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Stereotyped behavior of severely disabled children in classroom and free-play settings
Abstract
The relationships between stereotyped behavior, object manipulation, self-manipulation, teacher attention, and various developmental measures were examined in 101 severely developmentally disabled children in their classrooms and a free-play setting. Stereotyped behavior without objects was positively correlated with self-manipulation and CA and was negatively correlated with complex object manipulation, developmental age, developmental quotient, and teacher attention. Stereotyped behavior with objects was negatively correlated with complex object manipulation. Partial correlations showed that age, self-manipulation, and developmental age shared unique variance with stereotyped behavior without objects.
... RB features also appear as a part of early typical development, are present in individuals with other developmental disabilities (Berkson, 2002; Berkson, Tupa, & Sherman, 2001), and are a diagnostic part of other mental disorders, such as Obsessive Compulsive Disorder (American Psychiatric Association, 1994). Some reports suggest that intellectual ability is highly correlated with both the occurrence and type of RBs in individuals with autism (Bartak & Rutter, 1976; Carcani-Rathwell, Rabe-Hasketh, & Santosh, 2006; Gabriels, Cuccaro, Hill, Ivers, & Goldson, 2005; Matson, Kiely, & Bamburg, 1997; Militerni, Bravaccio, Falco, Fico, & Palermo, 2002; Poustka & Lisch, 1993; Thompson & Berkson, 1985); however, if a specific pattern of RBs distinguishes a unique ASD phenotype from general cognitive disabilities is not known. In addition to the core diagnostic features, individuals with ASD have a variety of challenges in areas such as cognition (Chakrabarti & Fombonne, 2001; Lainhart, 2003; Yeargin-Allsopp et al., 2003), adaptive behavior (Gabriels, Ivers, Hill, Agnew, & McNeill, 2007), and sleep (Schreck, Mulick, & Smith, 2004). ...
... The third goal was examining whether a phenotypic subtype of ASD was suggested with high rates of RBs and abnormal sensory responses. For all research questions methodology used in previous studies was improved upon by measuring and controlling for IQ, since intellectual ability has been shown to be related to the expression of RBs (Bartak & Rutter, 1976; Carcani-Rathwell et al., 2006; Gabriels et al., 2005; Matson et al., 1997; Militerni et al., 2002; Poustka & Lisch, 1993; Thompson & Berkson, 1985). ...
This study examined the relation between restricted, repetitive, and stereotyped behaviors and interests (RBs) and sensory responses in a group of 70 children and adolescents diagnosed with an autism spectrum disorder (ASD). Caregivers completed the Repetitive Behavior Scale-Revised (RBS-R) and the Sensory Profile. Controlling for IQ and age, total RBS-R and Sensory Profile scores revealed significant correlations both prior to and after removing overlapping items. Examination of the co-occurrence of RBs and atypical sensory responses in this population suggests a subgroup has consistently high rates of problems in both RBs and sensory processing. In addition, this subgroup has high rates of prescribed psychoactive medications and co-morbid psychiatric diagnoses. The IQ and age of this subgroup did not differ significantly from the rest of the participants. Results are consistent with previous research describing the co-occurrence of RBs and sensory response abnormalities in the ASD population. Further investigation of the subset of individuals with ASD who have high rates of RBs and abnormal sensory responses may lead to a more comprehensive understanding of their clinical picture and improve interventions. Additionally, research with this subgroup may have significance for identifying a specific phenotype in ASD.
... However, not all behavioural evidence points to greater sensitivity in autistic individuals. A number of studies found that autistic individuals do not differ from typically-developed individuals on measures of contrast sensitivity (Matson, Kiely, & Bamburg, 1997;Poustka & Lisch, 1993;Shafai, Armstrong, Iarocci, & Oruc, 2015; T. J. Thompson & Berkson, 1985). ...
Recent studies have suggested that individuals who exhibit heightened sensitivity also exhibit higher rates and severity of restricted interests and repetitive behaviours. This line of research has been conducted almost exclusively through caregiver reports of sensitivity. Here, a more rigorous psychophysics paradigm was applied to assess sensory sensitivity and relate hypersensitivity to restricted interests and repetitive behaviours. In addition, commonly used questionnaire measures of sensory sensitivity were collected to determine if self-reported measures accurately reflect behavioural measures of sensory sensitivity. In all, 90 typically developing participants completed a visual detection task, a questionnaire measure of sensory processing and a measure of restricted interests and repetitive behaviours. Visual sensitivity, measured both behaviourally and with questionnaires, is positively related to restricted interests and repetitive behaviours. Surprisingly, visual sensitivity as measured behaviourally and through self-report are unrelated. Furthermore, a regression analysis suggests that while restricted interests and repetitive behaviours can be predicted based on both behavioural and self-reported sensitivity, these two predictors account for different portions of the variance in restricted interests and repetitive behaviours. Thus, while these results provide evidence supporting the contribution of sensory sensitivity to restricted interests and repetitive behaviours, these results also indicate that behavioural and questionnaire measures of sensory sensitivity are measuring two distinct constructs. We hypothesize that behavioural measures are measuring sensory sensitivity, while questionnaires measures are in fact measuring sensory reactivity.
