscure the diagnostic utility of RRB.  

Objectives:  We aim to examine the similarities and differences in RRB in children with ASD relative to a heterogeneous non-ASD sample, as well as to subgroups varying in ASD and cognitive status. First, we explore the factor structure of the Childhood Routines Inventory (CRI), a measure of RRB (Evans, Leckman, Carter, Reznick, Henshaw, King & Pauls, 1997) on a large sample of children with neurodevelopmental disorders, and then compare the CRI factors across various clinical subgroups.

Methods:  Over 1000 consecutive patients at a clinic for neurodevelopmental disorders in rural Central PA, USA received the CRI by postal survey. Caregivers of three-hundred seventeen children (mean age 62 months, range 12-194 months) with a wide range of neurodevelopmental disorders completed the CRI. The CRI measures 19 RRB along a 5-point Likert scale.

Results:  First, we conducted a principal components analysis of the CRI using Varimax rotation. Consistent with earlier work with the CRI, the "'Just Right" and "Repetitive Behaviors" factors emerged. However, a third factor was retrieved – "Sensory Sensitivities", with the 3 factors accounting for a total of 58% of variance. Following the factor analysis, children were classified into one of three diagnostic groups: those with ASD, those with intellectual disability or global developmental delay (ID/DD) but no ASD, and those with another neurodevelopmental disorder (ND) without ASD or ID/DD. Next, ANOVAs compared the three groups on each of the three CRI factors (weighted by factor loadings). Groups differed on all three weighted factor scores: Just Right (F(2, 309)=4.56, p=.01; Repetitive Behavior (F(2, 309)=9.81, p< .0001 and Sensory Sensitivities (F(2,309)=10.02, p< .0001. Post hoc tests revealed that on all three ANOVAs the ASD group engaged in more Just Right, Repetitive Behavior and had more Sensory Sensitivities than both the ID/DD and ND groups.

Conclusions:  These findings add to the growing body of literature on RRB in children with neurodevelopmental disabilities. Our findings suggest that the structure of the CRI varies depending on the clinical status of the population. In children with neurodevelopmental disorders, a third factor (Sensory Sensitivities) emerges that has not appeared in factor analysis with typical populations.  All three factors differentiated children with ASD from children with other neurodevelopmental disorders. The CRI, unlike other measures of RRB, results in a range of scores and distribution that facilitates the exploration of RRB in a variety of clinical populations.