Current Developmental Disorders Reports

, Volume 5, Issue 2, pp 108–115 | Cite as

Restricted and Repetitive Behaviors in Autism Spectrum Disorder: a Review of Associated Features and Presentation Across Clinical Populations

  • Kathleen Berry
  • Kaylin Russell
  • Kyle Frost
Autism Spectrum (A Richdale and L Lawson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Autism Specrtum


Purpose of the Review

Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorder, though relatively under-studied compared to social communication deficits. The focus of this review is individual differences in RRBs, associated features, and change in presentation of RRBs over development. Additionally, a review of repetitive behaviors in typical development as well as other diagnostic categories is presented, with the goal of increasing our understanding of the function and prevalence of RRBs across diagnostic categories and across development more broadly.

Recent Findings

There is an increasing recognition in the field that ASD symptoms are quite often observed in other neurodevelopmental disabilities, warranting continued investigation of the prevalence, patterns, and underlying etiology across groups.


In the past decade, research has increasingly explored RRBs in ASD, contributing a greater awareness of the influence developmental and individual factors have on their presentation. Currently, there is a growing trend for studies to examine RRBs trans-diagnostically in order to increase understanding of the underlying etiology and developmental trajectory of this behavioral phenotype.


Autism spectrum disorder ASD Repetitive behaviors RRBs 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Kanner L. Autistic disturbances of affective contact. Nerv Child. 1943;2:217–50.Google Scholar
  2. 2.
    Asperger H. Die ‘Autistischen Psychopathen’ im Kindesalter. Archiv fur Psychiatrie und Nervenkrankheiten. 1944;117:76–136.CrossRefGoogle Scholar
  3. 3.
    Thelen E. Rhythmical stereotypies in normal human infants. Anim Behav. 1979;27:699–715.PubMedCrossRefGoogle Scholar
  4. 4.
    Thelen E. Rhythmical behavior in infancy: an ethological perspective. Dev Psychol. 1981;17:237–57.CrossRefGoogle Scholar
  5. 5.
    Evans DW, Leckman J, Carter A, Reznick J, Henshaw D, King R, et al. Ritual, habit and perfectionism: the prevalence and development of compulsive-like behavior in normal young children. Child Dev. 1997;68:58–68.PubMedCrossRefGoogle Scholar
  6. 6.
    Watt N, Wetherby A, Barber A, Morgan L. Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life. J Autism Dev Disord. 2008;38(8):1518–33.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Damiano C, Nahmias A, Hogan-Brown A, Stone W. What do repetitive and stereotyped movements mean for infant siblings of children with autism spectrum disorders? J Autism Dev Disord. 2013;43(6):1326–35.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Larkin F, Meins E, Centifanti LCM, Fernyhough C, Leekam SR. How does restricted and repetitive behavior relate to language and cognition in typical development? Dev Psychopathol. 2016;29:863–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Uljarevic M, Arnott B, Carrington SJ, Meins E, Fernyhough C, McConachie H, et al. Supplemental material for development of restricted and repetitive behaviors from 15 to 77 months: stability of two distinct subtypes? Dev Psychol. 2017;
  10. 10.
    Leekam S, Tandos J, McConachie H, Meins E, Parkinson K, Wright C, ... Le Couteur A (2007) Repetitive behavior questionnaire-2.Google Scholar
  11. 11.
    Wolff J, Botteron K, Dager S, Elison J, Estes A, Gu H, et al. Longitudinal patterns of repetitive behavior in toddlers with autism. J Child Psychol Psychiatry. 2014;55(8):945–53.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    McDonald R, Green G, Mansfield R, Geckeler N, Gardenier N, Anderson J, et al. Stereotypy in young children with autism and typically developing children. Res Dev Disabil. 2007;28(3):266–77.CrossRefGoogle Scholar
