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Restrictive & Repetitive Behaviors in ASD


Autism spectrum disorder (ASD) is a neurocognitive disorder impeding upon an individual’s ability to develop typical social abilities and behaviors. ASD typically develops in early childhood (Razjouyan et al., 2020). There is no singular cause for the ASD, however, there is much speculation that it is influenced by both genetic and environmental causes. It is speculated that some risk factors to developing ASD include having a sibling with ASD, having older parents, having Down Syndrome, Fragile X Syndrome, or Rett Syndrome, and having a low birth weight/premature birth (NIMH, 2018). Since there is no singular cause, a cure is yet to be discovered.

There are many symptoms associated with ASD, which may include repetitive patterns of behaviors (echolalia), making little eye contact, having a robotic/flat tone of voice, difficulty communicating and interacting with people, inability to understand another person’s point of view, and limited interests (NIMH, 2018). Since ASD is a spectrum and different people experience different levels of severity in their symptoms, each intervention plan must be individualized according to the individual’s symptoms and in accordance to where they fall on the spectrum (NIMH, 2018).

Some common interventions include applied behavioral analysis (ABA), floor time, sensory integration, nutritional approach, and music therapy (NIMH, 2018). It has been discovered that the earlier these interventions are applied, the more positive the developmental outcome will be for the child (Razjouyan et al., 2020).

Restrictive & Repetitive Behaviors

Often times, the most prevalent symptom is restrictive and repetitive behaviors, it would be beneficial to explore different interventions that work on improving the ability to manage these behaviors in a social setting. Repetitive and restrictive behaviors can include motor movements such as hand-flapping, rocking back-and-forth, the repetitive use of objects such as toys or repeatedly turning a light switch on and off. More severe symptoms include adhering to a strict routine or insisting that items must remain in the same place they put them in, such as lining up cars and insisting that they are not moved from their position (Herscu et al., 2020). These behaviors are broken down into four topographical categories: (1) stereotypy, (2) insistence on sameness, (3) perseverative interests, and (4) hyper/hypo reactivity to sensory input or unusual interest in sensory (Raulston et al., 2019). Stereotypy includes repetitive motor movements, object use, and repetitive vocalized responses. Insistence on sameness is when the child experiences difficulty when their routine changes, also ritualized behaviors falls within this category as well. Perseverative interests involves fascinations with unusual objects or topics that are often not age appropriate. Lastly, hyper/hypo reactivity involves unusual responses to certain sensory inputs such as smell, tastes, textures, and visual items (e.g. light, reflections, movement). Similarly, an individual may demonstrate under-reactivity to the aforementioned sensory inputs (Raulston et al., 2019). These symptoms are a highly common characteristic among individuals with ASD and has been known to interfere with their ability to learn new things, complete daily tasks, and process academic instruction (Herscu et al., 2020). Additionally, many individuals with ASD experience anxiety as their repetitive or restrictive behaviors typically take place in an effort to manage the distress connected to the compulsive behavior. Furthermore, a significant association has been discovered between repetitive and restrictive behaviors and aggression, which in turn effects the stress levels of the caregiver (Herscu et al., 2020).

The Autism Diagnostic Interview-Reviser (Lord et al., 1994), the Autism Diagnostic Observation Schedule-2 (Lord et al., 2012), and the Repetitive Behavior Scale-Revised (Bodfish et al., 2000) have separated repetitive and restrictive behaviors into two categories; repetitive sensory motor behaviors, and insistence on sameness behaviors (Herscu et al., 2020).

Intervention Process

For restrictive and repetitive behaviors, there are a few different options to consider when deciding which one will be best. Some interventions include medication, psychological therapy, and educational and skill-building interventions (NIMH, 2018). These interventions can help to learn necessary life-skills that will help him to live independently as one grows older, reduce challenging behaviors, and increase communication and social skills (NIMH, 2018). With successful intervention, ASD symptoms can be reduced in such a way that improves the independence, health, and overall well-being of the individual with ASD (Missouri Autism Guidelines Initiative, 2012).

