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Abstract

Although repetitive behaviors are a core diagnostic domain for autism spectrum disorders, research in this area has been neglected. This study had two major aims: (1) to provide a detailed characterization of repetitive behaviors in individuals with Asperger Syndrome (AS), high-functioning autism (HFA), and typically developing controls (TD); and (2) to examine whether differences in repetitive behavior profiles could provide evidence for the external validity of AS separate from HFA. Specifically, it was hypothesized that circumscribed interests would be more prevalent and cause more impairment in the AS group than the HFA group, while the reverse would be true for other categories of repetitive behavior. The parent(s) of 61 children and adolescents (19 with AS, 21 with HFA, and 21 TD) completed two interviews focused specifically on lifetime and current repetitive behavior symptoms. No reliable differences in repetitive behavior between AS and HFA children were found. Results suggested that circumscribed interests differ in developmental course from the three other DSM-IV-TR categories of repetitive behavior. Internal consistency among the four DSM-IV-TR categories of repetitive behavior was high, alpha = .84, providing evidence for a unitary repetitive behaviors factor. The importance of expanding research in the repetitive behavior domain is highlighted as part of the necessary integration of behavioral and neurobiological approaches to understanding the etiology of autism.
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... Comparisons of levels of SB, often represented by screen time (ST), between youth with ASD and youth with ND lead to mixed conclusions. Heavy ST use is well documented among youth with ASD (Stiller & Mößle, 2018), and several studies report higher levels of ST among youth with ASD compared to youth with ND (Chonchaiya et al., 2011;Engelhardt et al., 2013;Kuo et al., 2015;South et al., 2005). On the contrary, however, studies comparing levels of ST between youth with ASD and youth with ND have also reported no differences (McCoy et al., 2016;Montes, 2016;Potvin et al., 2013). ...
... On the contrary, however, studies comparing levels of ST between youth with ASD and youth with ND have also reported no differences (McCoy et al., 2016;Montes, 2016;Potvin et al., 2013). Difference in trajectories of ST use with age do, however, appear to differ between youth with ASD and ND; ST levels appear to be positively associated with age among youth with ASD and are negatively associated with age among youth with ND (Montes, 2016;Must et al., 2014;South et al., 2005). In other words, ST increases with age for youth with ASD and ST decreases for youth with ND. ...
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Lay abstract: To date, studies using cross-sectional methodologies make up a majority of the literature surrounding children with autism spectrum disorders and participation in physical activity and screen time. Longitudinal studies are needed to examine how physical activity and screen time behaviors co-develop for children with and without an autism spectrum disorder. To address this research gap, this study compared how physical activity and screen time levels changed over time (from 9 to 18 years of age) between youth with autism spectrum disorder and youth with neurotypical development. Data on the levels of moderate-to-vigorous physical activity, light physical activity, television-, and video game-based screen time, collected as a part of the "Growing up in Ireland" study, were compared between youth with autism spectrum disorder and a propensity-matched sample of youth with neurotypical development (n = 88 per group; 176 in total). Robust regression analyses indicated that children with autism spectrum disorder became less active over time compared to children with neurotypical development and that video game screen time also differed significantly between the groups when children were 9 years old. These findings elucidate important disparities present between these groups of children during pivotal developmental times.
... A SPEECH factor may represent a more clinically relevant symptom domain among preschool-aged children since increased expressive language skills developed during preschool years may be accompanied by emergence of unusual speech patterns. In contrast to previous three-factor models found among older age ranges and in line with findings for younger children, a distinct circumscribed interest (CI) factor did not emerge for the preschool-age ASD group, as circumscribed interests have been associated with higher developmental level and may increase in severity with age (South et al. 2005). Further, the circumscribed interest item has typically been excluded for children under 3 years of age when using the ADI-R. ...
... Differing associations between RRBs and clinical characteristics have been found for distinct RRB subtypes across prior studies (Bruckner and Yoder 2007;Harrop et al. 2014;Honey et al. 2007;Joseph et al. 2013;Mahone et al. 2004). For example, some studies have reported that "lower-order" RRBs, including repetitive use of objects, hand and finger mannerisms, and some sensory behaviors, are associated with younger age, lower nonverbal cognitive functioning, decreased adaptive skills, and more severe social communication deficits, while "higher-order" RRBs, such as insistence on sameness, ritualistic behaviors, and circumscribed interests are more prevalent in older children with ASD and are associated with higher nonverbal cognitive levels (Baranek et al. 2007;Bishop et al. 2006;Lam et al. 2008;Richler et al. 2010;South et al. 2005). ...
