Journal of Autism and Developmental Disorders

, Volume 38, Issue 8, pp 1518–1533 | Cite as

Repetitive and Stereotyped Behaviors in Children with Autism Spectrum Disorders in the Second Year of Life

  • Nola Watt
  • Amy M. Wetherby
  • Angie Barber
  • Lindee Morgan
Original Paper


This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, = 50), developmental delays without ASD (DD; = 25) and typical development (TD, = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.


Repetitive stereotyped behavior Autism spectrum disorder Second year 



This research was supported in part by a grant from the National Institutes of Health, National Institute on Deafness and Other Communication Disorders (R01DC007462) and a grant from the U.S. Department of Education, Office of Special Education and Rehabilitation Services (H324C030112). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or USDOE. The authors would like to thank the families who gave their time to participate in this project.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
  2. Bakeman, R., & Gottman, J. M. (1997). Observing interaction: An introduction to sequential analysis (2nd ed.), New York: Cambridge University Press.Google Scholar
  3. Bishop, S. L., Richler, J., & Lord, C. (2006). Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychology, 12, 247–267.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. Bopp, K. D., Mirenda, P., & Smith, V. (2005, November). Predictors of outcomes for children with autism receiving early intervention. Paper presented at the annual American Speech, Language, and Hearing Association (ASHA) convention, San Diego, CA.Google Scholar
  6. Bruckner, C. T., & Yoder, P. (2006). Interpreting kappa in observational research: Baserate matters. American Journal on Mental Retardation, 111, 433–441.PubMedCrossRefGoogle Scholar
  7. Charman, T., & Swettenham, J. (2001). Repetitive behaviors and social-communicative impairment in autism: Implications for developmental theory and diagnosis. In J. A. Burack, T. Charman, N. Yirmiya, & P. R. Zelazo (Eds.), The development of autism: Perspectives from theory and research (pp. 325–345). New Jersey: Lawrence Erlbaum Associates.Google Scholar
  8. Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500–513.PubMedCrossRefGoogle Scholar
  9. Cohen, J. (1960). Coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.CrossRefGoogle Scholar
  10. Cohen, J. (1988). Statistical power analyses for the behavioral sciences (2nd ed.), Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  11. Cox, A., Klein, K., Charman, T., Baird, G., Baron-Cohen, S., Swettenham, J., Wheelright, S., & Drew, A. (1999). Autism spectrum disorders at 20 and 42 months of age: stability of clinical and ADI-R diagnosis. Journal of Child Psychology and Psychiatry, 40, 719–732.PubMedCrossRefGoogle Scholar
  12. Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., et al. (2003). Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry and Human Development, 34, 3–17.PubMedCrossRefGoogle Scholar
  13. Einfeld, S. L., & Tonge, B. J. (2002). Manual for the developmental behavioural checklist: Primary career version (DBC-P) and teacher version (DBC-T) (2nd ed.). Melbourne: University of New South Wales and Monash University.Google Scholar
  14. Evans, D. W., Leckman, J. F., Carter, A., Reznick, J. S., Henshaw, D., King, R. A., & Pauls, D. (1997). Ritual, habit, and perfectionism: The prevalence and development of compulsive-like behavior in normal young children. Child Development, 68, 58–68.PubMedCrossRefGoogle Scholar
  15. Fleiss, J. S. (1981). Statistical methods for rates and proportions. New York: Wiley.Google Scholar
  16. Gardenier, N., MacDonald, R., & Green, G. (2004). Comparison of direct observational methods for measuring stereotypic behavior in children with autism spectrum disorders. Research in Developmental Disabilities, 25, 99–118.PubMedCrossRefGoogle Scholar
  17. Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627.PubMedCrossRefGoogle Scholar
  18. Honey, E., McConachie, H., Randle, V., Shearer, H. & Le Couteur, A. (in press). One-year change in repetitive behaviours in young children with communication disorders including autism. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-006-0191-1
  19. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.Google Scholar
  20. Krug, D., Arick, J., & Almond, P. (1979). Autism screening instrument for educational planning: Background and development. In J. Gilliam (Ed.), Autism: Diagnosis, instruction, management and research. Austin: University of Texas Press.Google Scholar
  21. Lewis, M. H., & Bodfish, J. W. (1998). Repetitive behavior disorders in autism. Mental Retardation and Developmental Disabilities, 4, 80–89.CrossRefGoogle Scholar
  22. Lord, C. (1995). Follow-up of 2 year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36, 1365–1382.PubMedCrossRefGoogle Scholar
  23. Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorder. Journal of Autism and Developmental Disorders, 24, 659–685.PubMedCrossRefGoogle Scholar
  24. Lord, C., & Pickles, A. (1996). Language level and nonverbal social-communicative behaviors in autistic and language-delayed children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1542–1550.PubMedCrossRefGoogle Scholar
