Correlates of Restricted and Repetitive Behaviours: The Role and Anxiety and Intolerance of Uncertainty. Insights Directly from Young People with ASD

Background:  Restricted and Repetitive Behaviours (RRB) such as repetitive movements, routines, restricted interests, and resistance to change can interfere with the ability to learn new skills and take part in daily living. Despite their ubiquity in ASD, research into RRB is relatively neglected in comparison to other features of the disorder. In order to reduce the potential negative consequences of RRB, research is required which provides information about the motivators for and correlates of RRB to inform the development of effective and targeted interventions. Some research suggests a relationship between RRB and anxiety and intolerance of uncertainty (IU) in ASD. This research is based on parental report of these phenomena with no research investigating these relationships by gaining information directly from people with ASD.

Objectives:  

This study aimed to further current understanding about the experience of RRB and how these behaviours may relate to uncertainty and anxiety in ASD by gaining information directly from young people with ASD and their parents.

Methods:  Nineteen families participated. Young people with ASD were aged between 13 and 20 (mean age 16 years 8 months). Young people with ASD and their parents completed the Repetitive Behaviour Questionnaire 2 (RBQ2), Spence Child Anxiety Scale (SCAS) and the Intolerance of Uncertainty Scale (IUS-12). Ten of the young people also took part in a novel semi-structured interview. The goal of the interview was to explore motivations for engagement in and cessation of a self-selected example of an RRB.

Results:  

Significant correlations were found between both parent reported (r = .670, p = .002) and young person self-reported (r = .570, p = .042) RBB and anxiety. Parent reported young person intolerance of uncertainty and RBB were also significantly correlated (r = .560, p = .013). Thematic analysis of the interview data identified five themes (Insight into RRB, experience of RRB, motivating factors anxiety and uncertainty).

Conclusions:

This study is the first to date to collect self-report information from young people with ASD about their RRB. This is important in two respects; firstly it provides evidence in support of existing findings that have previously only been evidenced through parent report and secondly it provides evidence that young people can self-report, providing support for such practices in ASD research. The results support and extend previous findings, demonstrating a significant positive relationship between parent reported RRB and anxiety. Further support is also provided for the centrality of the role of uncertainty to the relationship between anxiety and RRB in ASD.  This study has a number of implications for clinical practice, suggesting that consideration should be given the role of anxiety and IU in understanding RRB. Young people’s responses to the interview provide insight in to how clinicians can potentially engage young people in talking about their RRB.