  13. 13.
    Bishop SL, Richler J, Lord C. Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychol. 2006;12:247–67.PubMedCrossRefGoogle Scholar
  14. 14.
    Moore V, Goodson S. How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism. 2003;7(1):47–63.PubMedGoogle Scholar
  15. 15.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edition. doi:
  16. 16.
    Richler J, Huerta M, Bishop S, Lord C. Developmental trajectories of restricted and repetitive behaviors and interests in children with autism spectrum disorders. Dev Psychopathol. 2010;22:55–69.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Kanne SM (2013) Awareness eases challenges of autism. Columbia Daily Tribune Google Scholar
  18. 18.
    Leekam S, Prior M, Uljarevic M. Restricted and repetitive behaviors in autism spectrum disorders: a review of research in the last decade. Psychol Bull. 2011;137(4):562–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Joseph L, Thurm A, Farmer C, Shumway S. Repetitive behavior and restricted interests in young children with autism: comparisons with controls and stability over 2 years. Autism Res. 2013;6:584–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Turner M. Annotation: repetitive behavior in autism: a review of psychological research. J Child Psychol Psychiatry Allied Discip. 1999;40(6):839–349.CrossRefGoogle Scholar
  21. 21.
    Cuccaro M, Shao Y, Grubber J, Slifer M, Wolpert C, Donnelly S, et al. Factor analysis of restricted and repetitive behaviors in autism using the autism diagnostic interview-r. Child Psychiatry Hum Dev. 2003;34:3–17.PubMedCrossRefGoogle Scholar
  22. 22.
    Bishop S, Hus V, Duncan A, Huerta M, Gotham K, Pickles A, et al. Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. J Autism Dev Disord. 2012;43:1287–97.Google Scholar
  23. 23.
    Szatmari P, Georgiades S, Bryson S, Zwaigenbaum L, Roberts W, Mahoney W, et al. Investigating the structure of the restricted, repetitive behaviors and interests domain of autism. J Child Psychol Psychiatry. 2006;47(6):582–90.Google Scholar
  24. 24.
    Turner M. Towards and executive dysfunction account of repetitive behavior in autism. In: Russel J, editor. Autism as an executive disorder: 57-100. Oxford: Oxford University Press; 1997.Google Scholar
  25. 25.
    Evans DW, Uljarevic M, Lusk LG, Loth E, Fraizer T. Development of two dimensional measures of restricted and repetitive behavior in parents and children. J Am Acad Child Adolesc Psychiatry. 2017;56(1):51–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Matson JL, Matheis M, Burns CO, Esposito G, Venuti P, Pisula E … Goldin RL (2017) Examining cross-cultural differences in autism spectrum disorder: a multinational comparison from Greece, Italy, Japan, Poland, and the United States. Eur Psychiatry (42):70 - 76. doi:
  27. 27.
    Esbensen AJ, Seltzer MM, Lam KSL, Bodfish JW. Age-related differences in restricted repetitive behaviors in autism spectrum disorders. J Autism Dev Disord. 2009;39(1):57–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Militerini R, Bravavaccio C, Falco C, Fico C, Palermo M. Repetitive behaviors in autistic disorder. Eur Child Adolesc Psychiatry. 2002;11(5):210–8.CrossRefGoogle Scholar
  29. 29.
    Honey E, McConachie H, Randle V, Shearer H, LeCouteur A. One-year change in repetitive behaviors in young children with communication disorders including autism. J Autism Dev Disord. 2008;38:1439–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Bieleninik Ł, Posserud MB, Geretsegger M, Thompson G, Elefant C, Gold C. Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the Autism Diagnostic Observation Schedule: a systematic review and meta-analysis. PLoS One. 2017;12(9):e0183160.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Kim S, Lord C. Restricted and repetitive behaviors in toddlers and preschoolers with autism spectrum disorders based on the autism diagnostic observation schedule (ADOS). Autism Res. 2010;3:162–73.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Ray-Subramanian C, Weismer S. Receptive and expressive language as predictors of restricted and repetitive behaviors in young children with autism spectrum disorders. J Autism Dev Disord. 2012;42(10):2113–20.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Rao P, Landa R. Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism. 2014;18(3):272–80.PubMedCrossRefGoogle Scholar
