Medically Reviewed By Sonam Kothari, Written By Tejasvi Parekh
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects individuals differently in how they primarily communicate, interact socially, or behave.
One of the common behavioural characteristics associated with autism spectrum disorder is the pattern of Restricted and Repetitive behaviours (RRBs), though they are generally considered the core feature of the disorder and manifest in various forms ranging from mere repetitive motor activities to highly engaging interests.
RRBs can be divided into two main groups: repetitive behaviours and restricted behaviours, also termed fixed interests. The repetitive behaviours can include activities like body rocking, hand flapping, or the repetition of opening and closing drawers over and over.
The restricted behaviours will include an intense, nearly singular focus on a certain activity, object, or subject, such as memorizing all the minute details about a specific topic or repeating the same task time and again.
For many adults with ASD, such behaviours serve as methods of self-soothing and self-regulation. This may be because a particular individual needs to engage in some repetitive movements to control overwhelming stressors or fixate on favourite interests due to outward overstimulation or anxious feelings.
RRBs can become problematic when they cause the individual with ASD problems, particularly in a situation that requires flexibility and adaptability, like school or work.
Understanding these behaviours is crucial in the early diagnosis and intervention of autism. Knowing how important RRBs are can help identify the disorder and also help caregivers and professionals gain ideas about how to move forward in helping individuals with ASD manage these behaviours to enrich their quality of life.
Restricted and Repetitive behaviours (RRBs) are another important hallmark of Autism Spectrum Disorder (ASD), in both physical acts and cognitive routines. RRBs are functionally important for individuals with autism, even though they may seem redundant or ritualistic, such as to modulate sensory experience or to use to communicate emotions. Some common types of RRBs include:
Stimming or self-stimulatory behaviour has to be one of the most apparent types of RRBs. In these, repeating physical acts, children often engage with ASD as a means of controlling the sensory environment or improving the emotional state.
Examples include:
These behaviours can seem out of the norm; however, they are very often used as coping strategies for the overwhelm of sensory or emotional stress. Sometimes, stimming can be even one's form of articulation when interpreting joy or excitement means of self-comfort during overwhelming situations.
Stereotyped behaviours are repetitive actions or speech patterns that don't have an obvious function and are relentless; often they are automatic. These are behaviours that characteristically manifest in children with autism as well as other neurodevelopmental disorders, and they are one of the primary diagnostic markers used in the DSM-5.
Examples include:
Stereotyped behaviours give children with ASD a sense of predictability and order, which can be comforting in a world they often have difficulty interpreting or making sense of. They may also be used as a coping mechanism for either boredom, anxiety, or a need related to their sensory system.
Autism Spectrum Disorders usually require many individuals to have routines and rituals, such as repeating the same act and maintaining inflexible adherence to schedules. It is not just routine but often shows itself in speech, thought, or problem-solving.
Examples include:
For those with ASD, consistency and predictability are essential for maintaining a sense of control over their environment. Disruptions to established routines can cause significant anxiety and emotional distress.
Another area in which RRBs are characterized is through intense interest in specific topics or activities, known as special interests. Some individuals are passionate about sports or hobbies while others may have political or social issues of great importance to them; this range of interests differentiates them from other individuals and is considered a high-functioning area of ASD.
Examples include:
These focused interests create a basis for great satisfaction and expertise but often lead to social isolation when the individual cannot easily shift attention toward other topics or activities.
Many people with autism develop increased or decreased sensitivity to the sensory responses that tend to influence their behaviours. There are two types of sensitivities:
Sensory sensitivities tend to have an impact both on daily functioning as well as the initiation of stereotypic behaviours or even repetitive motor movements due to the attempts to cope with sensory experiences.
So researchers and clinicians have posited several theories that could explain the occurrence of such Restricted and Repetitive Behaviours, RRBs among people suffering from Autism Spectrum Disorder (ASD). The presented theories especially hone in on the role of a combination of neurological, cognitive, sensory, and developmental aspects, which contribute to the presence and persistence of these behaviours. In this regard, it is necessary to understand proper explanations through which interventions and support would be rendered to those on the spectrum.
Brain-Based Explanations: Another influential neurological theory postulated that RRBs are linked to various dysfunctions of specific brain regions, primarily the basal ganglia. The basal ganglia are considered to form components of motor control, procedural learning, and routine behaviours.
In ASD, abnormal activity in this area causes the individual to have difficulty with suppression of repetitive behaviour or shifting between behaviours, expressed as stereotypic motor activity or routine.
There have been research studies that have shown that the basal ganglia in people with ASD could be over or under-activated, leading to repetitive behaviours such as hand flapping or rocking. If this region of the brain is impaired, a person may not be able to turn off or initiate a behaviour, which leads to perseveration, such as repeating speech or acts.
Other brain regions, including the prefrontal cortex, which is involved in higher-order cognitive processes like planning and decision-making, as well as flexibility, also are implicated. Poor performance under conditions of underactive or weak connectivity between the prefrontal cortex and other brain regions appears to lead to the inflexible, rigid thinking style often observed in ASD.
Executive Dysfunction: RRBs have also been explained through cognitive theory: executive dysfunction. Executive functions refer to a series of mental processes that enable a person to plan and execute tasks, focus his or her attention, remember instructions, and switch between tasks.
