Skip to main content

Treatment for Higher-Order Restricted Repetitive Behaviors (H-RRB) in Children with Autism Spectrum Disorder

Abstract

Restricted repetitive behaviors (RRB) are one of the core symptoms of autism spectrum disorder (ASD). Evidence suggests that higher-order RRB (H-RRB) are particularly challenging and can negatively impact family functioning (e.g., insistence on sameness, following idiosyncratic routines). The study examined the effects of a parent-implemented behavior intervention using a multiple baseline single case experimental design in three young children with ASD. The intervention involved self-management procedures and included principles of pivotal response treatment during which parents provided bids for children to vary from H-RRB and children obtained points for engaging in these other interests and activities. Results showed improvements in child behavior, parent and child affect and interactions, children’s engagement in family activities, and overall parent ratings of RRB.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  • Albin, R. W., & Horner, R. H. (1988). Generalization with precision. In R. H. Horner, G. Dunlap & R. L. Koegel (Eds.), Generalization and maintenance: Life-style changes in applied settings (pp. 99–120). Baltimore, MD: Paul H. Brookes Publishing.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). Arlington, VA: American Psychiatric Association.

  • Attwood, T. (2003). Understanding and managing circumscribed interests. New York: Guilford Press.

    Google Scholar 

  • Baker, M. J. (2000). Incorporating the thematic ritualistic behaviors of children with autism into games: Increasing social play interactions with siblings. Journal of Positive Behavior Interventions, 2(2), 66–84.

    Article  Google Scholar 

  • Bandura, A. (1978). The self system in reciprocal determinism. American Psychologist, 33(4), 344–358.

    Article  Google Scholar 

  • Barlow, D. H., & Hersen, M. (1984). Single case experimental design: Strategies for studying behavior change (2nd ed.). New York: Pergamon.

    Google Scholar 

  • 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(4–5), 247–267.

    PubMed  Article  Google Scholar 

  • Boyd, B. A., Woodard, C. R., & Bodfish, J. W. (2011). Feasibility of exposure response prevention to treat repetitive behaviors of children with autism and intellectual disabilities: A brief report. Autism, 0, 1–9.

    Google Scholar 

  • Campbell, D. T., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Chicago: Rand McNally & Company.

    Google Scholar 

  • Carcani-Rathwell, I., Rabe-Hasketh, S., & Santosh, P. J. (2006). Repetitive and stereotyped behaviours in pervasive developmental disorders. Journal of Child Psychology and Psychiatry, 47(6), 573–581.

    PubMed  Article  Google Scholar 

  • Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.

    Article  Google Scholar 

  • 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 & Human Development, 34(1), 3–17.

    Article  Google Scholar 

  • 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(1), 56–68.

    Article  Google Scholar 

  • Fenstermaker, S. (1996). The dynamics of time use: Context and meaning. Journal of Family and Economic Issues, 17(3/4), 231–242.

    Article  Google Scholar 

  • Fiese, B. H., Tomcho, T. J., Douglas, M., Josephs, K., Poltrock, S., & Baker, T. (2002). A review of 50 years of research on naturally occurring family routines and rituals: Cause for celebration? Journal of Family Psychology, 16(4), 381–390.

    Article  PubMed  Google Scholar 

  • Gabriels, R. L., Cuccaro, M. L., Hill, D. E., Ivers, B. J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated clinical features. Research in Developmental Disabilities, 26(2), 169–181.

    Article  PubMed  Google Scholar 

  • Green, V. A., Sigafoos, J., Pituch, K. A., Itchon, J., O’Reilly, M., & Lancioni, G. E. (2006). Assessing behavioral flexibility in individuals with developmental disabilities. Focus on Autism and Other Developmental Disabilities, 21(4), 230–236.

    Article  Google Scholar 

  • Harrop, C. (2015). Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors. Autism, 19(6), 662–672. https://doi.org/10.1177/1362361314545685.

    PubMed  Article  Google Scholar 

  • Harrower, J. K., & Dunlap, G. (2001). Including children with autism in general education classrooms: A review of effective strategies. Behavior Modification.Special Issue: Autism, Part 1, 25(5), 762–784.

