Stereotypy Subscale Research Articles

Comparative Efficacy of Antipsychotic Medication for Stereotypic Behavior in Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Background: Stereotypic movements in autism form core symptoms under the rubric of repetitive and restricted patterns of behavior. Aim: The systematic review was aimed to find which antipsychotic has better efficacy in treating stereotypic behavior in autism spectrum disorder. Methods: We searched for journal publications in the English from PubMed and Cochrane databases (CENTRAL), January 1992–June 2024, for randomized controlled trials that compared antipsychotics with a placebo of at least 6 weeks’ trial, with the outcome measure being a change in stereotypy score. Quality assessment of the included studies in the meta-analysis was done using Cochrane risk of bias tool version 2. We followed PRISMA guidelines for systematic review. The mean difference in change of stereotypy symptoms score was calculated between antipsychotic and placebo participants along with 95% confidence interval (CI) using the random-effects model. Results: 146 studies were screened, and 25 studies were deemed eligible to retrieve full-length articles for review. A total of nine studies were included in the systematic review that had used aripiprazole, risperidone, or lurasidone as an antipsychotic. Six studies (n = 726) that had all data on mean difference in stereotypy scores on the Aberrant Behavior Checklist (ABC)-Stereotypy subscale and four studies (n = 554) that reported stereotypy scores using Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)-Compulsions subscale were included in the meta-analysis. Antipsychotics showed a significant reduction in ABC-Stereotypy scores (−1.84 [−2.84, −0.85; 95% CI], Z = 3.83, P < 0.001) with moderate heterogeneity between the studies (I 2 = 53%). Whereas, antipsychotics did not show significant improvement in compulsions as measured on CY-BOCS (−0.87 [−1.89, 0.16; 95% CI], Z = 1.65, P = 0.10). Conclusion: Stereotypy in autism is difficult to measure, and no uniform measure exists. Trials are limited to short duration and limited to few antipsychotics. Among antipsychotics, risperidone has robust efficacy in reducing stereotypic behaviors.

Effects of Aquatic Training in Children with Autism Spectrum Disorder

Simple SummarySwimming can be an alternative in the physical exercise curriculum to improve the motor abilities as well as the social behavior and communication skills of children with autism spectrum disorder (ASD) in schools and institutions. It is important to assess the effects of different forms of aquatic training (e.g., technical vs. game-based) to improve motor and stereotypy skills as well as emotion regulation in autistic children. This information should be of great interest to professionals to choose the appropriate training form to improve each of these abilities. The finding that both forms of swimming had a positive effect on gross motor skills and stereotyped behaviors in autistic children is in agreement with the accumulated evidence of swimming’s effectiveness to alleviate symptoms of motor and behavioral problems. In contrast, emotion regulation is not likely to improve after a short intervention period. The preliminary findings of this study are an important guidance for future researchers to further examine the neurophysiological and cognitive mechanisms of exercise–emotion and exercise–behavior relationships in children with ASD.A variety of aquatic training regimens have been found to be beneficial for individuals with autism spectrum disorders (ASD) in multiple domains. This study investigated and compared the efficacy of two aquatic training regimens (technical vs. game-based) on gross motor skills, stereotypy behavior and emotion regulation in children with ASD. Twenty-two autistic children were randomly assigned into three groups: two experimental groups performed either a technical aquatic program or a game-based aquatic program and a control group. Participants were assessed before and after an 8-week training period, with the Test of Gross Motor Development, the stereotypy subscale of the Gilliam Autism Rating Scale, and the Emotion Regulation Checklist. A significant effect for time was found in gross motor skills and stereotypy behavior in both experimental groups. An improvement in gross motor skills was observed in both experimental groups compared to the control group. A small pre-post change effect in emotion functioning was found in all groups. No significant differences were observed between the experimental groups in all assessed variables. Our findings provide additional evidence suggesting the effectiveness of beneficial effects of aquatic activities on the motor and social skills that underpin the hypothesis that motor and intellectual domains are highly interrelated in autistic children.

Aripiprazole for autism spectrum disorders (ASD).

