Journal of Autism and Developmental Disorders

, Volume 45, Issue 10, pp 3168–3182 | Cite as

Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention

  • Victoria Grahame
  • Denise Brett
  • Linda Dixon
  • Helen McConachie
  • Jessica Lowry
  • Jacqui Rodgers
  • Nick Steen
  • Ann Le Couteur
Original Paper


Early intervention for autism spectrum disorder (ASD) tends to focus on enhancing social-communication skills. We report the acceptability, feasibility and impact on child functioning of a new 8 weeks parent-group intervention to manage restricted and repetitive behaviours (RRB) in young children with ASD aged 3–7 years. Forty-five families took part in the pilot RCT. A range of primary and secondary outcome measures were collected on four occasions (baseline, 10, 18 and 24 weeks) to capture both independent ratings and parent-reported changes in RRB. This pilot established that parents were willing to be recruited and randomised, and the format and content of the intervention was feasible. Fidelity of delivery was high, and attendance was 90 %. A fully powered trial is now planned.


Restricted and repetitive behaviour Parent group intervention Clinical global impression of improvement Randomised controlled trial 



We are very grateful to the many parents of children with ASD in the North East of England who have supported the development of the MRB© group-based intervention and taken part in this pilot RCT. Without their generosity this project would not have been possible. We would also like to thank the course trainers Jan Raine, Linda Barker, Joyce Frater, Adele Fearon, and Carol Richardson. We thank Kathryn Burn, Deborah Garland, Fiona Gaultier, Anna Hodgson, Emma Honey, Kelly McGurk, Rachel Proud, Laura Rosby, Dr. Ellie Smith and Laura Surley for their contributions to the research. Finally we acknowledge the expertise of Sue Leach (previously employed by the UK Mental Health Research Network), members of the MRB Steering group (Simon Douglas, Dr. Mark Baggot) and the clinicians who helped recruit and support families with ASD during this research. This paper describes independent research commissioned by the National Institute for Health Research (NIHR) under the Research for Patient Benefit programme (PB-PG-1010-23305). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.