  25. Lord, C., Rutter, M., DiLavore, P., & Risi, S. (2002). Autism diagnostic observation schedule. ADOS manual. Los Angeles: Western Psychological Services.Google Scholar
  26. McCathren, R. B., Yoder, P. J., & Warren, S. F. (2000). Testing predictive validity of the communication composite of the communication and symbolic behavior scales. Journal of Early Intervention, 23, 36–46.CrossRefGoogle Scholar
  27. McWilliam, R. A., & Ware, W. B. (1994). The reliability of observations of young children’s engagement: An application of generalizability theory. Journal of Early Intervention, 18, 34–47.CrossRefGoogle Scholar
  28. Mervis, C. B., & Klein-Tasman, B. P. (2004). Methodological issues in group-matching designs: levels for control variable comparisons and measurement characteristics of control and target variables. Journal of Autism and Developmental Disorders, 34, 7–17.PubMedCrossRefGoogle Scholar
  29. Mitchell, S. K. (1979). Interobserver agreement, reliability, and generalizability of data collected in observational studies. Psychological Bulletin, 86, 376–390.CrossRefGoogle Scholar
  30. Mooney, E. L., Gray, K. M., & Tonge, B. J. (2006). Early features of autism: Repetitive behaviours in young children. European Child and Adolescent Psychiatry, 15, 12–18.PubMedCrossRefGoogle Scholar
  31. Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Autism, 7, 47–63.PubMedGoogle Scholar
  32. Mundy, P., Sigman, M., & Kasari, C. (1994). Joint attention, developmental level, and symptom presentation in autism. Development and Psychopathology, 6, 389–401.Google Scholar
  33. Mullen, E. (1995). The Mullen scales of early learning. Circle Pines, MN: American Guidance.Google Scholar
  34. Schopler, E., Reichler, R. J., Bashford, A., Lansing, M. D., & Marcus, L. M. (1990). Individualized assessment and treatment for autistic and developmental disabled children—Volume 1: Psychoeducational Profile-Revised (PEP-R) (Vol. 1). Texas: ProEd.Google Scholar
  35. Sparrow, S., Balla, D., & Cicchetti, D. (1984). Vineland adaptive behavior scales. Circle Pines, MN: American Guidance Service.Google Scholar
  36. Stone, W. L., Lee, E., Ashford, L., Brissie, J., Hepburn, S., Coonrod, E., & Weiss, B. (1999). Can autism be diagnosed accurately in children under 3 years? Journal of Child Psychology and Psychiatry, 40, 219–226.PubMedCrossRefGoogle Scholar
  37. Symons, F. J., Sperry, L. A., Dropik, P. L., & Bodfish, J. W. (2005). The early development of stereotypy and self-injury: A review of research methods. Journal of Intellectual Disability Research, 49, 144–158.PubMedCrossRefGoogle Scholar
  38. Thelen, E. (1979). Rhythmical stereotypies in normal human infants. Animal Behaviour, 27, 699–715.PubMedCrossRefGoogle Scholar
  39. Thelen, E. (1981). Kicking, rocking, and waving: Contextual analysis of rhythmical stereotypies in normal human infants. Animal Behaviour, 29, 3–11.PubMedCrossRefGoogle Scholar
  40. Turner, M. (1999). Annotation: Repetitive behavior in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40, 839–849.PubMedCrossRefGoogle Scholar
  41. Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry, 62, 889–895.PubMedCrossRefGoogle Scholar
  42. Werner, E., Dawson, G., Munson, J., & Osterling, J. (2005). Variation in early developmental course in autism and its relations with behavioral outcome at 3–4 years of age. Journal of Autism and Developmental Disorders, 35, 337–350.PubMedCrossRefGoogle Scholar
  43. Wetherby, A. M., Allen, L., Cleary, J., Kublin, K., & Goldstein, H. (2002). Validity and reliability of the communication and symbolic behavior scales developmental profile with very young children. Journal of Speech, Language and Hearing Research, 45, 1202–1218.CrossRefGoogle Scholar
  44. Wetherby, A., Goldstein, H., Cleary, J., Allen, L., & Kublin, K. (2003). Early identification of children with communication disorders. Concurrent and predictive validity of the CSBS Developmental Profile. Infants and Young Children, 16, 161–174.CrossRefGoogle Scholar
  45. Wetherby, A., & Prizant, B. (2002). Communication and symbolic behavior scales developmental profile—First normed edition. Baltimore, MD: Paul H. Brookes.Google Scholar
  46. Wetherby, A., Watt, N., Morgan, L., & Shumway, S. (2007). Social communication profiles of children with autism spectrum disorders late in the second year of life. Journal of Autism and Developmental Disorders, 37, 960–975.PubMedCrossRefGoogle Scholar
  47. Wetherby, A., & Woods, J. (2002). Systematic observation of red flags for autism spectrum disorders. Unpublished manual, Florida State University, Tallahassee, FL.Google Scholar
  48. Wetherby, A. M., Woods, J., Allen, L., Cleary, J., Dickenson, H., & Lord, C. (2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34, 473–493.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nola Watt
    • 1
  • Amy M. Wetherby
    • 2
  • Angie Barber
    • 2
  • Lindee Morgan
    • 2
  1. 1.Discipline of Speech Pathology and Audiology, School of Human and Community DevelopmentUniversity of the WitwatersrandJohannesburgSouth Africa
  2. 2.Department of Communication DisordersFlorida State UniversityTallahasseeUSA

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