... With that said, there is evidence that additional factors may impact the relationship between sensory sensitivity and repetitive behaviours. For example, repetitive behaviours and restricted interests have also been linked to MA and intelligence in the past (Bartak and Rutter, 1976;Bishop et al., 2006;Bodfish et al., 2000;Carcani-Rathwell et al., 2006;Gabriels et al., 2005;Matson et al., 1997;Militerni et al., 2002;Poustka and Lisch, 1993;Thompson and Berkson, 1985). Intelligence/MA has also been linked to hypersensitivity in both children with autism and TD children (Baranek et al., 2007). ...
The objective of this study was to examine the relationship between sensory hypersensitivity and restricted interests and repetitive behaviours associated with autism spectrum disorder and their typically-developing peers. Furthermore, the aims included the examination of the relationship across sensory modalities and various types of restricted interests and repetitive behaviours. Data were collected from the parents of 114 children: 49 of whom were diagnosed with autism spectrum disorder and 65 typically-developing children. Parents completed the Sensory Profile 2 – Child Version and the Repetitive Behaviours Questionnaire, Second Edition. The results suggested that sensory hypersensitivity is strongly related to the core autism spectrum disorder symptom of repetitive behaviours. This relationship was not specific to autism spectrum disorder; repetitive behaviours significantly increased with sensory hypersensitivity in typically-developing individuals as well. This effect was consistent across all modalities in both autism spectrum disorder and typically developing groups; group differences were observed in the oral and tactile modalities. Furthermore, sensory hypersensitivity was significantly predictive of repetitive behaviours in all participants, autism spectrum disorder and typically-developing, and importantly, autism spectrum disorder diagnosis did not add any predictive influence above and beyond sensory hypersensitivity. Finally, sensory hypersensitivity was significantly predictive of all subdomains of repetitive behaviours, including repetitive motor movements, rigidity and adherence to routine, preoccupation with restricted patterns of interest and unusual sensory interests, and diagnosis added no predictive ability beyond sensory hypersensitivity.
... Functional analyses as antecedents to interventions for stereotypy are reported far less often , however, than for other forms of aberrant behaviors. It may be that descriptive analyses based on naturalistic observations (e.g., Mace, Lalli, & Lalli, 1991) often indicate that stereotypy is maintained by some form of automatic reinforcement, such as sensory feedback (Thompson & Berkson, 1985), making further assessment unneces- sary. When automatic reinforcement is the function of stereotypy, an assessment of what stimuli are more likely to evoke stereotypy may be important for treatment planning (e.g., Repp, Singh, Karsh, & Deitz, 1991; Schultz & Berkson, 1995; Wahler & Fox, 1981; Wetzel, Taylor, & Lachowicz, 1991). ...
The behavior of 4 adolescents with severe or profound mental retardation was evaluated in the presence of four sets of materials during periods of unstructured leisure activity. Functional engagement with the materials, stereotypic engagement with the materials, stereotypy without interaction with the materials, and other aberrant behaviors were recorded. Across a series of experimental conditions, the number of sets of materials was reduced from four to one by eliminating the set most frequently manipulated in each preceeding condition. In the final condition, four sets of materials were again made available for manipulation. The procedures replicated Green and Striefel's (1988) response-restriction analysis of the activity preferences and play behaviors of children with autism. In general, the results of the present experiment replicate those of Green and Striefel in that reallocation of responding was idiosyncratic and unpredictable as sets of materials were removed. Nevertheless, the results provided insight into how responding might be reallocated if it were restricted through behavioral interventions rather than by restriction of access. Thus, the results are discussed with respect to how response-restriction analyses may be useful in identifying topographies of behavior that could be included in differential reinforcement contigencies that are designed to affect stereotypic behavior and in the selection and arrangement of environmental stimuli to minimize the presence of evokers of stereotypy.