Autism spectrum disorders (ASD) include autistic disorder, Asperger's disorder and pervasive developmental disorder - not otherwise specified (PDD-NOS). Antipsychotics have been used as a medication intervention for irritability related to ASD. Aripiprazole, a third-generation, atypical antipsychotic, is a relatively new drug that has a unique mechanism of action different from that of other antipsychotics. This review updates a previous Cochrane review on the safety and efficacy of aripiprazole for individuals with ASD, published in 2011 (Ching 2011). To assess the safety and efficacy of aripiprazole as medication treatment for individuals with ASD. In October 2015, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and seven other databases as well as two trial registers. We searched for records published in 1990 or later, as this was the year aripiprazole became available. Randomised controlled trials (RCTs) of aripiprazole (administered orally and at any dosage) versus placebo for treatment of individuals with a diagnosis of ASD. Two review authors independently collected, evaluated and analysed data. We performed meta-analysis for primary and secondary outcomes, when possible. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to rate the overall quality of the evidence. We included three trials in this review. Two were included in the previous published review, and the results of one, placebo-controlled discontinuation study were added to this review. Although we searched for studies across age groups, we found only studies conducted in children and youth. Included trials had low risk of bias across most domains. High risk of bias was seen in only one trial with incomplete outcome data. We judged the overall quality of the evidence for most outcomes to be moderate.Two RCTs with similar methods evaluated use of aripiprazole for a duration of eight weeks in 316 children/adolescents with ASD. Meta-analysis of study results revealed a mean improvement of -6.17 points on the Aberrant Behavior Checklist (ABC) - Irritability subscale (95% confidence intervals (CIs) -9.07 to -3.26, two studies, 308 children/adolescents, moderate-quality evidence), -7.93 points on the ABC - Hyperactivity subscale (95% CI -10.98 to -4.88, two studies, 308 children/adolescents, moderate-quality evidence) and -2.66 points on the ABC - Stereotypy subscale (95% CI -3.55 to -1.77, two studies, 308 children/adolescents, moderate-quality evidence) in children/adolescents taking aripiprazole relative to children/adolescents taking placebo. In terms of side effects, children/adolescents taking aripiprazole had a greater increase in weight, with a mean increase of 1.13 kg relative to placebo (95% CI 0.71 to 1.54, two studies, 308 children/adolescents, moderate-quality evidence), and had a higher risk ratio (RR) for sedation (RR 4.28, 95% CI 1.58 to 11.60, two studies, 313 children/adolescents, moderate-quality evidence) and tremor (RR 10.26, 95% CI 1.37 to 76.63, two studies, 313 children/adolescents, moderate-quality evidence). A randomised, placebo-controlled discontinuation study found that 35% of children/adolescents randomised to continue intervention with aripiprazole relapsed with respect to their symptoms of irritability, compared with 52% of children/adolescents randomised to placebo, for a hazard ratio of 0.57 (95% CI 0.28 to 1.12, 85 children/adolescents, low-quality evidence).All three included trials were supported by Bristol-Myers Squibb (Princeton, NJ) and Otsuka Pharmaceutical Company, Ltd. (Tokyo, Japan), with editorial support provided by Ogilvy Healthworld Medical Education and Bristol-Myers Squibb. Evidence from two RCTs suggests that aripiprazole can be effective as a short-term medication intervention for some behavioural aspects of ASD in children/adolescents. After a short-term medication intervention with aripiprazole, children/adolescents showed less irritability and hyperactivity and fewer stereotypies (repetitive, purposeless actions). However, notable side effects, such as weight gain, sedation, drooling and tremor, must be considered. One long-term, placebo discontinuation study found that relapse rates did not differ between children/adolescents randomised to continue aripiprazole versus children/adolescents randomised to receive placebo, suggesting that re-evaluation of aripiprazole use after a period of stabilisation in irritability symptoms is warranted. Studies included in this review used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (APA 2000) for ASD diagnosis; however, the diagnostic criteria for ASD changed significantly with release of the fifth edition of the DSM (DSM-5) in 2013 (APA 2013).

