Repetitive and restricted behaviours (RRB) in autism: Clinical evaluation

Introduction. - Restricted and repetitive behaviours (RRB) represent a common problem throughout the autistic spectrum. They comprise a wide range of behavioural manifestations that persist over time and resist therapeutics. Furthermore, degrees of heterogeneity have been reported in the clinical expression of autistic syndrome, particularly in the restricted and repetitive aspects. Advances are needed in the understanding of this complex and heterogeneous clinical dimension of autism to improve efficacy of therapeutics. Literature findings. - Most clinical studies have subdivided RRB into "lower-level" sensory-motor behaviours and "higher-level" behaviours, which are more complex and characteristic features of autism. However, none of these studies have taken into account all the forms of RRB. To date, there is no specific and thorough toot to evaluate this dimension of autism. From the analysis of the literature, we proposed a list of 43 behaviours covering the full range of repetitive, restricted and stereotyped activities observed in autism. Aim of the study. - The aim of the present study was to test the relevance of these 43 RRB in a family context. Clinical settings. - The participants were 14 children with an autism spectrum disorder, aged from six to 16 years. Circumscribed interests were the most commonly reported RRB, and motor stereotypies, aggressive and body-focused behaviours were the least expressed behaviours. Results. - Multivariate statistical analysis identified three groups of children with different behavioural profiles and three clusters of RRB, i.e. repetitive motor behaviours, repetitive sensory-vocal behaviours and restricted ideational behaviours. Discussion. - Although these preliminary results need to be validated in a wider population, the list of 43 RRB allowed us to describe accurately this symptomatology of autism and to confirm the heterogeneity of this dimension of autistic disorders. The identification of clinical subgroups, possibly underlain by different psychopathological or physiopathological factors would help research and contribute to the development of specific new therapeutic strategies which are still needed to improve quality of life of patients with autistic disorder and their families. (C) L'Encephale, Paris, 2008.