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Prior studies investigating restricted and repetitive behavior (RRB) subtypes within autism spectrum disorder (ASD) have found varied factor structures for symptom groupings, in part, due to variation in symptom measurement and broad sample age ranges. This study examined RRBs among 827 preschool-age children, ages 35 to 71 months, through an exploratory factor analysis of RRB items from the Autism Diagnostic Interview-Revised (ADI-R) collected through the Study to Explore Early Development. The factor structures of RRBs among children with confirmed ASD versus those with non-autism developmental concerns were qualitatively compared. Correlations between RRB factors and participant characteristics were examined in the ASD group. Three conceptually well-defined factors characterized as repetitive sensorimotor behaviors (RSMB), insistence on sameness (IS), and a novel stereotyped speech (SPEECH) factor emerged for the ASD group only. Distinct factors were supported by different clinical correlates. Findings have implications for improving differential diagnosis and understanding of ASD symptomatology in this age range.
... Research examining changes in SI with age in individuals with ASD is inconsistent. There is evidence of a decline in the number of SIs with age as well as changes in the types and intensity of SIs (Baron-Cohen and Wheelwright 1999;Shattuck et al. 2007;South et al. 2005). It is unclear how intensity changes over time with some indications that intensity of SIs increases with age (South et al. 2005). ...
... There is evidence of a decline in the number of SIs with age as well as changes in the types and intensity of SIs (Baron-Cohen and Wheelwright 1999;Shattuck et al. 2007;South et al. 2005). It is unclear how intensity changes over time with some indications that intensity of SIs increases with age (South et al. 2005). However, age effects have not been consistently replicated (Anthony et al. 2013;Cho et al. 2017). ...
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Special interests (SIs) are part of the diagnostic criteria for autism spectrum disorder (ASD). Though they can have both positive and negative effects on functioning and long-term outcomes, research on SIs is limited. This pilot study used a newly developed parent-report measure, the Special Interest Survey, to characterize SIs in 1992 children with ASD. The mean number of current special interests reported was 9, with television, objects, and music being most commonly endorsed interests. The mean age of onset reported across all categories was 5.24 years, with duration of past interests most often exceeding 2 years. Age of onset, interference, and relative unusualness of the SI was varied across categories. Interference was significantly correlated with the unusualness of the SIs.
... Indeed, the prevalence and presentation of RRBIs vary considerably across individuals (Bradley et al. 2016;Leekam et al. 2011) depending on several individual-specific variables such as age, gender, symptom severity, cognitive functioning, language skills, adaptive functioning. For instance, low-level RRBIs (e.g., stereotyped, repetitive motor movements and object use; sensory behaviors; Rapp and Vollmer 2005;South et al. 2005) have been typically observed in children with younger age, greater developmental delays, and/or lower cognitive ability (Prior and Macmillan 1973;Turner 1999), whereas high-level RRBIs (e.g. perseverative interests; repetitive questioning, obsessions, and compulsions; Boyd et al. 2012) have been observed in children with higher cognitive and language abilities (Bishop et al. 2006;Esbensen et al. 2009;Richler et al. 2010). ...
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by restricted, repetitive patterns of behavior and interests (RRBIs). With the latest update to the Diagnostic and Statistical Manual of Mental Disorders, a severity level rating is assigned to the two core features of ASD (American Psychiatric Association in Diagnostic and statistical manual of mental disorders 5 American Psychiatric Association Washington, D.C., 2013). Previous studies have identified factors associated with RRBI severity; however, the relationship among RRBIs, adaptive functioning, and diagnostic severity level remains unclear. The present study investigated whether adaptive functioning and parent-reported ASD symptoms predict RRBI severity in young children with ASD. Additionally, a fine-grained analysis was conducted to examine the factors associated with diagnostic severity level ratings. Several significant associations were found. Study findings and implications for assessment and treatment of RRBIs are discussed.
