Repetitive Behaviors In Autism Research Articles

Repetitive Behaviors in Autism and Obsessive-Compulsive Disorder: A Systematic Review.

Obsessive-compulsive disorder (OCD) and autism are characterized by the presence of repetitive behaviors. Differentiating between repetitive behaviors attributable to a diagnosis of autism, and those attributable to OCD, poses challenges for differential and co-occurring diagnosis. Differentiation is important to inform appropriate supports and interventions for phenotypically similar but functionally distinct behaviors. In this systematic review, the quantitative literature was examined to explore the similarities and differences in repetitive behaviors (including restricted and repetitive behaviors and interests, and obsessive-compulsive behaviors) in autistic individuals and those with OCD, and those with co-occurring diagnoses, in terms of: (1) expression, (2) content, and (3) associated factors. Thirty-one studies were identified that compared repetitive behaviors in autistic individuals, individuals with OCD, or individuals with both diagnoses. The results suggest considerable overlap in the intensity and content of repetitive behaviors between groups. The findings of this review highlight that research aimed specifically at understanding similarities and differences in repetitive behaviors between autistic individuals and individuals with OCD is limited and frequently only compare at total score or composite measure levels. Further research into differences in the presentation of repetitive behaviors at a subscale and item level is required to inform clearer differentiation of specific behaviors in autism versus OCD. Understanding and more accurately differentiating is essential for efficient diagnosis, effective treatment, and better outcomes.

Testing a Choline Diet in Neuroligin-Deficient C. elegans to Reduce Repetitive Behavior in Autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by obsessive adherence to repetitive motion and behavior. Previously my research tested whether neuroligin, a brain molecule and potential determinant of behavioral traits in autism, could be used in neuroligin-deficient C.elegans (strain NLG-1) to model autism. The experiment studied the sensitivity of neuroligin-deficient C. elegan to sensory stimuli, a core symptom of autism, and the results led to the conclusion that NLG-1 C. elegans could be used as a potential model for autism in worms. This project is a continuation study from last year that tested whether choline supplementation reduced repetitive locomotion in neuroligin-deficient C. elegans. Since people with neurological disorders are often deficient in the neurotransmitter acetylcholine, it was hypothesized that increasing the amount of choline, a building block of acetylcholine, would reduce repetitive behaviors. The C. elegans were age-synched to test three different age groups of worms, and over a 1-minute period, and the repetitive movement of the worms exposed to choline was compared to worms without choline using microscope camera software. The results showed the addition of choline in the diet significantly reduced the amount of repetitive locomotion in NLG-1 C. elegans in all 3 age groups. This study suggests that for people with ASD, adding choline to the diet in their daily schedule may help them reduce repetitive behavior. On a larger scale, scientists can use NLG-1 C. elegans to target neurochemical systems to develop early treatments, and ultimately reduce the significant deficits of autism.

COREAT: Developing a Mobile Application to Assess the Severity of Repetitive Behavior in Autism

<p style="text-align:justify">Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by difficulties in communication and repetitive behaviors. The early detection of ASD is a clinical priority in education centres and medical services. COREAT is a computer adaptation of the Repetitive Behavior Scale-Revised (RBS-R) which has been designed to facilitate the diagnosis of individuals with ASD and intellectual disability. This article describes the development, an initial evaluation of the feasibility and the preliminary outcomes of COREAT. The development of COREAT consists of two phases. Phase 1: Performing a prior analysis of the psychometric properties of the RBS-R scale. Phase 2: Developing the mobile application (pilot tests, testing real cases n = 11, and final feedback). Descriptive data of the pilot study shows that 91.31% of participants indicate that COREAT is very accessible and intuitive. COREAT proves to be a useful diagnostic resource for professionals and families. Cross-cultural differences must be analysed.</p>

Prenatal methotrexate injection increases behaviors possibly associated with depression and/or autism in rat offspring; A new animal model for mental disorder, based on folate metabolism deficit during pregnancy.

