Examining the Relationship of Specific Repetitive and Restricted Behaviors on Adaptive Functioning of Children with ASD

Background:  Restricted and repetitive behaviors (RRBs) include a broad category of behaviors which are considered core characteristics required for a diagnosis of Autism Spectrum Disorder (ASD) according to the Diagnostic and Statistical Manual (DSM-V; American Psychiatric Association, 2013). RRBs can be subdivided into repetitive and sensory motor behaviors (RSM) and Insistence on Sameness behaviors (IS). In previous studies, researchers found significant negative correlations between IQ and RSM behaviors and positive correlations between IQ and IS behaviors (Richler et al. 2010). Also, parents have often reported that RRBs can be the most stressful aspect of ASD (Bishop, Richler, Cain & Lord, 2007). This study uses a newly standardized measure, the Behavior and Sensory Interest Questionnaire (BSIQ) to classify a wide range of RRBs. Previous studies using the BSIQ have found negative correlations between RSM behaviors and overall adaptive functioning. Yet, no study has detailed which specific RRBs provide the most interference within the various domains of adaptive functioning. This study attempts to identify specific RRBs that are highly correlated with domains of adaptive functioning to help specify behaviors to be targeted for intervention when aiming to improve socialization skills amongst the ASD population. 

Objectives:  Using a newly standardized measure, this study aims to delve deeper into the relationship between RRBs and adaptive behavior to identify specific RRBs that highly coorleate to domains of adaptive functioning.

Methods:  A sample of 503 children with ASD (82% male) was drawn from the Simons Simplex Collection and the Boston Autism Consortium. Participant ages were between 24-216 months, (mean=92.3, SD=45.75). ASD diagnosis was verified with the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R).Parents were administered the BSIQ, designed to evaluate the number, type, and intensity of RRBs, by a trained clinician, as well as the Vineland Adaptive Behavior Scale (VABS), which measures adaptive skills in multiple subdomains. Preliminary analysis included Pearson Correlations and descriptive statistics. 

Results:  Analyses revealed significant negative correlations between RSM behaviors and all three Subdomains of the Socialization Domain on the VABS, Interpersonal Skills, Play and Leisure Time, and Coping Skills. Specifically, RSM behaviors such as Flapping (-.329, p≤0.001), Repetitive Throwing (-.352, p≤0.001), and Toe Walking (-.310, p≤0.001) displayed the strongest negative correlation. No significant trend was revealed of age on IS behaviors, reconfirming previous studies. All analyses were controlled for IQ, age and gender.

Conclusions:  Expanding on previous research, we have analyzed the relationship between RRBs and the socialization skills of children with ASD to a more specific level. We found significant effects of RSM but not IS behaviors on socialization skills, including Interpersonal Skills, Play and Leisure Time, and Coping Skills. By providing an understating of which repetitive behaviors are most strongly correlated with areas of socialization, we can begin to understand the impact of RRB’s on the functioning of children with ASD and apply this knowledge in adapting interventions for children with ASD. Future research should focus on if there are specific behaviors driving the RSM impact on adaptive skills.