    Article  Google Scholar 

  • Hofferth, S. L., & Sandberg, J. F. (2001). How american children spend their time. Journal of Marriage & the Family, 63(2), 295–308.

    Article  Google Scholar 

  • Kazdin, A. E. (1974). Reactive self-monitoring: The effects of response desirability, goal setting, and feedback. Journal of Consulting and Clinical Psychology, 42(5), 704–716. https://doi.org/10.1037/h0037050.

    PubMed  Article  Google Scholar 

  • Klin, A., Danovitch, J. H., Merz, A. B., & Volkmar, F. (2007). Circumscribed interests in higher functioning individuals with autism spectrum disorders: An exploratory study. Research & Practice for Persons with Severe Disabilities, 32(2), 89–100.

    Article  Google Scholar 

  • Klinger, L. G., Dawson, G., & Renner, P. (2003). Autistic disorder. New York: Guilford Press.

    Google Scholar 

  • Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Improving social skills and disruptive behavior in children with autism through self-management. Journal of Applied Behavior Analysis, 25(2), 341–353.

    PubMed  PubMed Central  Article  Google Scholar 

  • Koegel, L. K., Koegel, R. L., & Parks, D. R. (1992). How to teach self-management to people with severe disabilities: A training manual. Santa Barbara, CA: University of California.

    Google Scholar 

  • Koegel, R. L., Bimbela, A., & Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disorders, 26(3), 347–359.

    PubMed  Article  Google Scholar 

  • Koegel, R. L., & Egel, A. L. (1979). Motivating autistic children. Journal of Abnormal Psychology, 88(4), 418–426.

    PubMed  Article  Google Scholar 

  • Koegel, R. L., Koegel, L. K., & McNerney, E. K. (2001). Pivotal areas in intervention for autism. Journal of Clinical Child Psychology, 30(1), 19–32.

    PubMed  Article  Google Scholar 

  • Korotitsch, W. J., & Nelson-Gray, R. O. (1999). An overview of self-monitoring research in assessment and treatment. Psychological Assessment, 11(4), 415–425.

    Article  Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.

    Article  PubMed  Google Scholar 

  • Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50(3), 172–183.

    PubMed  Article  Google Scholar 

  • Lee, S., Simpson, R. L., & Shogren, K. A. (2007). Effects and implications of self-management for students with autism: A meta-analysis. Focus on Autism and Other Developmental Disabilities, 22(1), 2–13.

    Article  Google Scholar 

  • Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6(1), 131–166.

    PubMed  PubMed Central  Article  Google Scholar 

  • Mahoney, M. J. (1972). Research issues in self-management. Behavior Therapy, 3(1), 45–63.

    Article  Google Scholar 

  • Mancina, C., Tankersley, M., Kamps, D., Kravits, T., & Parrett, J. (2000). Reduction of inappropriate vocalizations for a child with autism using a self-management treatment program. Journal of Autism and Developmental Disorders, 30(6), 599–606.

    PubMed  Article  Google Scholar 

  • McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120–129.

    PubMed  Article  Google Scholar 

  • Mercier, C., Mottron, L., & Belleville, S. (2000). A psychosocial study on restricted interests in high-functioning persons with pervasive developmental disorders. Autism, 4(4), 406–425.

    Article  Google Scholar 

  • Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviors in autistic disorder. European Child & Adolescent Psychiatry, 11(5), 210–218.

    Article  Google Scholar 

  • Mischel, W. (1973). Toward a cognitive social learning reconceptualization of personality. Psychological Review, 80(4), 252–283.

    PubMed  Article  Google Scholar 

  • Newman, B., Reinecke, D. R., & Meinberg, D. L. (2000). Self-management of varied responding in three students with autism. Behavioral Interventions, 15(2), 145–151.

    Article  Google Scholar 

  • Palmen, A., Didden, R., & Arts, M. (2008). Improving question asking in high-functioning adolescents with autism spectrum disorders: Effectiveness of small-group training. Autism, 12(1), 83–98.

    PubMed  Article  Google Scholar 

  • Pierce, K. L., & Schreibman, L. (1994). Teaching daily living skills to children with autism in unsupervised settings through pictorial self-management. Journal of Applied Behavior Analysis, 27(3), 471–481.