People with ASD can be characterized as deficits of the executive functioning type, thereby failing to adjust their focus from one activity to the next, or getting accustomed to the new situation.
These deficits in flexibility contribute to a situation wherein an individual will tend towards predictability and routine, which then correlates with their ritualistic behaviours or insistence on sameness.
Whenever the routine is broken, there can be tremendous distress because their ability to regulate their responses and alter them in light of changing conditions is greatly diminished.
Sensory Seeking and Avoiding behaviours: The best understood and most classic feature of autism is its differential profile in processing sensations. Because individuals with ASD usually either avoid or seek certain types of experience, sensory dysregulation is a form that has been one of the most visible aspects of ASD.
A growing theory about sensory processing contributes to the occurrence of RRBs by way of how a person with autism perceives the sensory world.
There are other repetitive behaviours, like hand-flapping or spinning, which may also be something that may be the individual's means of seeking sensory input. These are sometimes stimulative for the individual, permitting them to regulate their sensory environment, especially in under-stimulated situations.
Other repetitive behaviours may counteract sensory overload. For instance, a child might repeatedly perform actions such as covering their ears or rocking in one direction and back to close out an overload of sensory input, including loud noises and bright lights.
Self-Regulation Mechanisms: Self-regulation with the propensity for sensory dysregulation often appears as RRBs, a means by which individuals gain mastery over emotional and sensory experiences when threatening, overwhelming, or anxious.
In many cases, RRBs operate as stress/anxiety-reducing mechanisms, providing a structured and manageable activity in an otherwise chaotic environment.
For example, an individual might engage in repetitive hand-flicking or pacing when they are anxious to calm down. This kind of stimming can provide sensory feedback that is comforting and familiar, which helps reduce the intensity of emotional responses to stressors.
Adaptive in Early Childhood: From the perspective of development, some presentations of RRBs are adaptive in early childhood. Most young neurotypical and autistic children will at one time or another exhibit repetitive play, such as lining up toys or repeating words or phrases.
During early development, such behaviours can make children learn cause and effect, pave the way for predictability, and further development of motor skills.
These behaviours may even persist after normal developmental stages in children with ASD. At first, they might serve a helpful purpose in self-regulation or even sensory exploration, helping them grasp their surroundings and, at the same time, be in control.
Becoming Maladaptive Over Time: However, with age, people with ASD may become more rigid and less adaptable in their RRBs. What once had helped them soothe themselves or learn now hinders daily functioning, social contact, and learning.
A child may line up toys in a cyclical way as an attempt towards order, but the same might later become stiff insistence on habits that cause problems if interrupted.
RRBs might be limiting opportunities for social engagement in adolescence and adulthood, or perhaps even be making it challenging to settle into a new environment, like school or work.
The consequence of the extreme pervasiveness of RRBs is that it may almost be impossible for an individual to be able to take part in everyday activities or to be able to hold meaningful relationships.
Behavioural Interventions: At times, repetitive behaviours are considered disruptive and problematic hence intervened and treated behaviourally. Among those methods is Applied Behaviour Analysis (ABA) which rewards favored behaviours while punishing undesired ones sometimes.
For example, positive reinforcement of alternative behaviours can reduce the rate of repetition of actions. However, it has to be done sensitively and ethically to respect the person's needs and preferences.
Sensory Integration Techniques: Since repetitive behaviours are one strategy for sensory regulation, a therapy like sensory integration therapy seems particularly promising if it helps ASD individuals cope better with their sensory experiences.
Strategies could be what one the use of sensory diets to include customized activities that help provide the individual with adequate sensory input to calm and stabilize him or her.
Such techniques reduce the necessity of repetitive behaviours as a self-soothing method by addressing issues related to sensory dysregulation.
Therapeutic Approaches: Therapies such as Floortime or Son-Rise are very effective with individuals in whom their repetitive behaviours truly represent something of interest or passion. That kind of therapy works based on an individual's interest and draws on using these interests as a foundation on which communication and social development can be built.
Such therapy assists in exchanging repetitive behaviours with constructive interactions, which encourages skill development by incorporating the subject's fixations into the therapeutic activities.
Medication: The consideration of medication should come when the repetitive behaviours are significantly more serious and established or in the presence of other neurological or psychological disorders. There is no such medicine that specifically treats RRBs, so medications will be prescribed to treat the comorbid condition-condition-anxiety or ADHD.
Medications like the class of selective serotonin reuptake inhibitors (SSRIs) may be prescribed to treat anxiety; such medication, however, can interfere with the rate and intensity of compulsive behaviours.
The challenge in understanding and addressing restricted and repetitive behaviours in autism spectrum disorders is deeply multi-factorial due to the vast underlying causes and functions of the behaviours.
Although they are initially suitable for sensory regulation or self-soothing, over time, these behaviours become maladaptive and interfere with a person's daily life and social interactions.
Well-managed RRBs are often achieved by a combination of behavioral interventions, sensory integration techniques, therapeutic approaches, and, when the latter is appropriate, medication.
Caregivers and professionals can support individuals with ASD by tailoring treatments according to individual requirements and underlying causes in order to manage their behaviors and improve their quality of life.
