Repetitive Behavior

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Repetitive Behavior


Basic Characteristics

  • Description

Children with ASD may display repetitive or stereotyped behaviors. This is a wide ranging set of behaviors where one is excessively interested in a narrow scope of topics. People with ASD may have inflexible mannerisms and a preoccupation with parts of a whole, like how children with ASD may be more interested in the wheels of a toy car rather than the car. They may have strong desires to watch the same movie or read the same book over and over again.1

RRBs are important to understand because they interfere with the ability to learn from and pay attention to the external world, as well as interfering with social and communicative development. They are also reported as the behavior that causes the most stress from parents of children with ASD. A factor analysis of the RRB items of the ADI-R found evidence for two factors. The first factor encompasses repetitive sensorimotor (RSM) behaviors like hand and finger and complex body mannerisms, repetitive use of objects, and unusual sensory interests. The second factor is made up of behaviors related to an individual's insistence on sameness (IS). These behaviors include compulsions and rituals, difficulties with changes in routine, and resistance to trivial changes in the environment. This factor analysis has been replicated in other data sets, with the same result.5,6,7 RSM behaviors are fairly common in ASD two year olds, while IS behaviors are more rare.5

The trajectories of IS and RSM behaviors differ. Variables that are associated with the two behaviors and which predict patterns of change over the time are also different.5

  • Characteristics Linked to Restricted/Repetitive Behaviors

Lower Nonverbal IQ(NVIQ) has been linked to RSMs.8 Links between cognitive profiles or skills and IS behaviors are convoluted. RSMs in children with ASD tend to stay stable or decrease over time while IS behaviors tend to increase slightly in severity and number as the child gets older.4 However, there is variability in the trajectory of IS behaviors, with some ASD children showing a sharp increase over time.5

  • History

Restricted and Repetitive Behaviors (RRBs) as a core symptom has received less attention than the other core deficits of Social/Communicative and Joint Attention. RRBs are distinct from these other core deficits, since many children with other disorders that involve social or language difficulties do not exhibit RRBs. Additionally, RRBs have even been reported in typically developing children.

Tests to Assess Repetitive Behaviors

Some studies(Richler (2010) ) that have specifically looked at ASD populations use the items on the ADI-R that are specifically classified as Restricted and Repetitive Behavior items.



There are some medications that may help in reducing repetitive behaviors.

Haloperidol, a potent postsynaptic dopamine-receptor antagonist, has been shown to have results in treatment of serious behavioral problems but has short and long term side effects. 2

Risperidone is an atypical antipsychotic agent that blocks postsynaptic serotonin receptors. The affinity of these agents for serotonin receptors may enhance their efficacy and provide protection against extrapyramidal symptoms. Alternatively, atypical antipsychotic agents may be more easily displaced by endogenous dopamine, which reduces the risk of neurologic side effects. Reports have indicated atypical antipsychotic agents have shown results with both positive and negative symptoms in Adults with Schizophrenia. In one eight-week, double-blind, randomized, placebo-controlled trial of Risperidone among 101 autistic children with tantrums, aggression, self-injurious behavior, the group assigned to take Risperidone had a 56.9% decrease in the mean irritability score in the Clinical Global Impression and Irritability subscare of the Aberrant Behavior while only a 14.1% decrease was seen in the placebo group. These gains in the Risperidone group lasted for 6 months after treatment ended in 68% of the children. Adverse effects were weight gain, fatigue, and drowsiness. The side effects subsided within 4-6 weeks into treatment. Parents or caretakers reported neurologic side effects of tremors, which was most common, dyskinesia, rigidity, akathisia, and difficulty swallowing.2

One recent large placebo controlled randomized trial to test the efficacy of Citalopram, a selective serotonin reuptake inhibitor, in treatment of repetitive behaviors in children with ASD did not support the prescription of Citalopram to treat repetitive behaviors in ASD. In the study, there was no difference between the citalopram group and placebo group after 12 weeks of treatment according to scores on the Clinical Global Impressions, the CYBOCS-PDD criteria, or any of the 6 subscale scores of the Repetitive Behavior Scale-Revised. Furthermore, adverse events such as increased energy levels, impulsiveness, decreased concentruation, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus were significantly more likely to occur in the citalopram treatment group (97.3% vs. 86.8% in the placebo group). Nightmares also occurred in 6.8% of the citalopram treatment group while there were no reported cases of nightmares in the placebo group. The rationale for prescribing Citalopram for treatment of repetitive behaviors in ASD children was based on previous studies which shows that the drug is effective in treatment for repetitive behaviors in patients with Obsessive Compulsive Disorder. However, it may be that repetitive behaviors in Obsessive Compulsive Disorder is fundamentally different from repetitive behaviors exhibited by ASD children. 3

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1. Bertoglio, Kiah and Robert L. Hendren. New Developments in Autism.Psychiatr Clin North Am. 2009 Mar;32(1):1-14. PMID 19248913

2. McCracken JT et. al. Risperidone in children with autism and serious behavioral problems.N Engl J Med. 2002 Aug 1;347(5):314-21. PMID 12151468

3. King, BH et. al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009 Jun;66(6):583-90. PMID 19487623

4. Richler J et. al. Developmental trajectories of restricted and repetitive behaviors and interests in children with autism spectrum disordersDev Psychopathol. 2010 Winter;22(1):55-69. PMID 20102647

5. Richler J et. al. Restricted and repetitive behaviors in young children with autism spectrum disorders. J Autism Dev Disord. 2007 Jan;37(1):73-85. PMID 17195920

6. Szatmari P et. al. Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. J Child Psychol Psychiatry. 2006 Jun;47(6):582-90. PMID 16712635

7. Cuccaro ML et. al. Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry Hum Dev. 2003 Fall;34(1):3-17. PMID 14518620

8. Bishop SL et. al. Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders.Child Neuropsychol. 2006 Aug;12(4-5):247-67.PMID 16911971

Related Information

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