Repetitive and Restricted Behaviors and Their Sensory Components in Young Children with ASD: Family Quality of Life and Improvement during Intervention.

Background:

Sensory processing issues (SP) often co-occur with restricted and repetitive behaviors (RRB). Following a developmental account RRBs are defined as developmentally immature responses serving adaptive functions (occupying self versus soothing) to arousal derived from sensory processing issues. Alternative considerations account for sensory processing issues as primary impairment resulting in interaction problems typical for ASD. Comprehensive programs intervene directly on RRBs defined as barriers for learning more mature responses from social experience.

Objectives:

Examine associations of SP and RRB and whether social deficits account for any relationship. Explore their impact on family’s Quality of Life and potential change during behavioral treatment.

Methods:

Sixteen parents of preschoolers with ASD who received EIBI intervention provided ratings of Quality of Life (WHOQOL-BREF, WHOQOL Group, 1998) and child characteristics (Restricted and Repetitive Behaviors Scale, Bourreau et al., 2009; Short Sensory Profile, Dunn, 1999). Evaluation of autism core symptoms (ADOS-2, Lord et al., 2012) and developmental cognitive level (GMDS-R, Luis et al., 2006) was provided by external licensed neurodevelopmental psychiatrists.

Results:

Fourteen children (87.5%) demonstrated an probable or definite difference in SP. Strongly associated SP and RRB scores confirmed lower-level clusters of repetitive sensorimotor behaviors and sensorimotor stereotypies (r=-.639, p>.001 to r=-.570, p>.05), associated with lower cognitive level (r=.771 to r=.,587 p>.05), and a higher-level cluster of insistence on sameness/modulation insufficiency and sensory seeking /auditory filtering (r=-.590 to r=.508, p>.05). No association was found of ADOS social communication and presence of repetitive behaviors or sensory processing issues. Family QOL was impacted by lower cognitive level (t=3.695, p>.05) and atypical sensory processing of movement (t=3.543, p>.05), tactile (t=5.216, p>.01), visual (t=4.175, p>.05) stimuli and inattention due to auditory filtering issues. Family QOL was not predicted by age, autism severity or repetitive behavioral representations alone. The full model explained 85% of variability. At six months of intervention SP (t=-7.001, p>.0001) and RRB (t=4.759, p>.001) were reduced at a rate of 19% in frequency of case occurrence, with 11 remaining children (68%) demonstrating a difference in SP. Subscale analyses revealed improvement predominantly in under-responsiveness, and distractibility with decline in behavioral representations such as adoption of control, rituals, object attachment, and echolalia. Magnitude of improvement was significantly associated with social communication severity (p>.01).

Conclusions:

Results confirm clusters of lower- and higher-order repetitive behaviors, differentially associated with cognitive impairment. This pilot is novel in demonstrating the negative impact of Sensory processing issues on family Quality of Life as well as the efficacy of comprehensive intervention in reducing repetitive behaviors and correlated sensory issues. The present results did not support the assumption of a social-communication dysfunction as a shared mechanism that underlines SP and RRBs. Nevertheless, social-communication deficit was shown to impact the rate of improvement. It is reasonable that decreasing engagement in repetitive behaviors may make the child more amenable to treatment targeting autism core symptoms.