Repetitive and Restricted Behaviors in Infants at Risk for ASD: Comparing Caregiver Report and Observational Measurement

Background: Diagnostic criteria for autism spectrum disorder (ASD) necessitate significant impairment in social communication behaviors and the presence of restricted and repetitive behaviors (RRBs). Early identification research has dedicated most of it’s attention to social communication impairments, leaving a gap understanding early manifestations of RRBs. Studies have found infants exhibiting the highest frequency and variety of RRBs were at highest risk (HR) for ASD (Wolff, et al., 2014) which indicates the ability of RRBs to augment early identification tools in detecting early manifestations of ASD (Elison, et al., 2014). Many of the studies examining RRBs have used caregiver report, yet researchers have yet to validate caregivers’ ability to recognize these behaviors in infancy.

Objectives: The goal of this study is to examine if caregiver reports of RRBs relate to observational coding in an infant population exhibiting risk for ASD. Infant characteristics such as DQ and 12- month follow up ADOS scores were also explored to further characterize the potential developmental impact early RRB presentations have on infants at risk.

Methods: Thirty-two infants between 15 and 29 months old (M=22) completed a caregiver-child play interaction (CCX) and caregiver questionnaires including the Parent PDD Behavior Inventory (PDDBI). The CCX was discretely coded for RRB frequencies across 6 domains: object, visual, verbal, hand/body, sensory seeking and sensory aversion. Subscales from the PDDBI corresponding to each RRB domain were analyzed to determine the correlation between caregiver report and observational coding of RRBs. Further, child characteristics such as their developmental quotient and 12-month follow up ADOS scores were analyzed to determine relationships between RRB presentation and these areas of development.

Results: Results indicate that the only RRB domain that showed a significant relationship between caregiver report and observational coding score was for sensory-seeking behaviors (S/S) (r_s = .417, p = .018). In fact, observed frequencies of S/S behaviors was the only domain to have a significant correlation to the follow-up ADOS (r_s =.507, p = .01). Interestingly, the observed RRB domains of object, visual, verbal and hand/body were significantly correlated with each other (all p < .05) and with the total observed RRBs (all p < .01); yet S/S and sensory aversion (S/A) did not follow this pattern.  

Conclusions: These findings highlight several important factors in studying RRBs early in development. First, there is extreme heterogeneity in early RRB manifestation, yet with the utilization of observational measures, patterns have emerged across studies such as the domain of repetitive object use being most endorsed. Results indicate S/S behaviors may be an important domain, which did not correlate with more commonly rated RRBs; yet may provide insight into the emerging understanding of early RRB presentation and the implications for improving early detection practices.