... In some cases, RRB in children can have a distressing and negative impact for the child and their family members (7). RRB can interfere with learning opportunities, community participation, aspects of health such as sleep and nutrition, and deplete child, parent and sibling wellbeing (8). Examples observed by practitioners include: an elaborate and rigid bedtime routine lasting 3 hours or more; a restricted diet of only 5 different foods; a repetitive pattern of pinching members of the public in order to hear them squeal. ...
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Background: Restricted and repetitive behaviours vary greatly across the autism spectrum, and although not all are problematic some can cause distress and interfere with learning and social opportunities. We have, alongside parents, developed a parent group based intervention for families of young children with autism, which aims to offer support to parents and carers; helping them to recognise, understand and learn how to respond to their child’s challenging restricted repetitive behaviours. Methods: The study is a clinical and cost effectiveness, multi-site randomised controlled trial of the Managing Repetitive Behaviours (MRB) parent group intervention versus a psychoeducation parent group Learning about Autism (LAA) (n=250; 125 intervention/125 psychoeducation; ~83/site) for parents of young children aged 3-9 years 11 months with a diagnosis of autism. All analyses will be done under intention-to-treat principle. The primary outcome at 24 weeks will use Generalised Estimating Equation (GEE) to compare proportion of children with improved RRB between the MRB group and the LAA group. The GEE model will account for the clustering of children by parent groups using exchangeable working correlation. All secondary outcomes will be analysed in a similar way using appropriate distribution and link function. The economic evaluation will be conducted from the perspective of both NHS costs, and family access to local community services. A ‘within trial’ cost-effectiveness analysis with results reported as the incremental cost per additional child achieving at least the target improvement in CGI-I scale at 24 weeks. Discussion This is an efficacy trial to investigate the clinical and cost effectiveness of a parent group based intervention designed to help parents understand and manage their child’s challenging RRB. If found to be effective this intervention has the potential to improve the well-being of children and their families, reduce parental stress, greatly enhance community participation and potential for learning, and improve longer-term outcomes. Trial Registration: Trial ID: ISRCTN15550611 Date registered: 07/08/2018 URL: https://doi.org/10.1186/ISRCTN15550611
... The main aim of this study was to investigate developmental differences in learning processes underlying cognitive flexibility and the effect of various types of feedback using a probabilistic reversal learning task in children and adolescents. The secondary aim was to explore possible relationships with subclinical measures of ASD symptomatology, with a specific interest in restrictive and repetitive behavior, since it has been proposed that impairments in cognitive flexibility may contribute to this domain (South et al., 2005;D'Cruz et al., 2013). We therefore (1) tested a sample of children and adolescents in order to compare both age groups; (2) used various kinds of feedback including social (i.e., an actor posing thumbs up and smiling versus an actor gazing straight with a neutral expression), individual (i.e., favorite hobby of each participant versus pixelated video of the hobby), and control (i.e., a check mark versus a cross) feedback within participants performing a probabilistic reversal learning task; and (3) used reinforcement learning and HGF models to infer the psychological mechanisms underlying the learning processes and potential individual differences. ...
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Cognitive flexibility helps us to navigate through our ever-changing environment and has often been examined by reversal learning paradigms. Performance in reversal learning can be modeled using computational modeling which allows for the specification of biologically plausible models to infer psychological mechanisms. Although such models are increasingly used in cognitive neuroscience, developmental approaches are still scarce. Additionally, though most reversal learning paradigms have a comparable design regarding timing and feedback contingencies, the type of feedback differs substantially between studies. The present study used hierarchical Gaussian filter modeling to investigate cognitive flexibility in reversal learning in children and adolescents and the effect of various feedback types. The results demonstrate that children make more overall errors and regressive errors (when a previously learned response rule is chosen instead of the new correct response after the initial shift to the new correct target), but less perseverative errors (when a previously learned response set continues to be used despite a reversal) adolescents. Analyses of the extracted model parameters of the winning model revealed that children seem to use new and conflicting information less readily than adolescents to update their stimulus-reward associations. Furthermore, more subclinical rigidity in everyday life (parent-ratings) is related to less explorative choice behavior during the probabilistic reversal learning task. Taken together, this study provides first-time data on the development of the underlying processes of cognitive flexibility using computational modeling.