BackgroundDeficiency of folate, an essential vitamin for DNA synthesis and methylation, is reported as a risk factor for mental disorders. Considering a possibility that folate metabolism deficit during pregnancy may disturb CNS development and increase mental disorders in offspring, we treated pregnant rats with methotrexate (MTX), an inhibitor of folate metabolic enzyme, and evaluated offspring behaviors.MethodsSaline or MTX was intraperitoneally administered to female SD rats on gestational day 17. Offspring behaviors were evaluated during approximately 6–9 weeks old; prepulse inhibition (PPI), social interaction (SI), locomotor activity (LA), and forced swimming test (FST) for evaluation of schizophrenia, depression, and autism related behaviors; the elevated plus maze (EPM) and the light–dark box (LD) test for evaluation of anxiety.ResultsCompared to saline‐treated group, MTX‐treated group showed decrease of SI and increase of immobility time in FST. In addition, increases of time spent in the light box and shuttling between the light–dark boxes were observed in LD test. On the other hand, no changes were confirmed in EPM, LA, and PPI.ConclusionDecrease of SI and increase of immobility time in FST may suggest association of this animal model with depression and/or autism. Increase of time spent in the light box and shuttling between the light–dark boxes may indicate changes in anxiety or cognitive level to environment, or repetitive behaviors in autism. Although further studies are warranted to characterize this animal model, at least we can say that prenatal MTX exposure, possibly causing folate metabolism deficit, affects offspring behaviors.

Big Data Approach to Characterize Restricted and Repetitive Behaviors in Autism.

Despite being a core diagnostic feature of autism spectrum disorder (ASD), demographic, developmental and clinical correlates of restricted and repetitive behaviors and interests (RRB) remain poorly characterized. This study aimed to utilize the largest available RRB data set to date to provide a comprehensive characterization of how distinct RRB domains vary according to a range of individual characteristics. Data were obtained from 17,581 children and adolescents with ASD (meanage= 8.24 years, SDage= 4.06) from the Simons Foundation Powering Autism Research for Knowledge cohort. Caregivers completed the Repetitive Behavior Scale-Revised questionnaire as a measure of repetitive motor behaviors, self-injurious behaviors, compulsions, insistence on sameness, and circumscribed interests RRB domains. Caregivers also provided information on children's cognitive functioning, language ability, and social and communication impairments. Male sex was associated with higher severity of repetitive motor behaviors and restricted interests and with lower severity of compulsions and self-injurious behaviors; no sex differences were found for the insistence on sameness domain. Although repetitive motor behaviors showed a mostly linear (negative) association with age, other RRB domains showed more complex and nonlinear pattern of associations. Higher severity of social and communication impairments provided significant independent contribution in predicting higher severity of all RRB domains at the p< .001 level; however, these effects were small (d< 0.25). The strongest of these effects was observed for insistence on sameness (d= 0.24), followed by repetitive motor behaviors (d= 0.21), compulsions (d=0.17), restricted interests (d= 0.14), and self-injurious behaviors (d= 0.12). Findings reported here provide further evidence that RRB subdomains show a somewhat distinct pattern of associations with demographic, developmental, and clinical variables, with a key implication that separate consideration of these domains can help to facilitate efforts to understand diverse ASD etiology and to inform the design of effective interventions.

Understanding the Influence of Social and Motor Context on the Co-occurring Frequency of Restricted and Repetitive Behaviors in Autism.

The social and motor context in which restricted and repetitive behaviors (RRBs) occur in autism and their relationship to social traits are not well-understood. Participants with and without autism completed tasks that varied in social and motor engagement and RRB frequency was measured. Motor and verbal RRBs were most common, RRBs varied based on motor and social context for participants with autism, and social engagement was associated with lower motor and verbal RRBs. Significant correlations between RRBs and autism severity, social synchrony, and nonverbal mental age were also found. This research confirms the importance of context for understanding RRBs during on-going tasks and raises questions about whether the factors that elicit vocal and motor RRBs are unique for individual children.

