Repetitive and restricted behaviours and anxiety in autism spectrum disorder: protocol for a systematic review and meta-analysis

Tegan Sellick,Katrina Williams,Alexandra Ure

doi:10.1186/s13643-021-01830-2

Abstract

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder defined by persistent deficits in social functioning and the presence of restricted and repetitive behaviours (RRBs). RRBs refer to four subtypes of behaviour including repetitive movements, speech, or use of objects; insistence on sameness; restricted interests; and sensory processing abnormalities. Many individuals with ASD also experience anxiety, which compounds ASD-related difficulties and inhibits daily functioning. RRBs have been found to be positively associated with anxiety; however, our understanding of the interplay between RRB subtypes and anxiety remains unclear. Thus, the current review aims to clarify the association between RRBs and anxiety by conducting a systematic review and meta-analysis.MethodsTo identify relevant studies, we will search five databases: CINAHL Plus, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, PsycINFO, and Scopus. Articles included in the review will have their titles, abstracts, and full texts reviewed by two independent authors and their methodological quality assessed via the modified Newcastle-Ottawa Scale. Random-effects meta-analyses will then be conducted to calculate the pooled association between RRB subtypes and anxiety. Sensitivity analyses will also be conducted to assess the potential impact of bias, missing data, outliers, and methodological differences on this relationship. Additionally, this review will collate the factors which may influence the anxiety-RRB relationship to help identify who is most vulnerable to developing anxiety.DiscussionThis will be the first review to examine the association between the four subtypes of RRBs and anxiety in individuals with ASD. Understanding this relationship, and the factors associated with this, may help clinicians understand the different underpinnings and presentations of anxiety within this population with potential implications for assessment and treatment.Systematic review registrationPROSPERO CRD42020185434

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by persistent deficits in social functioning and the presence of restricted and repetitive behaviours (RRBs) [1]
Eligibility criteria Observational studies will be included in the review if they meet the following eligibility criteria: 1. The sample consists of participants with a diagnosis of ASD under the Diagnostic and Statistical Manual of Mental Disorders (DSM) (DSM-III, DSM-III-R, DSM-IV, DSM-IV-TR, or DSM-5), International Classification of Diseases (ICD: ICD-9, ICD-10, or ICD-11), or an equivalent diagnosis from the Autism Diagnostic Interview – Revised, Autism Diagnostic Observation Schedule, or Childhood Autism Rating Scale
Data extraction A standardised form will be utilised by two reviewers to extract the following data for each study: (1) study details including the study design; (2) sample size; (3) participant demographics including gender, age, intelligence quotient (IQ), level of functioning, and severity of ASD symptoms; (4) how ASD diagnoses were confirmed; (5) anxiety type/s investigated; (6) anxiety measure/s used; (7) RRB subtype/s investigated; (8) RRB measure/s used; (9) factors associated with RRBs and anxiety; (10) reported outcomes, statistical analyses, adjustments, and significance; and (11) information for assessing methodological quality

Summary

Methods

Eligibility criteria Observational studies will be included in the review if they meet the following eligibility criteria: 1. The sample consists of participants with a diagnosis of ASD under the DSM (DSM-III, DSM-III-R, DSM-IV, DSM-IV-TR, or DSM-5), International Classification of Diseases (ICD: ICD-9, ICD-10, or ICD-11), or an equivalent diagnosis from the Autism Diagnostic Interview – Revised, Autism Diagnostic Observation Schedule, or Childhood Autism Rating Scale. Data extraction A standardised form will be utilised by two reviewers to extract the following data for each study: (1) study details including the study design; (2) sample size; (3) participant demographics including gender, age, IQ, level of functioning, and severity of ASD symptoms; (4) how ASD diagnoses were confirmed; (5) anxiety type/s investigated; (6) anxiety measure/s used; (7) RRB subtype/s investigated; (8) RRB measure/s used; (9) factors associated with RRBs and anxiety; (10) reported outcomes, statistical analyses, adjustments, and significance; and (11) information for assessing methodological quality (see Additional file 2). Data analysis and synthesis Research questions 1 and 2 For each study, the association between anxiety symptoms and RRB subtypes and the association between different RRB subtypes will be reported, including whether the association is unadjusted or adjusted. Whether a factor significantly mediates or moderates the anxiety-RRB relationship will be reported

Discussion

Background

Findings