Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorders. They constitute a major barrier to learning and social adaptation, but research on their definition, cause, and capacity for change has been relatively neglected. The last decade of research has brought new measurement techniques that have improved the description of RRBs. Research has also identified distinctive subtypes of RRBs in autism spectrum disorders. Research on potential causal origins and immediate triggers for RRBs is still at an early stage. However, promising new ideas and evidence are emerging from neurobiology and developmental psychology that identify neural adaptation, lack of environmental stimulation, arousal, and adaptive functions as key factors for the onset and maintenance of RRBs. Further research is needed to understand how these factors interact with each other to create and sustain atypical levels of RRB. The literature indicates that RRBs have the potential to spontaneously reduce across time, and this is enhanced for those with increased age and cognitive and language ability. Research on interventions is sparse. Pharmacological treatments can be helpful in some children but have adverse side effects. Behavioral intervention methods provide the better intervention option with positive effects, but a more systematic and targeted approach is urgently needed. Evidence suggests that we will learn best from the last decade of research by taking a developmental perspective, by directing future research toward subtypes of RRBs, and by implementing early intervention targeted to improve RRBs before these behaviors become entrenched.

/pdf/restricted-and-repetitive-behaviors-in-autism-spectrum-33awy7yi0u.pdf

Restricted and repetitive behaviors in autism spectrum disorders: a review of research in the last decade.

This study tested the effect of reductions in children's anxiety over time on improvements in school performance and social functioning in the context of participation in a cognitive-behavioral intervention program. Participants included 40 children with high anxiety (6-13 years of age). Independent evaluators, children, and parents rated child anxiety; parents rated school performance; and children and parents rated social functioning. Measures were completed at preintervention, midintervention, and postintervention. Fixed-effects regression analyses and random-effects regression analyses indicated that decreased anxiety was predictive of improved school performance and social functioning over the course of the intervention. These findings suggest that changes in anxiety influence trajectories of children's scholastic and social functioning.

https://psycnet.apa.org/journals/dev/42/2/345.pdf

Effect of anxiety reduction on children's school performance and social adjustment

This article reports on school functioning for 227 youth ages 7-14 (M = 10.3) with principal diagnoses of separation anxiety disorder (n = 40), social phobia (n = 58), generalized anxiety disorder (n = 76), or no diagnoses (n = 53). School functioning data were gathered via parent and teacher report. Youth with no diagnoses demonstrated significantly higher levels of school functioning than those with separation anxiety disorder, social phobia, or generalized anxiety disorder. The specific anxiety-disordered groups were differentiated to some degree on parent and teacher report of school functioning. Analyses revealed that differences were often attributable to increasingly complex comorbidity. These results underscore the need for services for youth with anxiety given the range of challenges they face in the school environment. ********** Reviews of epidemiologic studies conclude that anxiety disorders are common and possibly the most prevalent category of disorder in youth (Albano, Chorpita, & Barlow, 2003; Bernstein & Borchardt, 1991; Chavira, Stein, Bailey, & Stein, 2004). Using diagnostic criteria (e.g., Diagnostic Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR]; American Psychiatric Association, 2000), prevalence rates of anxiety disorders in children and adolescents range from 2% to 27%, depending on age, measure/assessment used, and assessment interval (Costello, Egger, & Angold, 2004). Yet, despite initial efforts (e.g., Phillips, 1978) and the high prevalence of anxiety disorders in youth, the relationship between anxiety and school functioning remains understudied. Surprisingly, a search of four major school psychology journals (e.g., School Psychology Review, Journal of School Psychology, School Psychology Quarterly, and Psychology in the Schools) has revealed a dearth of published studies involving a specific focus on the overlap between DSM-classified anxiety disorders typically found among school-age children and the associated influence on school functioning. Only a very small number (e.g., Callahan, Panichelli-Mindel, & Kendall, 1996; Wood, Chiu, Hwang, Jacobs, & Ifekwunigwe, 2008) have addressed this topic area. The literature highlights a number of deleterious outcomes linked to anxiety as rated by various informants. Children with anxiety tend to be rated by peers as being shyer and more socially withdrawn (Coplan, Girardi, Findlay, & Frohlick, 2007), and are rated as less popular and less likeable, relative to children who are not anxious (Nelson, Rubin, & Fox, 2005). Other studies (e.g., Kashani et al., 1990) have compared parent report of anxious youth to those who are not anxious, finding more difficulties experienced among the former group across ages. Strauss, Frame, and Forehand (1987) found that children classified as highly anxious by their teachers exhibited greater psychosocial difficulties and problems with adjustment than did children rated as nonanxious. Moreover, the effects of anxiety are not confined to childhood and adolescence, but can lead to problems in later functioning. Negative sequelae of childhood anxiety include adult anxiety disorders, mood disorders, and substance use problems (Kendall, Safford, Flannery-Schroeder, & Webb, 2004; Woodward & Fergusson, 2001). In considering contexts likely to produce anxiety for youth, the school environment emerges as especially salient, offering no lack of stress-producing stimuli for youth. Indeed, Langley, Bergman, McCracken, and Piacentini (2004) found that school-related stressors were among the most frequently endorsed as causing significant interference by their sample of youth with an anxiety disorder. Furthermore, numerous school-related "hassles" (e.g., peers, schoolwork, teachers, homework, and parent-school relations) affecting elementary and middle school children have been found to be significantly correlated with internalizing disorders such as anxiety (Barrett & Heubeck, 2000; Heubeck & O'Sullivan, 1998). …

