Associations between Repetitive Behaviours, Play and Development in Preschool Autism

The incidence of repetitive and restricted behaviours (RRBs) represent a key diagnostic feature of autism (DSM-IV, APA); however the links to other areas of the autism triad are poorly understood. Similarly the over-reliance on parental reports merits the need for observational research. Free play sessions offer a naturalistic way to observe RRBs and study the links to other areas of development and autism symptomology. It was predicted that a higher incidence of RRBs would associate negatively with advanced play behaviours (Bruckner and Yoder, 2007), language and non-verbal development (Militerni et al, 2002), but positively with simple play and autism severity. 51 children (mean age = 44.5 months, SD = 8.53) with autism were filmed playing with their caregiver with a standardised set of toys. 10 minutes were coded using Noldus Observer (1991). RRBs were modified from items used in the Repetitive Behaviour Questionnaire (Turner, 1999), DISCO (Wing et al, 2002) and Watt et al (2008). Play levels were similar to those described previously by Naber et al (2008), Belsky and Most (1981) and Leslie (1987). Children also completed the Pre-School Language Scales (Zimmerman et al, 1997), Mullen Scale of Early Learning (Mullen, 1995) and the Autism Diagnostic Observation Schedule (ADOS; Lord et al, 2000). This completed the child’s baseline assessment for the Pre-School Autism Communication Trial (PACT; www.medicine.manchester.ac.uk/pact). During a 10 minute free play session, children on average displayed 6.76 RRBs (SD = 7.84). The most common behaviour was “fiddling with toys” followed by “throwing and kicking.” Total RRBs negatively correlated with mean language scores (rs = -.294, p = .04) and positively with ADOS stereotyped behaviours and restricted interests (rs = 302, p = .035). Negative associations were found between the total number of RRBs and time spent in functional (rs = -.349, p = .014) and advanced functional play (rs = -.287, p = .045). Total RRBs positively correlated with simple exploratory play (rs = .326, p = .022). Results suggest an inverse relationship between RRBs and advanced forms of play providing support for previous research (Bruckner and Yoder, 2007). No associations were found between autism severity and RRBs, but a marginal correlation with ADOS stereotyped behaviours and restricted interests. Future work aims to explore the incidence of RRBs over time and their expression in non-verbally matched controls.