September 20, 2021


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Tags: among, Autistic, behaviors, Repetitive, Spectrum, wane, wax, youth


Categories: autism

Repetitive behaviors wax and wane amongst autistic youth | Spectrum

Calming Rituals: Autistic children and adolescents use some restricted and repetitive behaviors to regulate emotions, so therapies that target emotion regulation may be more beneficial than therapies that target specific behaviors.

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Some types of restricted and repetitive behavior become more common in autistic children and adolescents over time, depending on their age and intellectual ability, while others decrease, two new studies show.

The results re-support the argument that constrained and repetitive behavior – a core diagnostic trait that includes repetitive movement, insistence on equality, sensory sensitivities, and limited interests – are too diverse to be lumped together.

“This is a complex behavioral domain that includes several different sub-domains that are likely to have different causes and respond to different treatments,” says Mirko Uljarević, Senior Research Fellow at the University of Melbourne in Victoria, Australia, who led one of the studies.

Tracking how these behaviors change over time can help clinicians develop better strategies for helping autistic children and adolescents, says Benjamin Yerys, assistant professor of psychology in psychiatry at the University of Pennsylvania at Philadelphia, who is not involved in any of the studies was involved. For example, a child who needs support for one type of behavior at the age of 3 may no longer need support for it – or possibly another type of support – by the age of 13, he says.

“Perhaps it is not necessary to invest resources and efforts to reduce those who are going to lose weight anyway,” says Valérie Courchesne, postdoctoral fellow at the Center for Addiction and Mental Health in Toronto, Canada who led the second study.

Gender difference:

Uljarević and his team analyzed parent-reported data on the severity of restricted and repetitive behavior, language skills, and cognitive functions of 17,581 autistic children and adolescents in a genetic registry called SPARK. (SPARK is funded by the Simons Foundation, Spectrum’s parent organization.) They categorized the different types of restricted and repetitive behavior into five groups: repetitive motor behavior, insistence on equality, self-harming behavior, compulsions, and limited interests.

Autistic boys have more repetitive motor behaviors and limited interests than autistic girls, while the opposite is true for compulsions and self-harming behaviors, the study shows. More severe repetitive motor behaviors tended to track with lower cognitive and language skills and with younger age. The work appeared in the Journal of the American Academy of Child & Adolescent Psychiatry in August.

Close interests are also more pronounced in participants with a low intelligence quotient (IQ), according to the study. But the questionnaire the parents filled out – called the Repetitive Behavior Scale-Revised – does not distinguish between narrow interests that are unusual in intensity from those that are unusual in terms of content, says Uljarević. “It is clear that these two different types of interests may have different mechanisms and are related in different ways to factors such as IQ.”

The other study documented 15 types of restricted and repetitive behavior in 205 autistic children at three time points, from diagnosis to age 11, using the Autism Diagnostic Interview-Revised, which is based on parenting reports. Close interests and sensitivity to noise increased with age, while repeated use of objects, unusual sensory interests, complex mannerisms, and unusual pursuits decreased, the study shows.

Some of the trajectories appear to shift with age based on IQ. For example, difficulty changing routine was more common in children with IQs below 93, but remained constant in those with IQs of 93 and above. The work appeared in Molecular Autism in August.

“The role of these behaviors in development is very complex and still poorly understood,” says Courchesne.

Tailoring support:

Together, the studies support the notion that different restrained and repetitive behaviors have dynamic relationships with one another and that strategies for improving one another could reinforce the other, Yerys says. For example, a child who is particularly sensitive to noise may get used to the use of headphones, leading them to become more and more insistent on equality when they become dependent on this routine.

“We don’t know how our support helps or hurts in any particular way,” he says.

Rather than targeting individual behaviors, clinicians could help autistic children and adolescents more by addressing the core problems underlying those behaviors. For example, nurturing the executive skills of young autistic people can help them be more flexible in the face of change, says Yerys.

Treating anxiety can also be beneficial, Courchesne says. Many autistic young people say that their restricted and repetitive behavior helps them regulate their emotions and calm themselves down; Focusing on emotional regulation rather than specific behaviors will likely lead to more effective coping skills, she adds.

The results underscore the importance of examining individual restricted and repetitive behavior, Courchesne says. Too fine a breakdown runs the risk of missing out on their relationships, she adds. Some clumping can be useful in exploring common mechanisms and treatment goals.

To this end, Uljarević and his colleagues are working on a new clinical tool to better capture the full range of individually restricted and repetitive behaviors and gain better insight into their role in development, while maintaining the subdivision at the category level.

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