Repetitive behaviors in autism are linked to imbalance of corticostriatal connectivity: a functional connectivity MRI study.

The neural underpinnings of repetitive behaviors (RBs) in autism spectrum disorders (ASDs), ranging from cognitive to motor characteristics, remain unknown. We assessed RB symptomatology in 50 ASD and 52 typically developing (TD) children and adolescents (ages 8–17 years), examining intrinsic functional connectivity (iFC) of corticostriatal circuitry, which is important for reward-based learning and integration of emotional, cognitive and motor processing, and considered impaired in ASDs. Connectivity analyses were performed for three functionally distinct striatal seeds (limbic, frontoparietal and motor). Functional connectivity with cortical regions of interest was assessed for corticostriatal circuit connectivity indices and ratios, testing the balance of connectivity between circuits. Results showed corticostriatal overconnectivity of limbic and frontoparietal seeds, but underconnectivity of motor seeds. Correlations with RBs were found for connectivity between the striatal motor seeds and cortical motor clusters from the whole-brain analysis, and for frontoparietal/limbic and motor/limbic connectivity ratios. Division of ASD participants into high (n = 17) and low RB subgroups (n = 19) showed reduced frontoparietal/limbic and motor/limbic circuit ratios for high RB compared to low RB and TD groups in the right hemisphere. Results suggest an association between RBs and an imbalance of corticostriatal iFC in ASD, being increased for limbic, but reduced for frontoparietal and motor circuits.

Repetitive behaviors in autism and obsessive-compulsive disorder: new perspectives from a network analysis.

The association between autism and obsessive-compulsive disorder (OCD) seems largely dependent upon observed similarities in the repetitive behaviors that manifest in both disorders. The aim of this study was to use a network approach to explore the interactions between these behaviors. We constructed a network based on clinician's perceptions as well as a network based on 213 clinically diagnosed children. In all networks, autism and OCD emerged as two distinct symptom clusters and obsessions and compulsions showed few direct associations with autism symptoms. Further, sensory interests were identified as behaviors that may contribute to the link between autism and OCD. Through network analysis, we expose the symptom pathways that may lead to the perceived association between autism and OCD.

Functional connectivity during cognitive control in children with autism spectrum disorder: an independent component analysis

Restrictive and repetitive behavior in autism may be related to deficits in cognitive control. Here, we aimed to assess functional connectivity during a cognitive control task and compare brain network activity and connectivity in children with autism spectrum disorders (ASD) and typically developing children using a multivariate data-driven approach. 19 high-functioning boys with ASD and 19 age-matched typically developing boys were included in this study. Functional magnetic resonance imaging was performed at 3T during the performance of a cognitive control task (go/no-go paradigm). Functional networks were identified using independent component analysis. Network activity and connectivity was compared between groups and correlated with clinical measures of rigid behavior using multivariate analysis of covariance. We found no differences between the groups in task performance or in network activity. Power analysis indicated that, if this were a real difference, it would require nearly 800 subjects to show group differences in network activity using this paradigm. Neither were there correlations between network activity and rigid behavior. Our data do not provide support for the presence of deficits in cognitive control in children with ASD, or the functional networks supporting this ability.Electronic supplementary materialThe online version of this article (doi:10.1007/s00702-014-1237-8) contains supplementary material, which is available to authorized users.

An Analysis of Treatment Efficacy for Stereotyped and Repetitive Behaviors in Autism

Stereotyped, repetitive, ritualistic, obsessive, and compulsive behaviors are a common feature for many individuals with autism, and multiple topographies of such behavior exist. Previous reviews have discussed treatments for stereotypy and repetitive behaviors; however, to date, none have systematically evaluated the efficacy of such treatments. An abundance of treatments based on the principles of applied behavior analysis exist within the literature; however, many assume that stereotypy is maintained by automatic reinforcement. The current review aimed to evaluate the efficacy of treatments for stereotypy across disciplines including behavioral, pharmacological, and sensory-based therapies. Furthermore, this review compares the efficacy of function-based and nonfunction-based treatments for stereotypy.

