Evaluating the Role of Social and Motor Engagement for Reducing Restrictive and Repetitive Behaviors in Autism

Background:

Restrictive and repetitive behaviors (RRBs) are some of the most common and most stigmatizing symptoms of ASD. Research has found that motor engagement can reduce RRB presentation without affecting academic ability (Celiberti, Bobo, Kelly, Harris, & Handleman, 1997; Rosenthal-Malek & Mitchell, 1997); while other research has found that social engagement also reduces RRB presentation (Enloe & Rapp, 2014; Lee, Odom, & Loftin, 2007). While both of these research areas have found that different forms of engagement reduce the levels of RRB presentation in children with autism, few if any studies have looked at the joint effect of social and motor engagement. Additionally, many of the previous studies had a small sample of participants. 

Objectives:  

This research intended to evaluate the impact of social and motor engagement on RRB presentation in children with autism. In particular, we were interested in whether diagnosis affected RRB presentation levels, if differences in presentation were based on RRB type, if type of engagement differentially influenced RRB presentation, and if RRB presentation was related to other measures of symptoms of autism. 

Methods:  

A sample of 91 children (46 ASD, 45 Control) was coded over four tasks that varied in the levels of both social and motor engagement. Frequency coding was conducted using video analysis software (Interact, Mangold Inc.) for four different types of RRBs: motor-based RRBs, nonverbal-oral RRBS, oral-motor RRBs, and vocal/verbal RRBs. We also correlated the frequency measures to clinical measures of social skill: the RBSR, CBCL-ADHD, ADOS, and SRS; as well as to measures of social cognition: theory of mind, initiating joint attention, and responding joint attention. 

Results:  A 2X2X2X4 ANOVA with independent variables of diagnosis, motor engagement, social engagement, and RRB type revealed a significant four way interaction between all independent variables (F(3,267)=4.75,p<.001, h_p²=.05). This interaction meant that for the children diagnosed with autism, an environment with both high social and motor engagement had the greatest impact on reducing certain RRBs more than others, namely the motor and vocal/verbal based RRBs. We also found significant main effects for all independent variables, as well as significant two-way and three-way interactions between all combinations possible between variables. We found significant positive correlations between frequency of RRBs and clinical measures of social skill, and significant negative correlations between the dependent variable and measures of social cognition. 

Conclusions:

These findings suggest that a combined effect of social and motor engagement has the greatest possibility to reduce the number of RRBs in children with autism. Observed frequencies were also related to clinical measures of social skill and measures of social cognition. These findings are important because they demonstrate a potential for future research to examine how to best utilize combined forms of engagement in ways that improve the social skills and education of children with autism, while simultaneously reducing the most stigmatizing behaviors of the disorder.