School Functioning in Youth with and without Anxiety Disorders: Comparisons by Diagnosis and Comorbidity.

The purpose of the study was to evaluate neuropsychological and behavioral rating measures of executive functions (EF) in children with two subtypes of ADHD, Asperger syndrome (AS), and controls. Relative to the control group, the clinical groups experienced more difficulty in EF. The AS group showed the most difficulty in emotional control, behavioral regulation, fluid reasoning, and planning compared to the ADHD groups. Number of symptoms of ADHD or AS was found to be significantly related to ratings of difficulty with behavior regulation, metacognition, and general behavioral regulation across the sample. These findings indicate that children with AS or ADHD may have a differing EF profile and thus, may respond differentially to interventions.

Executive Functioning in Children with Asperger Syndrome, ADHD-Combined Type, ADHD-Predominately Inattentive Type, and Controls.

Cluster analysis of test scores on expressive phonology and comprehension of words and sentences in 7-9-year-old children with preschool diagnosis of Autistic Disorder yielded 4 clusters. Cluster 1 (N = 11): phonology and comprehension both low; Cluster 2 (N = 4): phonology low, near average comprehension; Cluster 3 (N = 40): average phonology, comprehension low to low average; Cluster 4 (N = 7): average or better phonology and comprehension. The clusters support two major types of language disorders in autism driven by impaired expressive phonology, each divisible by comprehension ability. The clusters refute a single language disorder in autism and are consonant with earlier-defined clinical subtypes.

Subtypes of Language Disorders in School-Age Children With Autism

https://webs.wofford.edu/boppkl/courseFiles/Psy150/Labs/SocialLab/BarrettHeubeck_Hassles%20and%20Uplifts%20in%20school%20behavior.pdf

Relationships Between School Hassles and Uplifts and Anxiety and Conduct Problems in Grades 3 and 4

A sample of 37 children aged 4-7 years who all showed some autistic features was investigated. Children with a primary diagnosis of autism were compared with those diagnosed with a language disorder, on behaviours within four domains; social behaviour, imaginative activities, repetitive behaviour and communication. The aim was to identify potentially differentiating features of the two groups using observational ratings and questionnaire measures provided by parents and teachers. Information on participants' intelligence and language skills was also collected. The children with autism showed greater deficits in joint attention, functional play and pragmatic language, and engaged in more repetitive behaviours, than the language disordered children. However, the groups did not differ significantly on formally assessed language skills. A cluster analysis produced three groups of children varying in level of functioning and parent-rated behaviours. The results are informative for clinicians dealing with the challenge of differential diagnosis.

Children on the Borderlands of Autism Differential Characteristics in Social, Imaginative, Communicative and Repetitive Behaviour Domains

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Relationships Between School Hassles and Uplifts and Anxiety and Conduct Problems in Grades 3 and 4

Children on the Borderlands of Autism Differential Characteristics in Social, Imaginative, Communicative and Repetitive Behaviour Domains