Restricted interests and repetitive behaviors constitute one of two criteria that define autism in the diagnostic manual for psychiatry
What are repetitive behaviors?
Scientists categorize repetitive behaviors into two groups. So-called ‘lower-order’ repetitive behaviors are movements such as hand-flapping, fidgeting with objects or body rocking, and vocalizations such as grunting or repeating certain phrases. ‘Higher-order’ repetitive behaviors include autism traits such as routines and rituals, insistence on sameness and intense interests.
How did repetitive behaviors come to be understood as an important part of autism?
Repetitive behaviors are among the first signs of autism to emerge in toddlerhood. They are seen in people across the autism spectrum. They tend to be more pronounced in those with lower cognitive ability, however.
Repetitive behaviors have been recognized as part of autism since the condition was first described. Leo Kanner and Hans Asperger noted repetitive movements and insistence on sameness in the first children they described, as did Grunya Sukhareva, an early autism researcher.
However, for many decades autism research focused on the other major group of autism traits: social difficulties and communication problems. As a result, repetitive behaviors were not well studied or understood.
Repetitive behaviors were not a required part of the criteria for an autism diagnosis as defined in the previous edition of the Diagnostic and Statistical Manual of Mental Disorders. Over the past decade, scientists have come to see these behaviors as central to autism’s definition.
How can repetitive behaviors best be managed?
There are no reliable methods to treat repetitive behaviors in autism.
For many years, clinicians focused on eliminating repetitive behaviors in people with autism. This sometimes involved extreme methods, such as prescribing powerful antipsychotic drugs, slapping the children or administering electric shocks to them when they engaged in these behaviors.
Many clinicians now question whether the behaviors even require intervention, unless they result in physical harm to the autistic person or others.
When a behavior is distracting or preventing an autistic person from participating in school or other activities, clinicians may try to identify the behavior’s function. If spinning in circles in the classroom helps an autistic child soothe her anxiety, for example, her doctor may try to find ways to minimize the anxiety or suggest another calming behavior that is less disruptive.
In the case of behaviors that others may see as odd, autistic people may need help devising strategies to delay engaging in those behaviors until they are alone or with nonjudgmental people. Or it may simply be that it is society, and not autistic people, who must change
The results lend fresh support to the argument that restricted and repetitive behaviors — a core diagnostic trait that includes repetitive movements, insistence on sameness, sensory sensitivities and restricted interests — are too diverse to be lumped together.
“This is a complex behavioral domain that comprises several different subdomains that likely have different causes and might respond to different treatments,” says Mirko Uljarević, senior research fellow at the University of Melbourne in Victoria, Australia, who led one of the studies
Sex difference:
Uljarević and his team analyzed parent-reported data on restricted and repetitive behavior severity, language abilities and cognitive functioning for 17,581 autistic children and teenagers in a genetic registry called SPARK. (SPARK is funded by the Simons Foundation, Spectrum’s parent organization.) They categorized the various types of restricted and repetitive behaviors into five groups: repetitive motor behaviors, insistence on sameness, self-injurious behaviors, compulsions and narrow interests.
Autistic boys have more severe repetitive motor behaviors and narrow interests than autistic girls do, whereas the opposite is true for compulsions and self-injurious behaviors, the study shows. More severe repetitive motor behaviors tended to track with lower levels of cognitive and language abilities and with younger age. The work appeared in August in the Journal of the American Academy of Child & Adolescent Psychiatry.
Narrow interests are also more pronounced among participants with a low intelligence quotient (IQ), the study suggests. But the questionnaire that parents completed — called the Repetitive Behavior Scale-Revised — does not distinguish narrow interests that are unusual in their intensity from those that are unusual in terms of content, Uljarević says. “It is clear that these two different types of interests possibly have different mechanisms and might be related in different ways to factors such as IQ.”
Together the studies support the notion that different restricted and repetitive behaviors have dynamic relationships with one another, and so strategies to ameliorate one might amplify another, Yerys says. For instance, a child who is particularly sensitive to sound may become accustomed to using headphones, setting her up for a greater insistence on sameness as she grows to depend on that routine.
Rather than targeting individual behaviors, clinicians might help autistic children and teenagers more by addressing the core issues that underlie those behaviors. For instance, fostering young autistic people’s executive functioning skills can help them be more flexible in the face of changes, Yerys says.
Addressing anxiety may also be beneficial, Courchesne says. Many autistic young people say that their restricted and repetitive behaviors help them regulate their emotions and self-soothe; focusing on emotional regulation rather than specific behaviors will likely yield more effective coping skills, she adds.
Over the past several years, however, autistic people have described a wide variety of functions that their repetitive behaviors serve.
Sometimes, they say, engaging in these behaviors just feels good. But beyond that, repetitive behaviors may offer these individuals a way to calm their anxiety, generate or maintain awareness of their bodies, focus their concentration or deal with overwhelming sensations or emotions. They may also help autistic people communicate their mental or emotional state to others.
The same behavior may serve different purposes in different people, or even in the same person at different times, depending on the situation or mood.
Refrence:
https://www.autismparentingmagazine.com
https://www.ambitiousaboutautism.org.uk
https://pubmed.ncbi.nlm.nih.gov
IMUTISM TEAM