  1. Ahrens, E. N., Lerman, D. C., Kodak, T., Worsdell, A. S., & Keegan, C. (2011). Further evaluation of response interruption and redirection as treatment for stereotypy. Journal of Applied Behavior Analysis, 44, 95–108. doi: 10.1901/jaba.2011.44-95.PubMedCentralCrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). DC: Washington.Google Scholar
  3. Arnold, L. E., et al. (2003). Parent-defined target symptoms respond to risperidone in RUPP autism study: Customer approach to clinical trials. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1443–1450. doi: 10.1097/00004583-200312000-00011.CrossRefPubMedGoogle Scholar
  4. Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, P., & Charman, T. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). Lancet, 368, 210–215. doi: 10.1016/S0140-6736(06)69041-7.CrossRefPubMedGoogle Scholar
  5. Barber, A. B., Wetherby, A. M., & Chambers, N. W. (2012). Brief report: Repetitive behaviors in young children with autism spectrum disorder and developmentally similar peers: A follow up to Watt et al. (2008). Journal of Autism and Developmental Disorders, 42, 2006–2012.CrossRefPubMedGoogle Scholar
  6. Bishop, S. L., Richler, J., Cain, A. C., & Lord, C. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorder. American Journal of Mental Retardation, 112, 450–461. doi: 10.1352/0895-8017(2007).CrossRefPubMedGoogle Scholar
  7. Boyd, B. A., McDonough, S. G., Rupp, B., Khan, F., & Bodfish, J. W. (2011). Effects of a family-implemented treatment on the repetitive behaviors of children with autism. Journal of Autism and Developmental Disorders, 41, 1330–1341. doi: 10.1007/s10803-010-1156-y.PubMedCentralCrossRefPubMedGoogle Scholar
  8. Boyd, B. A., Rupp, B., & Bodfish, J. W. (2010). Direct observation of repetitive behaviors in autism. Unpublished manual: University of North Carolina at Chapel Hill.Google Scholar
  9. Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry and Allied Disciplines, 52, 741–752. doi: 10.1111/j.1469-7610.2011.02395.x.CrossRefGoogle Scholar
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  11. Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale (SRS). Los Angeles, CA: Western Psychological Services.Google Scholar
  12. Cunningham, A. B., & Schreibman, L. (2008). Stereotypy in autism: The importance of function. Research in Autism Spectrum Disorders, 2, 469–479. doi: 10.1016/j.rasd.2007.09.006.PubMedCentralCrossRefPubMedGoogle Scholar
  13. Dunlap, G., Dyer, K., & Koegel, R. L. (1983). Autistic self-stimulation and intertrial interval duration. American Journal of Mental Deficiency, 88, 194–202.PubMedGoogle Scholar
  14. Gordon, C. T. (2000). Commentary: Considerations on the pharmacological treatment of compulsions and stereotypies with serotonin reuptake inhibitors in pervasive developmental disorders. Journal of Autism and Developmental Disorders, 30, 437–438.CrossRefPubMedGoogle Scholar
  15. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, H., et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375(9732), 2152–2160. doi: 10.1016/S0140-6736(10)60587-9. (eScholarID:81710).CrossRefGoogle Scholar
  16. Greenberg, J. S., Seltzer, M. M., Hong, J., & Orsmond, G. I. (2006). Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism. American Journal of Mental Retardation, 111, 229–249. doi: 10.1352/0895-8017(2006).CrossRefPubMedGoogle Scholar
  17. Guy, W. (1976). Clinical global impression. In: ECDEU assessment manual for psychopharmacology, revised (pp. 218–222). Rockville, MD: National Institute of Mental Health.Google Scholar
  18. Harrop, C., McConachie, H., Emsley, R., Leadbitter, K., & Green, J. (2014). Restricted and repetitive behaviors in autism spectrum disorders and typical development: Cross-sectional and longitudinal comparisons. Journal of Autism and Developmental Disorders, 44(5), 1207–1219.CrossRefPubMedGoogle Scholar
  19. Hine, J., & Wolery, M. (2006). Using point-of-view video modeling to teach play to preschoolers with autism. Topics in Early Childhood Special Education, 26(2), 83–93.CrossRefGoogle Scholar
  20. Honey, E., Leekam, S., McConachie, H., & Turner, M. (2007). Repetitive behaviour and play in typically developing children and children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(6), 1107–1115.CrossRefPubMedGoogle Scholar
  21. Honey, E., Rodgers, J., & McConachie, H. (2012). Measurement of restricted and repetitive behaviour in children with autism spectrum disorder: Selecting a questionnaire or interview. Research in Autism Spectrum Disorders, 6, 757–776. doi: 10.1016/j.rasd.2011.10.011.CrossRefGoogle Scholar
  22. Julious, S. A. (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics, 4, 287–291.CrossRefGoogle Scholar
  23. Kuhn, D. E., Hardesty, S. L., & Sweeney, N. M. (2009). Assessment and treatment of excessive straightening and destructive behaviour in an adolescent diagnosed with autism. Journal of Applied Behavior Analysis, 42, 355–360. doi: 10.1901/jaba.2009.42-355.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: Recommendations for good practice. Journal of Evaluation in Clinical Practice, 10, 307–312. doi: 10.1111/j.2002.384.doc.x.CrossRefPubMedGoogle Scholar
  25. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007a). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37, 894–910. doi: 10.1007/s10803-006-0218-7.CrossRefPubMedGoogle Scholar