    PubMed  PubMed Central  Article  Google Scholar 

  • Richler, J., Bishop, S. L., Kleinke, J. R., & Lord, C. (2007). Restricted and repetitive behaviors in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 73–85.

    PubMed  Article  Google Scholar 

  • Scahill, L., Aman, M. G., Lecavalier, L., Halladay, A. K., Bishop, S. L., Bodfish, J. W., et al. (2015). Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder. Autism, 19(1), 38–52. https://doi.org/10.1177/1362361313510069.

    PubMed  Article  Google Scholar 

  • Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8.

    PubMed  PubMed Central  Article  Google Scholar 

  • Schreibman, L., Kaneko, W. M., & Koegel, R. L. (1991). Positive affect of parents of autistic children: A comparison across two teaching techniques. Behavior Therapy, 22(4), 479–490.

    Article  Google Scholar 

  • South, M., Ozonoff, S., & McMahon, W. M. (2005). Repetitive behavior profiles in asperger syndrome and high-functioning autism. Journal of Autism and Developmental Disorders, 35(2), 145–158.

    PubMed  Article  Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Stahmer, A. C., & Gist, K. (2001). The effects of an accelerated parent education program on technique mastery and child outcome. Journal of Positive Behavior Interventions, 3(2), 75–82.

    Article  Google Scholar 

  • Sytsma, S. E., Kelley, M. L., & Wymer, J. H. (2001). Development and initial validation of the child routines inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 241–251.

    Article  Google Scholar 

  • Troyb, E., Knoch, K., Herlihy, L., Stevens, M. C., Chen, C., Barton, M., et al. (2016). Restricted and repetitive behaviors as predictors of outcome in autism spectrum disorders. Journal of Autism and Developmental Disorders, 46(4), 1282–1296. https://doi.org/10.1007/s10803-015-2668-2.

    PubMed  Article  PubMed Central  Google Scholar 

  • Turner, M. (1999). Repetitive behaviour in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40(6), 839–849.

    PubMed  Article  Google Scholar 

  • Turner-Brown, L., Lam, K. S. L., Holtzclaw, T. N., Dichter, G. S., & Bodfish, J. W. (2011). Phenomenology and measurement of circumscribed interests in autism spectrum disorders. Autism, 15(4), 437–456. https://doi.org/10.1177/1362361310386507.

    PubMed  PubMed Central  Article  Google Scholar 

  • Ventola, P. E., Yang, D., Abdullahi, S. M., Paisley, C. A., Braconnier, M. L., & Sukhodolsky, D. G. (2016). Brief report: Reduced restricted and repetitive behaviors after pivotal response treatment. Journal of Autism and Developmental Disorders, 46(8), 2813–2820. https://doi.org/10.1007/s10803-016-2813-6.

    PubMed  PubMed Central  Article  Google Scholar 

  • Zaborskis, A., Zemaitiene, N., Borup, I., Kuntsche, E., & Moreno, C. (2007). Family joint activities in a cross-national perspective. BMC Public Health, 7(94), 1–14.

    Google Scholar 

  • Zandt, F., Prior, M., & Kyrios, M. (2007). Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder. Journal of Autism and Developmental Disorders, 37(2), 251–259.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the families who participated in the study and undergraduate assistants who aided with data management. The study was funded in part by the Ray E. Hosford Fellowship Research Grant and the Eli Broad Foundation.

Author information

Authors and Affiliations

Authors

Contributions

CEL conceived of the study, implemented the design of the study, collected data, conducted data analyses, interpreted the data and drafted the manuscript. RK participated in the conception of the study, design of the study, data analyses, and reviewed the manuscript.

Corresponding author

Correspondence to C. Enjey Lin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

The data was collected at the University of California, Santa Barbara as part of the corresponding author’s doctoral dissertation.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lin, C.E., Koegel, R. Treatment for Higher-Order Restricted Repetitive Behaviors (H-RRB) in Children with Autism Spectrum Disorder. J Autism Dev Disord 48, 3831–3845 (2018). https://doi.org/10.1007/s10803-018-3637-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-018-3637-3

Keywords

  • Autism spectrum disorder
  • Restrictive repetitive behaviors
  • Repetitive behaviors
  • Intervention
  • Restricted interests
  • Insistence on sameness