Relations among restricted and repetitive behaviors, anxiety and sensory features in children with autism spectrum disorders

https://doi.org/10.1016/j.rasd.2013.10.001Get rights and content

Highlights

  • Factor analysis using the RBQ-2 resulted in two subtypes of repetitive behavior.

  • One subtype, insistence on sameness (IS), was found to be associated to anxiety.

  • The association between IS and anxiety was mediated by sensory features.

Abstract

The purpose of this study was to explore how atypical reactions to sensory stimuli contribute to the relation between restricted and repetitive behaviors and anxiety in children with autism spectrum disorders (ASD). In Study 1, factor analysis of restricted and repetitive behaviors was carried out using the Repetitive Behavior Questionnaire-2 (RBQ-2), completed by 120 parents of 2- to 17-year-olds with ASD. Two subtypes resulted: repetitive sensory and motor behaviors, and insistence on sameness, accounting for 40% of the variance. This two-factor solution was retained even when the sensory items of the RBQ-2 were removed. In Study 2, 49 of the same parents also completed the Spence Anxiety Scales and the Sensory Profile. The insistence on sameness factor was significantly associated with anxiety while the repetitive motor behaviors factor was not. The relation between anxiety and insistence on sameness was mediated by sensory avoiding and to a lesser extent by sensory sensitivity. Implications for arousal explanations of ASD and for clinical practice are discussed.

Section snippets

General introduction

Restricted and repetitive behaviors (RRBs) are part of the core criteria for autism spectrum disorders (ASD). They form a heterogeneous class of behaviors that are characterised by invariant repetition and desire for sameness in the environment (Kanner, 1943). Factor analytic studies using the Autism Diagnostic Interview-Revised (ADI-R) consistently indicate a division into two subclasses: (a) repetitive motor and sensory (RSM) behaviors such as repetitive hand or finger movements and (b)

Study 1

Study 1 examined the factor structure of the RBQ-2 questionnaire, using this measure for the first time with a sample of children with ASD. To date, published data on the factor analytic structure and psychometric properties of the RBQ-2 has been confined to a typically developing sample at 15 and 24 months of age (Arnott et al., 2010, Leekam et al., 2007), with results showing that the items group into two factors (RSM and IS). Study 1 aimed to replicate this finding with an ASD sample,

Study 2

Study 2 examined the association between the two subtypes of RRB and anxiety and the contribution made by sensory features to this association using the Sensory Profile (Dunn, 1999).

General discussion

Recent explanations of RRBs have described their function as a marker for anxiety, forming a buffer to alleviate distress. It has also been proposed that different subclasses of RRBs may function in different ways to either increase sensory stimulation or to reduce both anxiety and sensory stimulation. This research investigated the potential relationships between different types of RRBs, anxiety and sensory features in order to identify the contribution made by sensory features to the

Conflict of interest statement

None of the authors have any conflicts of interest.

Acknowledgements

This research was supported by PhD funding from the Wales Office of Research and Development for Health and Social Care, National Institute for Social Care and Health Research, and project grant funding from the Baily Thomas Charitable Fund (awarded to author SL). We thank Julie Mullis, Hilary Kanaris, Anne Marie McKigney, and Ruth Paradice for clinical advice and all the parents and children who participated in the study.

References (56)

  • T.M. Achenbach et al.

    Manual for the ASEBA school-age forms & profiles

    (2001)
  • C.W. Allen et al.

    Validity of the Social Communication Questionnaire in assessing risk of autism in preschool children with developmental problems

    Journal of Autism and Developmental Disorders

    (2007)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (1994)
  • B. Arnott et al.

    The frequency of restricted and repetitive behaviors in a community sample of 15-month-old infants

    Journal of Developmental & Behavioral Pediatrics

    (2010)
  • R.M. Baron et al.

    The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations

    Journal of Personality and Social Psychology

    (1986)
  • A. Ben-Sasson et al.

    A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders

    Journal of Autism and Developmental Disorders

    (2009)
  • S.L. Bishop et al.

    Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders

    Child Neuropsychology

    (2006)
  • B.A. Boyd et al.

    Sensory features and repetitive behaviors in children with autism and developmental delays

    Autism Research

    (2010)
  • Y.H. Chen et al.

    Restricted and repetitive behaviors, sensory processing and cognitive style in children with autism spectrum disorders

    Journal of Autism and Developmental Disorders

    (2009)
  • M.L. Cuccaro et al.

    Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R

    Child Psychiatry & Human Development

    (2003)
  • W. Dunn

    The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model

    Infants and Young Children

    (1997)
  • W. Dunn

    Sensory Profile

    (1999)
  • A.J. Esbensen et al.

    Age-related differences in restricted repetitive behaviors in autism spectrum disorders

    Journal of Autism and Developmental Disorders

    (2009)
  • D.W. Evans et al.

    Ritual, habit, and perfectionism: The prevalence and development of compulsive-like behavior in normal young children

    Child Development

    (1997)
  • E. Gal et al.

    Sensory differences and stereotyped movements in children with autism

    Behavior Change

    (2002)
  • K. Gotham et al.

    Exploring the relationship between anxiety and insistence on sameness in autism spectrum disorders

    Autism Research

    (2013)
  • S.A. Green et al.

    Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship?

    Journal of Autism and Developmental Disorders

    (2010)
  • S.A. Green et al.

    Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: Bidirectional effects across time

    Journal of Autism and Developmental Disorders

    (2012)
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    1

    Joint first authors.

    2

    Now at Psychology Department, Durham University, UK.

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    Now at Sensory Processing Disorder Foundation, Colorado, USA.

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