Intervention is a constant and ongoing process that is broken down into three steps; (1) assessment planning for intervention, including: identifying goals choosing which intervention is best suited for the individual, and deciding which procedures to adapt in order to monitor the progress, (2) creating an individualized plan, and (3) using the data from monitoring the progress to adjust intervention strategies and goals accordingly (Missouri Autism Guidelines Initiative, 2012).

Intervention Step One: Assessment

During the first step of assessment, the following essential areas need to be analyzed first: cognitive and academic functioning, adaptive functioning, social/emotional/behavioral functioning, communication, sensory/motor functioning, comprehensive medical exam, and family functioning (Missouri Autism Guidelines Initiative, 2012). Furthermore, these areas need to be based off the clinical indicators, intervention history, prior assessments, and existing/current concerns and priorities (Missouri Autism Guidelines Initiative, 2012).

Intervention Step Two: Developing a Plan

The second step of the intervention process is focused on creating a plan and is further broken down into three components: identifying goals, selecting interventions, and determining progress monitoring procedures (Missouri Autism Guidelines Initiative, 2012).

Intervention Step Three: Monitoring Progress

The last step in the intervention process involves monitoring the progress of the selected intervention plan and procedures taking place. This is where the data is collected in order to further assess and ensure that targeted areas are improving towards the identified goal.

Intervention Strategies

Medication can be helpful in managing restrictive and repetitive behaviors as it would inhibit his compulsion to do them. One common medication used to do this is called a selective serotonin reuptake inhibitor (SSRI), which can help to reduce the obsessive-compulsive symptoms associated with repetitive and restrictive behaviors, however there is limited evidence supporting its effectiveness among individuals with ASD (Herscu et al., 2020).

Another intervention strategy could involve environmental enrichment and exercise, along with consequence-based strategies involving different kinds of reinforcement and punishment procedures (Raulston et al., 2019).

Conclusion

In conclusion, there are a few intervention options that could be taken into consideration when determining how to treat repetitive and restrictive behaviors. Those options include medication, environmental enrichment, and using consequence-based strategies. There are limitations to all three intervention strategies, however it is important to remember that intervention planning is an ongoing process that involves constant re-adjustments in order to evolve the way the individual does throughout their treatment program.

 

References

Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30, 237–243.

Herscu, P., Handen, B. L., Arnold, L. E., Snape, M. F., Bregman, J. D., Ginsberg, L., Hendren, R., Kolevzon, A., Melmed, R., Mintz, M., Minshew, N., Sikich, L., Attalla, A., King, B., Owley, T., Childress, A., Chugani, H., Frazier, J., Cartwright, C., & Murphy, T. (2020).

The SOFIA Study: Negative Multi-center Study of Low Dose Fluoxetine on Repetitive

Behaviors in Children and Adolescents with Autistic Disorder. Journal of Autism &

Developmental Disorders, 50(9), 3233–3244. https://doi-

org.proxy1.ncu.edu/10.1007/s10803-019-04120-y

Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule (ADOS2) (2nd ed.). Torrance, CA: Western Psychological Services.

Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

Missouri Autism Guidelines Initiative. (2012). Autism Spectrum Disorders: Guide to Evidence-Based Interventions.

National Institute of Mental Health (NIMH) (2018). Autism spectrum disorder. Retrieved February 07, 2021, from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

Raulston, T. J., Hansen, S. G., Machalicek, W., McIntyre, L. L., & Carnett, A. (2019). Interventions for Repetitive Behavior in Young Children with Autism: A Survey of Behavioral Practices. Journal of Autism & Developmental Disorders, 49(8), 3047–3059. https://doi-org.proxy1.ncu.edu/10.1007/s10803-019-04023-y

Razjouyan, K., Miri, M., Zarei, M., Farhangdoost, H., & Tavakoli, S. (2020). Study of the

effectiveness of comprehensive, timely, and family-oriented interventions in reducing the symptoms of autism in children. Journal of Family Medicine & Primary Care, 9(6),

2945–2949. https://doi-org.proxy1.ncu.edu/10.4103/jfmpc.jfmpc_947_19






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