Changes in the Development of Striatum Are Involved in Repetitive Behavior in Autism

Repetitive behavior is a core feature of autism and has been linked to differences in striatum. In addition, the brain changes associated with autism appear to vary with age. However, most studies investigating striatal differences in autism are cross-sectional, limiting inferences on development. In this study, we set out to 1) investigate striatal development in autism, using a longitudinal design; and 2) examine the relationship between striatal development and repetitive behavior. We acquired longitudinal structural magnetic resonance imaging scans from 86 individuals (49 children with autism, 37 matched control subjects). Each individual was scanned twice, with a mean scan interval time of 2.4 years. Mean age was 9.9 years at time 1 and 12.3 years at time 2. Striatal structures were traced manually with high reliability. Multivariate analyses of variance were used to investigate differences in brain development between diagnostic groups. To examine the relationship with behavior, correlations between changes in brain volumes and clinical measures were calculated. Our results showed an increase in the growth rate of striatal structures for individuals with autism compared with control subjects. The effect was specific to caudate nucleus, where growth rate was doubled. Second, faster striatal growth was correlated with more severe repetitive behavior (insistence on sameness) at the preschool age. This longitudinal study of brain development in autism confirms the involvement of striatum in repetitive behavior. Furthermore, it underscores the significance of brain development in autism, as the severity of repetitive behavior was related to striatal growth, rather than volume per se.

More Research Needed on SSRIs for Treating Autism Disorders

Back to table of contents Previous article Next article Professional NewsFull AccessMore Research Needed on SSRIs for Treating Autism DisordersMark MoranMark MoranSearch for more papers by this authorPublished Online:1 Jun 2012https://doi.org/10.1176/pn.47.11.psychnews_47_11_11-aAbstractMeta-analysis of the published literature suggests a small but significant effect of SSRIs in the treatment of repetitive behaviors in autism spectrum disorders (ASDs), but this effect appears to be attributable to selective publication of trial results, according to a report published online April 23 in Pediatrics.The report concludes that without timely, transparent, and complete disclosure of trial results, it is difficult to determine the efficacy of available medications. And child psychiatrists and autism experts who reviewed the report told Psychiatric News that SSRIs are not as beneficial for repetitive behaviors in autism as they were once thought to be and should be used with caution.The study was conducted by Melisa Carrasco, Ph.D., Fred Volkmar, M.D., and Michael Bloch, M.D., M.S., of the University of Michigan and of the Child Study Center and Department of Psychiatry at Yale University.“This research made it clear that the effects of SSRI treatment in ASD are considerably overrated because of publication bias,” they wrote. “In addition, our search strategy uncovered as many completed SSRI trials in ASD with unpublished results as have been published, further supporting the influence of potential publication bias on effect estimates.”For the study, the researchers searched PubMed and Clinicaltrials.gov for randomized, double-blind, placebo-controlled trials evaluating the efficacy of SSRIs for repetitive behaviors in ASD; the primary outcome was mean improvement in ratings scales of repetitive behavior. They identified five published and five unpublished but completed trials eligible for meta-analysis.They used standard statistical methods for computing effect sizes from available data, then applied special statistical methods to adjust effect sizes for unpublished results or missing data.The meta-analysis of five published and one unpublished trial with available data demonstrated a small but significant effect of SSRIs for the treatment of repetitive behaviors in ASDs. But when analysis was adjusted for the effect of publication bias, there was no longer a significant benefit of SSRIs for the treatment of repetitive behaviors in ASDs. Secondary analyses demonstrated no significant effect of type of medication, patient age, method of analysis, trial design, or trial duration on SSRI efficacy.“This paper provides a helpful reminder of the ongoing problems posed by publication bias,” said child psychiatrist David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont and APA treasurer. “Utilizing a meta-analysis, the authors demonstrate that the published literature overstates the efficacy of SSRIs in the treatment of repetitive behaviors in children, adolescents, and adults with autism spectrum disorders. Physicians, patients, and family members need and deserve as much information as possible, including accurate and complete research data, to make fully informed decisions about treatment options. Selective publication of trial results can influence clinical practice, potentially placing patients at increased risk and/or postponing access to more appropriate and effective intervention.”Louis Kraus, M.D., an expert in autism, told Psychiatric News that there is a dearth of research evidence for effective treatments of the repetitive behaviors commonly seen in autism.Kraus said treatments for children are often extrapolated from research on adults, which may not be appropriate. And in the case of autism, the clinical logic behind using SSRIs rests on their efficacy for obsessive-compulsive disorder.“But the reality is that the data regarding effectiveness for stereotypic behaviors in autism is limited,” he said in an interview. “There is a concern that SSRIs are not as helpful as we once thought.”He cited a June 2009 article in the Archives of General Psychiatry that found no significant benefit for citalopram over placebo for repetitive behaviors. The article is titled “Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior.”Kraus added that children with autism are unusually sensitive to medication, and even a theoretical benefit from SSRIs is likely to be accompanied by an increase in agitation. “SSRIs may offer some benefit to some children, but in a general way clinicians should not use SSRIs for stereotypic behaviors without the understanding when getting informed consent from parents that the research is not definitive in this area,” Kraus said.Funding for the study was provided by the National Institute of Mental Health and the National Institutes of Health. “Pharmacologic Treatment of Repetitive Behaviors in Autism Spectrum Disorders: Evidence of Publication Bias” is posted at http://pediatrics.aappublications.org/content/early/2012/04/17/peds.2011-3285.full.pdf+html. “Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=210271. 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Cognitive Control of Intentions for Voluntary Actions in Individuals With a High Level of Autistic Traits