An examination of response variability in children with autism and the relationship to restricted repetitive behavior subtypes

The current study investigated response variability in children with autism and its relationship to restricted repetitive behaviors, one of the core symptoms of the disorder. The “Penny-Hiding Game” (Baron-Cohen, 1992) was used as a measure of response variability. Variability was compared for children with autism (n=65) and typically developing children (n=65) and patterns of response variability were categorized from least variable to most variable for both groups. For the participants with a diagnosis of autism, these patterns were examined relative to their scores on the Repetitive Behavior Scale-Revised (RBS-R; Bodfish, Symons, & Lewis, 1999). Results showed that children with autism demonstrated significantly lower variability in their responding in the “Penny-Hiding Game” than their typically developing peers. Variability was significantly negatively correlated with total RBS-R scores and with the Stereotypy subscale and the self-injurious behavior subscale, indicating that lower variability in responding was related to higher rates of these types of restricted and repetitive behaviors. No significant correlations were observed between variability and the Compulsion subscale, the Ritualistic/Sameness behaviors subscale or the Restricted Interests subscale.

Stereotyped behaviours in children with autism spectrum disorders and atypical development as measured by the BPI-01

Objective: As repetitive behaviours in children with autism spectrum disorders (ASDs) can significantly interfere with one's daily functioning, continued research on these behaviours is needed.Methods: This study examined the occurrence of repetitive motor movements in toddlers (17–37 months) with ASD and atypical development and the relationship between stereotypies and sensory impairment.Results: Children with ASD (n = 13) exhibited significantly more repetitive behaviours than the non-ASD group (n = 12). Greater percentages of endorsement were evident for the ASD group on nearly all items of the Behaviour Problems Inventory-01 (BPI-01) Stereotypy subscale. More repetitive behaviours tended to co-occur with other stereotypies for the ASD group. A moderate correlation was found between stereotypy severity and sensory deficits.Conclusion: These findings suggest that stereotyped behaviours can be identified at very young ages, negatively affect the behavioural presentation of those with ASDs and should be considered when developing treatment plans.

Differences in Stereotypic Behavior in Adults Diagnosed with Autism Spectrum Disorders Using the DSM-IV-TR and the DSM-5

The purpose of the current study was to investigate differences in the frequency of stereotypic behavior (e.g., engaging in repetitive activities; repetitive body movements such as rocking, spinning, handflapping; repetition of words or sounds; and perseveration on specific topics) using a psychometrically sound measure, the Diagnostic Assessment for the Severely Handicapped, second edition (DASH-II). The sample investigated included 261 adults with severe or profound intellectual disability (ID), 51 of whom met criteria for ASD according to the DSM-5; 84 of whom met criteria for the DSM-IV-TR, but no longer qualify for an ASD diagnosis with the new criteria; and a control group of 126 adults who did not qualify for an ASD diagnosis according to either version of the DSM. The DSM-5 captured a more impaired population in terms of stereotypies, though a significant difference remains between those who no longer meet criteria and a control group with ID who did not meet criteria for ASD under either version of the DSM. Highlights • Approximately 38 % of adults with ID currently meeting criteria for autism under the DSM-IV-TR did not meet the DSM-5 criteria. • Those who continued to meet criteria for ASD had higher scores on the DASH-II stereotypy subscale. • People meeting DSM-IV but not DSM-5 criteria had significantly more stereotypic behavior than adults without ASD.

Challenging Behaviors in Adults With Intellectual Disability: The Effects of Race and Autism Spectrum Disorders

Rates of challenging behaviors were assessed in 175 adults with intellectual disability (ID) or ID and a comorbid autism spectrum disorder (ASD). The relationship between ASD diagnosis, race, and challenging behaviors was assessed using the Autism Spectrum Disorders-Behavior Problems for Adults (ASD-BPA). Those with ASD and ID were found to exhibit significantly more challenging behaviors than those with ID alone. No significant main effect of race was found. However, a significant interaction between ASD diagnosis and race was found: In those with ASD, Caucasian participants exhibited more challenging behaviors than African Americans, whereas the opposite held true in those without ASD. Specific subscales of the ASD-BPA were also examined, with a significant interaction found on the Stereotypy subscale. Results and their implications are discussed.

