Inter-Relationship Between Insistence on Sameness, Effortful Control and Anxiety in Adolescents and Young Adults with Autism Spectrum Disorder

Thursday, May 11, 2017: 5:30 PM-7:00 PM
Golden Gate Ballroom (Marriott Marquis Hotel)
M. Uljarevic1,2, A. L. Richdale3,4 and R. Y. Cai4,5, (1)Olga Tennison Autism Research Centre, Olga Tennison Autism Research Centre, Melbourne, CA, (2)Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, CA, (3)Olga Tennison Autism Research Centre, Olga Tennison Autism Research Centre, Bundoora, Australia, (4)Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Australia, (5)Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia

Insistence on Sameness (IS) behaviours include complex patterns of rigid, routinized and ritualistic patterns of behaviour. In addition to being a diagnostic feature of autism spectrum disorder (ASD), these behaviours also form part of typical development. Whilst IS behaviours in ASD tend to be relatively stable over time and negatively impact the functioning of individuals and their families, in early typical development, these behaviours are transitory and often serve an adaptive role. More specifically, these behaviours appear to be related to normative fears and anxieties, serving as an early form of self-regulation, and eventually reducing as more advanced forms of self-regulation develop. In ASD, it is possible that IS behaviours continue to serve a regulatory function beyond the period when they should have been replaced by more developmentally appropriate forms of self-regulation. Thus IS behaviours may negatively affect development including sustaining anxiety. However, this proposal has not been previously tested.


The aim of the present study was to characterise the IS-self-regulation-anxiety inter-relationship by investigating the potential contribution made by self-regulation, measured via effortful control, to the IS-anxiety relation in a cross-sectional sample of adolescents and young adults with ASD.


Participants were 58 adolescents and young adults with ASD (40 males, 18 females; Mage= 19.14 years, SDage= 2.53, range: 15.71-24.91) who participated in the Autism CRC School leavers study. As a part of the study, participants completed the Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A), Effortful Control Domain of the Adolescent/Adult Temperament Questionnaire and DSM-5 Dimensional Anxiety Scales (DSM-5 DAS) as measures of IS behaviours, Effortful Control and anxiety respectively.


The cut-off score (≥ 14) for elevated anxiety was met by 44.8% of participants. Preliminary analysis showed no statistically significant association between chronological age and gender and IS behaviours, anxiety, or effortful control scores. IS behaviour score was associated with both effortful control (r = -.42, p = .001) and anxiety (r = .47, p < .001), and anxiety was in turn associated with effortful control (r = -.51, p < .001). In order to characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of effortful control on anxiety through IS (Model 1a; b = -.06; BCa CI [-.13, -.02], standardized effect size = .13; BCa CI [-.27, -.04]) and there was a significant indirect effect of effortful control on IS through anxiety (Model 1b; b = -.006; BCa CI [-.01, -.002], standardized effect size = -.17; BCa CI [-.34, -.06]).


Our study provides first exploration of the IS-anxiety-self-regulation inter-relationship in ASD. However, findings are limited by a cross-sectional nature of our data, as cross-sectional designs are unable to capture these dynamic processes as they unfold over time. Despite this limitation, our study has potential implications for interventions targeting IS behaviours and also anxiety in ASD. Our finding that lower levels of self-regulation are related to both anxiety and IS behaviours, suggest self-regulation as a viable intervention target.