Impairments in cognitive control generating deviant adaptive cognition have been proposed to account for the strong preference for repetitive behavior in autism. We examined if this preference reflects intentional deficits rather than problems in task execution in the broader autism phenotype using the Autism-Spectrum Quotient (AQ). Participants chose between two tasks differing in their relative strength by indicating first their voluntary task choice and then responding to the subsequently presented stimulus. We observed a stronger repetition bias for the harder task in high AQ participants, with no other differences between the two groups. These findings indicate that the interference between competing tasks significantly contributes to repetitive behavior in autism by modulating the formation of task intentions when choosing tasks voluntarily.

Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

Brain growth rate abnormalities visualized in adolescents with autism.

Autism spectrum disorder is a heterogeneous disorder of brain development with wide ranging cognitive deficits. Typically diagnosed before age 3, autism spectrum disorder is behaviorally defined but patients are thought to have protracted alterations in brain maturation. With longitudinal magnetic resonance imaging (MRI), we mapped an anomalous developmental trajectory of the brains of autistic compared with those of typically developing children and adolescents. Using tensor-based morphometry, we created 3D maps visualizing regional tissue growth rates based on longitudinal brain MRI scans of 13 autistic and seven typically developing boys (mean age/interscan interval: autism 12.0 ± 2.3 years/2.9 ± 0.9 years; control 12.3 ± 2.4/2.8 ± 0.8). The typically developing boys demonstrated strong whole brain white matter growth during this period, but the autistic boys showed abnormally slowed white matter development (P = 0.03, corrected), especially in the parietal (P = 0.008), temporal (P = 0.03), and occipital lobes (P = 0.02). We also visualized abnormal overgrowth in autism in gray matter structures such as the putamen and anterior cingulate cortex. Our findings reveal aberrant growth rates in brain regions implicated in social impairment, communication deficits and repetitive behaviors in autism, suggesting that growth rate abnormalities persist into adolescence. Tensor-based morphometry revealed persisting growth rate anomalies long after diagnosis, which has implications for evaluation of therapeutic effects.