  26. Leekam, S. R., Prior, M. R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin, 137, 562–593. doi: 10.1037/a0023341.CrossRefPubMedGoogle Scholar
  27. Leekam, S., Tandos, J., McConachie, H., Meins, E., Parkinson, K., Wright, C., et al. (2007b). Repetitive behaviours in typically developing 2-year-olds. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48, 1131–1138. doi: 10.1111/j.1469-7610.2007.01778.x.CrossRefGoogle Scholar
  28. Lidstone, J., Uljarevic, M. (joint first authors), Sullivan, S., Rodgers, J., McConachie, H., Freeston, M., et al. (2014). Relations among restricted and repetitive behaviours, anxiety and sensory features in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 8(2), 82–92.Google Scholar
  29. Lord, C., Rutter, M., DiLavore, P. C., et al. (2012). Autism diagnostic observation schedule, second edition: ADOS-2. Torrance: Western Psychological Services.Google Scholar
  30. Magiati, I., Tay, X. W., & Howlin, P. (2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34, 73–86. doi: 10.1016/j.cpr.2013.11.002.CrossRefPubMedGoogle Scholar
  31. McConachie, H., Parr, J., Glod, M., Hanratty, J., Livingstone, N., Oono, I. P., et al. (2015). Systematic review of tools to measure outcomes for young children with autism spectrum disorder. HTA Report (forthcoming).Google Scholar
  32. Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviors in autistic disorder. European Child and Adolescent Psychiatry, 11, 210–218. doi: 10.1007/s00787-002-0279-x.CrossRefPubMedGoogle Scholar
  33. Miller, N., & Neuringer, A. (2000). Reinforcing variability in adolescents with autism. Journal of Applied Behavior Analysis, 33, 151–165. doi: 10.1901/jaba.2000.33-151.PubMedCentralCrossRefPubMedGoogle Scholar
  34. Mulligan, S., Healy, O., Lydon, S., Moran, L., & Foody, C. (2014). An analysis of treatment efficacy for stereotyped and repetitive behaviors in autism. Journal Autism Developmental Disorders, 1, 143–164.CrossRefGoogle Scholar
  35. Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). The Cochrane Database of Systematic Reviews, 4, CD009774. doi: 10.1002/14651858.CD009774.pub2.PubMedGoogle Scholar
  36. Parsons, S., & Mitchell, P. (2002). The potential of virtual reality in social skills training for people with autistic spectrum disorders. Journal of Intellectual Disability Research, 46, 430–443.CrossRefPubMedGoogle Scholar
  37. Rapp, J. T., & Vollmer, T. R. (2005). Stereotypy I: A review of behavioral assessment and treatment. Research in Developmental Disabilities, 26, 527–547. doi: 10.1016/j.ridd.2004.11.005.CrossRefPubMedGoogle Scholar
  38. Ritchie, J., & Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman & R. G. Burgess (Eds.), Analysing qualitative data (pp. 173–194). London: Routledge.CrossRefGoogle Scholar
  39. Rodgers, J., Glod, M., Connolly, B., & McConachie, H. (2012). The relationship between anxiety and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders, 42, 2404–2409. doi: 10.1007/s10803-012-1531-y.CrossRefPubMedGoogle Scholar
  40. Shafi, D. (2009). How parents of young children with autism manage repetitive behaviour: An observational study. Unpublished Clin. Psy. D. thesis, Newcastle University.Google Scholar
  41. Sofronoff, K., & Farbotko, M. (2002). The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome. Autism: The International Journal of Research and Practice, 6, 271–286.CrossRefGoogle Scholar
  42. Sparrow, S. S., Cicchetti, V. D., & Balla, A. D. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines, MN: American Guidance Service.Google Scholar
  43. Swettenham, J. (1996). Can children with autism be taught to understand false belief using computers? Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 157–165.CrossRefGoogle Scholar
  44. Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the North. London: Croom Helm.Google Scholar
  45. Turner, M. (1995). Repetitive behaviour and cognitive functioning in autism. Unpublished Ph.D. thesis, University of Cambridge, Cambridge.Google Scholar
  46. Watt, N., Wetherby, A. M., Barber, A., & Morgan, L. (2008). Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 38, 1518–1533. doi: 10.1007/s10803-007-0532-8.PubMedCentralCrossRefPubMedGoogle Scholar
  47. Wetherby, A., & Prizant, B. (2002). Communication and symbolic behavior scales developmental profile—First normed edition. Baltimore, MD: Paul H. Brookes.Google Scholar
  48. Wing, L., Leekam, S. R., Libby, S. J., Gould, J., & Larcombe, M. (2002). The diagnostic interview for social and communication disorders: Background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 307–325.CrossRefGoogle Scholar
  49. World Health Organisation. (1992). International Classification of Diseases (ICD 10. Geneva: World Health Organisation.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Victoria Grahame
    • 1
  • Denise Brett
    • 2
  • Linda Dixon
    • 1
  • Helen McConachie
    • 2
  • Jessica Lowry
    • 2
  • Jacqui Rodgers
    • 3
  • Nick Steen
    • 2
  • Ann Le Couteur
    • 1
    • 2
  1. 1.Complex Neurodevelopmental Disorders ServiceNorthumberland, Tyne and Wear NHS Foundation TrustNewcastle upon TyneUK
  2. 2.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
  3. 3.Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK

Personalised recommendations