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 as a whole. They may have strong desires to watch the same movie or read the same book over and over again.1

  • Intervention

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 in 68% of the children. Adverse effects were weight gain, fatigue, and drowsiness. The 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

  • References

1. Bertoglio, Kiah and Robert L. Hendren. New Developments in Autism. 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

Related Information

  • Indicators (dependent variables, conditions, or contrasts; measurement variables used for analysis) associated with this construct (vote or nominate by editing this page):
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External Resources

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