Evidence for three subtypes of repetitive behavior in autism that differ in familiality and association with other symptoms

Restricted repetitive behaviors (RRBs) are a core feature of autism and consist of a variety of behaviors, ranging from motor stereotypies to complex circumscribed interests. The objective of the current study was to examine the structure of RRBs in autism using relevant items from the Autism Diagnostic Interview-Revised in a sample of 316 individuals with autistic disorder

Conditioned Placebo Dose Reduction: A new treatment in ADHD?

This study examined if pairing a placebo with stimulant medication produces a placebo response that allows children with ADHD to be maintained on a lower dose of stimulant medication. Primary aim was to determine the efficacy, side effects and acceptability of a novel conditioned placebo dose reduction (CPDR) procedure

Feasibility of exposure response prevention to treat repetitive behaviors of children with autism and an intellectual disability: A brief report

There is a lack of evidence-based behavioral therapies or pharmacotherapies to treat repetitive behaviors found in autism. Effective behavioral therapies are needed to counter any negative consequences these behaviors may have on the child’s early learning and socialization. The purpose of this proof-of-principle study was to test the feasibility of modifying exposure response prevention, an evidence-based strategy for obsessive–compulsive disorder, to treat the repetitive behaviors found in autism. Five school-aged participants (ages 5–11) diagnosed with an autism spectrum disorder participated in the study. Our preliminary findings suggest it is feasible, and potentially efficacious, to modify standard exposure response prevention to treat the specific forms of repetitive behaviors found in individuals with autism and comorbid intellectual disabilities. A larger clinical trial is needed to substantiate these preliminary findings

Affective Responses by Adults with Autism Are Reduced to Social Images but Elevated to Images Related to Circumscribed Interests

Individuals with autism spectrum disorders (ASD) demonstrate increased visual attention and elevated brain reward circuitry responses to images related to circumscribed interests (CI), suggesting that a heightened affective response to CI may underlie their disproportionate salience and reward value in ASD. To determine if individuals with ASD differ from typically developing (TD) adults in their subjective emotional experience of CI object images, non-CI object images and social images, 213 TD adults and 56 adults with ASD provided arousal ratings (sensation of being energized varying along a dimension from calm to excited) and valence ratings (emotionality varying along dimension of approach to withdrawal) for a series of 114 images derived from previous research on CI. The groups did not differ on arousal ratings for any image type, but ASD adults provided higher valence ratings than TD adults for CI-related images, and lower valence ratings for social images. Even after co-varying the effects of sex, the ASD group, but not the TD group, gave higher valence ratings to CI images than social images. These findings provide additional evidence that ASD is characterized by a preference for certain categories of non-social objects and a reduced preference for social stimuli, and support the dissemination of this image set for examining aspects of the circumscribed interest phenotype in ASD

Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat “lower order” RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for “higher order” behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research

Age-Related Differences in Restricted Repetitive Behaviors in Autism Spectrum Disorders

Restricted repetitive behaviors (RRBs) were examined in a large group of children, adolescents and adults with ASD in order to describe age-related patterns of symptom change and association with specific contextual factors, and to examine if the patterns of change are different for the various types of RRBs. Over 700 individuals with ASD were rated on the Repetitive Behavior Scale – Revised. RRBs were less frequent and less severe among older than younger individuals, corroborating that autism symptoms abate with age. Our findings further suggest that repetitive behaviors are a heterogeneous group of behaviors, with the subtypes of RRBs having their own individual patterns across the lifespan, and in some cases, a differential association with age depending on intellectual functioning

Adults with autism spectrum disorders exhibit decreased sensitivity to reward parameters when making effort-based decisions

Background: Efficient effort expenditure to obtain rewards is critical for optimal goal-directed behavior and learning. Clinical observation suggests that individuals with autism spectrum disorders (ASD) may show dysregulated reward-based effort expenditure, but no behavioral study to date has assessed effort-based decision-making in ASD. Methods: The current study compared a group of adults with ASD to a group of typically developing adults on the Effort Expenditure for Rewards Task (EEfRT), a behavioral measure of effort-based decision-making. In this task, participants were provided with the probability of receiving a monetary reward on a particular trial and asked to choose between either an “easy task” (less motoric effort) for a small, stable reward or a “hard task” (greater motoric effort) for a variable but consistently larger reward. Results: Participants with ASD chose the hard task more frequently than did the control group, yet were less influenced by differences in reward value and probability than the control group. Additionally, effort-based decision-making was related to repetitive behavior symptoms across both groups. Conclusions: These results suggest that individuals with ASD may be more willing to expend effort to obtain a monetary reward regardless of the reward contingencies. More broadly, results suggest that behavioral choices may be less influenced by information about reward contingencies in individuals with ASD. This atypical pattern of effort-based decision-making may be relevant for understanding the heightened reward motivation for circumscribed interests in ASD

Affective Modulation of the Startle Eyeblink and Postauricular Reflexes in Autism Spectrum Disorder

Eyeblink and postauricular reflexes to standardized affective images were examined in individuals without (n = 37) and with (n = 20) autism spectrum disorders (ASDs). Affective reflex modulation in control participants replicated previous findings. The ASD group, however, showed anomalous reflex modulation patterns, despite similar self-report ratings of pictures. Specifically, the ASD group demonstrated exaggerated eyeblink responses to pleasant images and exaggerated postauricular responses to unpleasant images. Although ASD is often conceptualized in terms of specific deficits in affective responding in the social domain, the present results suggest a domain-general pattern of deficits in affective processing and that such deficits may arise at an early phase in the stream of information processing

Low dimensional temporal organization of spontaneous eye blinks in adults with developmental disabilities and stereotyped movement disorder

This study investigated the mean rate and time-dependent sequential organization of spontaneous eye blinks in adults with intellectual and developmental disability (IDD) and individuals from this group that were additionally categorized with stereotypic movement disorder (IDD+SMD). The mean blink rate was lower in the IDD+SMD group than the IDD group and both of these groups had a lower blink rate than a contrast group of healthy adults. In the IDD group the n to n+1 sequential organization over time of the eye blink durations showed a stronger compensatory organization than the contrast group suggesting decreased complexity/dimensionality of eye-blink behavior. Very low blink rate (and thus insufficient time series data) precluded analysis of time-dependent sequential properties in the IDD+SMD group. These findings support the hypothesis that both IDD and SMD are associated with a reduction in the dimension and adaptability of movement behavior and that this may serve as a risk factor for the expression of abnormal movements

Brief Report: Exposure and Response Prevention for Obsessive Compulsive Disorder in a 12-year-old with Autism

Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective in symptom reduction for children with comorbid autism and OCD