... Then bacterial concentrations were determined by measuring optical density (OD) at 600 nm through time series. (OD600 = 1.0 is around 10 8 cell mL −1 ) , South, Ozonoff, & McMahon, 2005. ...
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Background: antibacterial agent based on herbal extracts is considered an attractive area for developing countries. Nevertheless, herbal aqueous extracts usually show drawbacks, such as long-term volatility, poor bioavailability and rapid burst release. Methodology: In this study, polymer films were prepared from poly (vinyl alcohol) (PVA) blended with poly (vinylpyrrolidone) (PVP)and cross-linked with glutaraldehyde (GA), then post-loaded with T. indica, C. pepo, H. sabdriffol, and L. nobilis hot water extracts. The effects of two polymers (PVA, PVP) and of the incorporated extracts were studied concerning the physical and in vitro bacterial growth inhibition properties of films; additionally, the antioxidant activity of each extracts was investigated. Results: The results showed improved swelling behaviour and mechanical properties (tensile strength, tensile modulus, and % elongation at break) of the cross-linked PVA/PVP films (CPP) compared to pure PVA (PV) films. Plant extracts conferred significant antibacterial effects to (CPP) films toward E. coli (ATCC 25922) and S. aureus (ATCC 25923). Also, both T. indica and H. sabdriffol extracts showed strong antioxidant against DPPH in vitro. Conclusion: The prepared films showed significant antibacterial activities, specifically in films loaded with the T.indica extract against E. Coli and in films loaded with C.pepo and L.nobilis against S.aureus.
... Intense interests are a common symptom of autism spectrum disorder (ASD) (South et al., 2005;Turner-Brown et al., 2011;Klin et al., 2013) and are a specific kind of Restricted and Repetitive Behavior (RRB) (American Psychiatric Association, 2013). The current study focuses on the possible relationship between intense interests and visual processing. ...
Article
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Intense interests are a core symptom of autism spectrum disorders (ASD) and can be all-encompassing for affected individuals. This observation raises the hypothesis that intense interests in ASD are related to pervasive changes in visual processing for objects within that category, including visual search. We assayed visual processing with two novel tasks, targeting category search and exemplar search. For each task, three kinds of stimuli were used: faces, houses, and images personalized to each participant’s interest. 25 children and adults with ASD were compared to 25 neurotypical (NT) children and adults. We found no differences in either visual search task between ASD and NT controls for interests. Thus, pervasive alterations in perception are not likely to account for ASD behavioral symptoms.
Article
This study aimed to characterize the relationship between insistence on sameness (IS), executive functioning (EF) and anxiety among individuals with PTEN mutations and individuals with macrocephalic ASD. The sample included 38 individuals with PTEN mutation and ASD diagnosis (PTEN-ASD; Mage = 8.93 years, SDage = 4.75), 23 with PTEN mutation without ASD (PTEN-no ASD; Mage = 8.94 years; SDage = 4.85) and 25 with ASD and macrocephaly but with no PTEN mutation (Macro-ASD; Mage = 11.99 years; SDage = 5.15). The final model accounted for 45.7% of variance in IS, with Set-Shifting EF subdomain as a unique independent predictor (t = 4.12, p < 0.001). This investigation provides the first preliminary evidence for the EF-anxiety-IS interrelationship in individuals with PTEN mutations and with macrocephalic ASD.
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The present study compared individuals with high-functioning autism (HFA) and Asperger disorder (AD) in intellectual, motor, visuospatial, and executive function domains. Participants with AD demonstrated significantly higher Verbal and Full Scale IQ scores, significantly larger Verbal-Performance IQ discrepancies, and significantly better visual-perceptual skills than those with HFA. Once the superior intellectual abilities of the AD group were controlled (both statistically through analysis of covariance and by examining IQ-matched subgroups of HFA and AD participants), no significant group differences in motor, visuospatial, or executive functions were evident, save a marginally significant trend toward poorer fine motor performance in the AD group. This suggests that AD may simply be "high-IQ autism" and that separate names for the disorders may not be warranted. The relation of these findings to theories of autism and AD are discussed.