Factor Analysis of Repetitive Behaviors in Autism as Measured by the Y-BOCS

Factor Analysis of Repetitive Behaviors in Autism as Measured by the Y-BOCS

Factor Analysis of Repetitive Behaviors in Autism as Measured by the Y-BOCS

The authors carried out a factor analysis of the Yale-Brown Obsessive-Compulsive Scale checklist at the category level in order to reduce the number of variables in this domain and ultimately identify possible endophenotypes; 181 children with autism were enrolled. The authors estimated a tetrachoric correlation matrix among the dichotomous symptom categories and then used exploratory and confirmatory factor analyses to identify a clinically meaningful factor structure for this correlation matrix. Their analysis supported a four-factor solution: obsessions, higher-order repetitive behaviors, lower-order repetitive behaviors, and hoarding. These findings are another step in the effort to identify genetically and biologically distinct groups within this population.

Evidence-based behavioral interventions for repetitive behaviors in autism.

Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat "lower order" RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for "higher order" behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research.

Pharmacologic Rescue of Impaired Cognitive Flexibility, Social Deficits, Increased Aggression, and Seizure Susceptibility in Oxytocin Receptor Null Mice: A Neurobehavioral Model of Autism

Oxytocin (OT) has been suggested as a treatment to improve social behavior in autistic patients. Accordingly, the OT (Oxt(-/-)) and the OT receptor null mice (Oxtr(-/-)) display autistic-like deficits in social behavior, increased aggression, and reduced ultrasonic vocalization. Oxtr(-/-) mice were characterized for general health, sociability, social novelty, cognitive flexibility, aggression, and seizure susceptibility. Because vasopressin (AVP) and OT cooperate in controlling social behavior, learning, and aggression, they were tested for possible rescue of the impaired behaviors. Primary hyppocampal cultures from Oxtr(+/+) and Oxtr(-/-) mouse embryos were established to investigate the balance between gamma-aminobutyric acid (GABA) and glutamate synapses and the expression levels of OT and AVP (V1a) receptors were determined by autoradiography. Oxtr(-/-) mice display two additional, highly relevant, phenotypic characteristics: 1) a resistance to change in a learned pattern of behavior, comparable to restricted interests and repetitive behavior in autism, and 2) an increased susceptibility to seizures, a frequent and clinically relevant symptom of autism. We also show that intracerebral administration of both OT and AVP lowers aggression and fully reverts social and learning defects by acting on V1a receptors and that seizure susceptibility is antagonized by peripherally administered OT. Finally, we detect a decreased ratio of GABA-ergic versus total presynapses in hippocampal neurons of Oxtr(-/-) mice. Autistic-like symptoms are rescued on administration of AVP and OT to young Oxtr(-/-) adult animals. The Oxtr(-/-) mouse is thus instrumental to investigate the neurochemical and synaptic abnormalities underlying autistic-like disturbances and to test new strategies of pharmacologic intervention.

Children with high functioning autism show increased prefrontal and temporal cortex activity during error monitoring

Evidence exists for deficits in error monitoring in autism. These deficits may be particularly important because they may contribute to excessive perseveration and repetitive behavior in autism. We examined the neural correlates of error monitoring using functional magnetic resonance imaging (fMRI) in 8–12-year-old children with high functioning autism (HFA, n = 11) and typically developing children (TD, n = 15) during performance of a Go/No-Go task by comparing the neural correlates of commission errors versus correct response inhibition trials. Compared to TD children, children with HFA showed increased BOLD fMRI signal in the anterior medial prefrontal cortex (amPFC) and the left superior temporal gyrus (STempG) during commission error (versus correct inhibition) trials. A follow-up region-of-interest analysis also showed increased BOLD signal in the right insula in HFA compared to TD controls. Our findings of increased amPFC and STempG activity in HFA, together with the increased activity in the insula, suggest a greater attention towards the internally driven emotional state associated with making an error in children with HFA. Since error monitoring occurs across different cognitive tasks throughout daily life, an increased emotional reaction to errors may have important consequences for early learning processes.