  34. 34.
    Bauman M. Motor dysfunction in autism. In: Joseph A, Young R, editors. Movement disorders in neurology and psychiatry. Boston: Blackwell; 1992.Google Scholar
  35. 35.
    Gidley-Larson J, Mostofsky S. Evidence that the pattern of visuomotor sequence learning is altered in children with autism. Autism Res. 2008;1:341–53.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Haas R, Townsend J, Courchesne E, Lincoln A, Schreibman L, Yeung-Courchesne R. Neurological abnormalities in infantile autism. J Child Neurol. 1996;11:84–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Hallett M, Lebiedowska M, Thomas S, Stanhope S, Denckla M, Rumsey J. Locomotion of autistic adults. Arch Neurol. 1993;50(12):1304–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Molloy C, Dietrich K, Bhattacharya A. Postural stability in children with autism spectrum disorder. J Autism Dev Disord. 2003;33(6):643–52.PubMedCrossRefGoogle Scholar
  39. 39.
    Ravizza S, Solomon M, Ivry R, Carter C. Restricted and repetitive behaviors in autism spectrum disorders: the relationship of attention and motor deficits. Dev Psychopathol. 2013;25:773–84.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Elison J, Wolff J, Reznick J, Botteron K, Estes A, Gu H, et al. Repetitive behavior in 12-month-olds later classified with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(11):1216–24.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Bodfish JW, Parker D, Lewis M, Sprague R, Newell K. Stereotypy and motor control: differences in the postural stability dynamics of persons with stereotyped and dyskinetic movement disorders. Am J Ment Retard. 2001;106(2):123–34.PubMedCrossRefGoogle Scholar
  42. 42.
    South M, Ozonoff S, McMahon WM. Repetitive behavior profiles in Asperger syndrome and high-functioning autism. J Autism Dev Disord. 2005;35(2):145–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Mccormick C, Hepburn S, Young GS, Rogers SJ. Sensory symptoms in children with autism spectrum disorder, other developmental disorders and typical development: a longitudinal study. Autism. 2015;20:572–9.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Hoch J, Spofford L, Dimian A, Tervo R, Maclean WE, Symons FJ. A direct comparison of self-injurious and stereotyped motor behavior between preschool-aged children with and without developmental delays. J Pediatr Psychol. 2015;41:566–72.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    World Health Organization. ICD-10, the ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.Google Scholar
  46. 46.
    Glenn S, Cunningham C, Nananidou A, Prasher V, Glenholmes P. Routinised and compulsive-like behaviours in individuals with Down syndrome. J Intellect Disabil Res. 2015;59:1061–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Evans DW, Kleinpeter FL, Slane MM, Boomer KB. Adaptive and maladaptive correlates of repetitive behavior and restricted interests in persons with Down syndrome and developmentally-matched typical children: a two-year longitudinal sequential design. PLoS One. 2014;9:e93951. Scholar
  48. 48.
    Uljarević M, Evans DW. Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and Down syndrome. Autism Res. 2017;10:502–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Glenn S. Repetitive Behaviours and restricted interests in individuals with Down syndrome—one way of managing their world? Brain Sci. 2017;7:66.PubMedCentralCrossRefGoogle Scholar
  50. 50.