A Randomized Controlled Pilot Trial of Oral N-Acetylcysteine in Children with Autism

An imbalance in the excitatory/inhibitory systems with abnormalities in the glutamatergic pathways has been implicated in the pathophysiology of autism. Furthermore, chronic redox imbalance was also recently linked to this disorder. The goal of this pilot study was to assess the feasibility of using oral N-acetylcysteine (NAC), a glutamatergic modulator and an antioxidant, in the treatment of behavioral disturbance in children with autism. This was a 12-week, double-blind, randomized, placebo-controlled study of NAC in children with autistic disorder. Subjects randomized to NAC were initiated at 900 mg daily for 4 weeks, then 900 mg twice daily for 4 weeks and 900 mg three times daily for 4 weeks. The primary behavioral measure (Aberrant Behavior Checklist [ABC] irritability subscale) and safety measures were performed at baseline and 4, 8, and 12 weeks. Secondary measures included the ABC stereotypy subscale, Repetitive Behavior Scale-Revised, and Social Responsiveness Scale. Thirty-three subjects (31 male subjects, 2 female subjects; aged 3.2-10.7 years) were randomized in the study. Follow-up data was available on 14 subjects in the NAC group and 15 in the placebo group. Oral NAC was well tolerated with limited side effects. Compared with placebo, NAC resulted in significant improvements on ABC irritability subscale (F = 6.80; p < .001; d = .96). Data from this pilot investigation support the potential usefulness of NAC for treating irritability in children with autistic disorder. Large randomized controlled investigations are warranted.

Behavior problems: Differences among intellectually disabled adults with co-morbid autism spectrum disorders and epilepsy

Behavior problems such as aggression, property destruction, stereotypy, self-injurious behavior, and other disruptive behavior are commonly observed among adults with intellectual disabilities (ID), autism spectrum disorders (ASD), and epilepsy residing at state-run facilities. However, it is unknown how these populations differ on behavior problem indicies. Assessment of behavior problems were made with the ASD–behavior problems-adult version battery. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups, Wilks's Λ = .79, F(12, 246) = 1.93, p < .05. The multivariate η 2 based on Wilks's Λ was .08. A one-way ANOVA was conducted for each of the four subscales of the ASD–BPA as follow-up tests to the MANOVA. Groups differed on the aggression/destruction subscale, F(3, 96) = .79, p > .05, η 2 = .03, and stereotypy subscale, F(3, 96) = 2.62, p > .05, η 2 = .08. No significant differences were found on the self-injury subscale and disruptive behavior subscale. Trend analysis demonstrated that individuals with ID expressing combined co-morbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single co-morbid factor with ID (ASD or epilepsy only) on these four subscales. Implications of these findings in the context of known issues in ID, epilepsy, and ASD, current assessment practices among these populations and associated challenges are discussed.

The Behavior Problems Inventory: Reliability and Factor Validity in Institutionalized Adults with Intellectual Disabilities

Background The aim of this study was to reevaluate the reliability (internal consistency, inter‐rater and re‐test) and the factor structure of the Behavior Problems Inventory (BPI‐01) with adults with intellectual disabilities who resided in a state‐run developmental centre.Methods BPI‐01 was administered to informants who had known participants for a minimum of 6 months. For study 1, data were collected in two samples: 100 residents who were selected based on the challenging behaviour targeted in their behaviour treatment plan and 325 randomly selected residents.Results The internal consistencies of the BPI‐01 subscales were in the good to excellent range. Overall, the inter‐rater and test–re‐test reliability of the subscales and items were adequate with relatively lower reliability found for the Stereotypy subscale and items. For study 2, the data of the 425 participants from study 1 were used in a confirmatory factor analysis, which indicated that three a priori BPI‐01 subscales (Self‐Injurious Behavior, Stereotyped Behavior and Aggression/Destruction) were a reasonable fit.Conclusions The current study provides additional support to the reliability and factor structure of the BPI‐01 in adults with intellectual disabilities.