    Oakes A, Thurman AJ, Mcduffie A, Bullard LM, Hagerman RJ, Abbeduto L. Characterising repetitive behaviours in young boys with fragile X syndrome. J Intellect Disabil Res. 2016;60:54–67.PubMedCrossRefGoogle Scholar
  51. 51.
    Cordeiro L, Ballinger E, Hagerman R, Hessl D. Clinical assessment of DSM-IV anxiety disorders in fragile X syndrome: prevalence and characterization. J Neurodev Disord. 2010;3(1):57.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Hagerman R, Harris S. Autism profiles of males with fragile X syndrome. Am J Ment Retard. 2008;113(6):427–38.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Hogan AL, Caravella KE, Ezell J, Rague L, Hills K, Roberts JE. Autism spectrum disorder symptoms in infants with fragile X syndrome: a prospective case series. J Autism Dev Disord. 2017;47:1628–44. Scholar
  54. 54.
    Hartley SL, Wheeler AC, Mailick MR, Raspa M, Mihaila I, Bishop E, et al. Autism symptoms across adulthood in men with fragile X syndrome: a cross-sectional analysis. J Autism Dev Disord. 2015;45:3668–79.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Darrow SM, Grados M, Sandor P, Hirschtritt ME, Illmann C, Osiecki L, et al. Autism spectrum symptoms in a Tourette’s disorder sample. J Am Acad Child Adolesc Psychiatry. 2017;56(7):610–7. Scholar
  56. 56.
    Canitano R, Vivanti G. Tics and Tourette syndrome in autism spectrum disorders. Autism. 2007;11:19–28.PubMedCrossRefGoogle Scholar
  57. 57.
    Scharf J, Miller L, Guavin C, Alabiso J, Mathews C, Ben-Shlomo Y. Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Mov Disord. 2015;30:221–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Anttila V, Bulik-Sullivan B, Finucane HK, Bras J, Duncan L, Escott-Price V, Ripke S (2016) Analysis of shared heritability in common disorders of the brain bioRxiv, 048991Google Scholar
  59. 59.
    Shafran R. Childhood obsessive-compulsive disorder. In: Graham PJ, editor. Cognitive-behavioral therapy for children and families. New York: Cambridge University Press; 1998.Google Scholar
  60. 60.
    Van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17. Scholar
  61. 61.
    Hallett V, Ronald A, Rijsdijk F, Happé F. Disentangling the associations between autistic-like and internalizing traits: a community based twin study. J Abnorm Child Psychol. 2011;40(5):815–27. Scholar
  62. 62.
    Rodgers J, Riby DM, Janes E, Connolly B, Mcconachie H. Anxiety and repetitive behaviours in autism spectrum disorders and Williams syndrome: a cross-syndrome comparison. J Autism Dev Disord. 2011;42(2):175–80. Scholar
  63. 63.
    Zandt F, Prior M, Kyrios M. Repetitive behavior in children with high functioning autism and obsessive compulsive disorder. J Autism Dev Disord. 2007;37:251–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Ruzzano L, Borsboom D, Geurts H. Repetitive behaviors in autism and obsessive-compulsive disorder: new perspectives from a network analysis. J Autism Dev Disord. 2015;45:192–202.PubMedCrossRefGoogle Scholar
  65. 65.
    Mosconi M, Kay M, D’Cruz A, Seidenfeld A, Guter S, Stanford L, et al. Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders. Psychol Med. 2009;39(09):1559–66.Google Scholar
  66. 66.
    Factor RS, Condy EE, Farley JP, Scarpa A. Brief report: insistence on sameness, anxiety, and social motivation in children with autism spectrum disorder. J Autism Dev Disord. 2016;46(7):2548–54. Scholar
  67. 67.
    Gotham K, Bishop S, Hus V, Huerta M, Lund S, Buja A, et al. Exploring the relationship between anxiety and insistence on sameness in autism spectrum disorders. Autism Res. 2013;6(1):33–41.Google Scholar
  68. 68.
    Lidstone J, Uljarević M, Sullivan J, Rodgers J, Mcconachie H, Freeston M, et al. Relations among restricted and repetitive behaviors, anxiety and sensory features in children with autism spectrum disorders. Res Autism Spectr Disord. 2014;8(2):82–92.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyMichigan State UniversityEast LansingUSA

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