Convergent validity of the aberrant behavior checklist and behavior problems inventory with people with complex needs

The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404] by examining the convergent validity of the behavior problems inventory (BPI) and the aberrant behavior checklist (ABC) for individuals presenting with multiple complex behavior problems. Data were collected from 69 children and adults with severe intellectual disabilities and challenging behavior living in residential establishments. MANCOVA analyses showed that individuals with elevated BPI stereotyped behavior subscale scores had higher scores on ABC lethargy and stereotypy subscales, while those with elevated BPI aggressive/destructive behavior subscale scores obtained higher scores on ABC irritability, stereotypy and hyperactivity subscales. Multiple regression analyses showed a corresponding pattern of results in the prediction of ABC subscale scores by BPI subscale scores. Exploratory factor analysis of the BPI data suggested a six-factor solution with an aggressive/destructive behavior factor, four factors relating to stereotypy, and one related to stereotypy and self-injury. These results, discussed with reference to Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404], support the existence of relationships between specific subscales of the two instruments in addition to an overall association between total scores related to general severity of behavioral disturbance.

Down syndrome and comorbid autism‐spectrum disorder: Characterization using the aberrant behavior checklist

To report on the cognitive and behavioral attributes of 61 children with Down syndrome (DS) and autistic-spectrum disorder (ASD) according to DSM-IV criteria; to determine the utility of the aberrant behavior checklist (ABC) to characterize these subjects for research purposes; and to test the hypothesis that subjects with DS + ASD could be distinguished from their typical DS peers using the ABC. Cross-sectional design. Cases with DS + ASD (N = 61), comparison group of DS + stereotypy movement disorder (SMD) (N = 26) and typical DS controls without behavior problems (N = 44) were ascertained and enrolled sequentially upon presentation to a DS clinic at an academic medical center over a 10-year period from 1991 to 2001. All subjects underwent neurodevelopmental and medical evaluation, and standardized cognitive testing. The parents provided responses to standardized behavioral questionnaires. Cognitive function (IQ) differed markedly across the three groups. The Lethary and Stereotypy subscales of the ABC were highly significant (P < 0.001) in distinguishing the three groups from one another. Within the ASD group differences were apparent by DSM-IV type on the Lethargy subscale, which reached significance, ANOVA (F = 0.002) and t-test (Autism > PDD, P = 0.005; PDD < CDD, P = 0.002). Using a multivariate regression model, the ABC scales alone explained 62% of variance of ASD outcome; addition of demographic variables explained up to 68% of the variance. There is good correlation between DSM-IV criteria for autism and subscales scores on the ABC in subjects with DS. This study demonstrates the feasibility of using the ABC to characterize the neurobehavioral phenotype of a cohort of children with trisomy 21 and ASD for ongoing research purposes.

Excessive infant crying and later behaviour problems: Findings of the bavarian longitudinal study (BLS)

The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404] by examining the convergent validity of the behavior problems inventory (BPI) and the aberrant behavior checklist (ABC) for individuals presenting with multiple complex behavior problems. Data were collected from 69 children and adults with severe intellectual disabilities and challenging behavior living in residential establishments. MANCOVA analyses showed that individuals with elevated BPI stereotyped behavior subscale scores had higher scores on ABC lethargy and stereotypy subscales, while those with elevated BPI aggressive/destructive behavior subscale scores obtained higher scores on ABC irritability, stereotypy and hyperactivity subscales. Multiple regression analyses showed a corresponding pattern of results in the prediction of ABC subscale scores by BPI subscale scores. Exploratory factor analysis of the BPI data suggested a six-factor solution with an aggressive/destructive behavior factor, four factors relating to stereotypy, and one related to stereotypy and self-injury. These results, discussed with reference to Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404], support the existence of relationships between specific subscales of the two instruments in addition to an overall association between total scores related to general severity of behavioral disturbance.

The effect of stereotypies on adaptive skills as assessed with the DASH-II and Vineland Adaptive Behavior Scales

The relationship of the Stereotypy subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to adaptive functioning was investigated. Differences in adaptive skills measured with the Vineland Adaptive Behavior Scales (VABS) for individuals scoring at or above the cutoff of the Stereotypy scale and below the cutoff of the scale were analyzed. Individuals with high stereotypy scores had significantly lower VABS scores. Implications of these findings for assessment and treatment are discussed.