... Thus, although the display of stereotyped movements is inversely related to IQ in nonautistic learning disabled individuals (e.g. Berkson & Davenport, 1962 ; Matson et al., 1997 ; Thompson & Berkson, 1985), there appears to be no such relationship in autism (Campbell et al., 1990). Others have suggested that higher-level repetitive behaviour is more common in high-functioning individuals because it demands a higher level of ability. ...
... For instance, in a British epidemiological study Wing (1981) found that 82% of the children with IQs below 20, 47% with IQs between 20 and 34 and 40% of the children with IQs between 35 and 50 had impairments in social interaction , communication and imaginative activities. Other studies have also shown that many individuals with severe mental retardation have characteristics of pervasive developmental disorders (Cherry, Matson, & Paclawskyj, 1997; Nordin & Gillberg, 1996) or show stereotyped repetitive behaviors (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987; Thompson & Berkson, 1985). Because there are differences in behavioral characteristics depending on the developmental level of individuals; therefore, diagnostic instruments need to be appropriate for a person's mental level (Freeman, Ritvo, Guthrie, Schroth, & Ball, 1978; Vig & Jedrysek, 1999). ...
The Autism Diagnostic Observational Schedule (ADOS) is a semi-structured observational scale developed to assess social interaction, communication and play in individuals who are suspected to have autism. Since the ADOS is not suitable to be used with severely or profoundly mentally retarded adolescents and adults with very limited language skills, materials and some of the tasks of the PL-ADOS and the original ADOS (the former versions of the current ADOS) were adapted. Results indicated that almost all of the overall ratings showed good reliability and discriminative diagnostic validity. Furthermore, the combination of codings into an overall algorithm score on social/communicative behavior resulted in a sensitivity of .82 and a specificity of .85 when using a cut-off score of 15.
In this paper, we address the transition between the normal repetitive behaviours of infancy and the abnormal stereotyped movements of severely handicapped children and adults. The focus of the discussion assumes that, as children grow, the environment increasingly influences their motor behaviour. We believe that the pathology of stereotyped behaviours represents a reflection not only of the pathology of the children but more particularly a failure of the child-environment interaction.
Stereotyped behaviors, movements, and acts, stereotypies, autisms, self-stimulatory behaviors, idiosyncratic mannerisms, or blindisms are synonymous terms that refer to a set of clinically conspicuous, socially undesirable, and topographically heterogeneous behaviors. Stereotyped behavior, which will be the preferred term for this chapter, is characteristic of severely and profoundly mentally retarded individuals. It is a key diagnostic feature of childhood autism, and also occurs in blind persons, in the mentally ill, and in geriatric patients. Typical forms are body rocking, mouthing, complex hand and finger movements, repetitive vocalizations, and gazing. The diversity of these behaviors is strikingly illustrated in a review by LaGrow and Repp (1984), who identified 50 different categories in 60 treatment studies.
Mental retardation is characterized by significant intellectual limitations and poor adaptive behavior appearing before the age of 18 (Aman, Hammer, & Rojahn, 1993; Luckasson et al., 1992; Tassé, Aman, Rojahn, & Kern, in press). It is a persistent condition caused by a variety of biological and psychosocial determinants. Mental retardation manifests on a continuum of severity with a rapidly decelerating rate of occurrence as the behavioral and intellectual limitations increase. Neurological illnesses such as cerebral palsy, spina bifida, and seizure disorders frequently accompany mental retardation but without causal connection. In addition, individuals with mental retardation are highly vulnerable for psychopathology. Ever since the landmark Isle of Wight epidemiological studies conducted between 1964 and 1974 (Rutter, Tizard, Yule, Graham, & Whitmore, 1976), we have known that individuals with mental retardation have an elevated risk for psychiatric disorders such as schizophrenia and depression. Besides, many develop severe behavior disorders during their lives, such as aggressive and destructive behavior, violent tantrum behavior, or stereotyped and self-injurious behaviors.
One striking aspect of the behaviour of some young children with developmental disabilities is their engagement in stereotyped, repetitive movements which appear to lack adaptive significance and are perceived as aberrant. These behaviours have received a significant amount of attention by researchers, particularly in relation to their remediation. Repetitive movements are not always aberrant and occur during typical child development. This article reviews research describing developmentally typical and atypical repetitive motor movements of children with and without a disability. Additionally, findings from a regression analysis describing factors associated with the expression of developmentally typical and atypical motor behaviours of young children with developmental disabilities are reported. Findings are discussed in light of previous research.
Adults can learn a great deal about young children’s development by watching them play with toys or other objects. Insights
derived from theoretical and empirical explorations of object play are particularly useful for early childhood professionals
who assess the development of preschool children with disabilities. The following discussion reviews theoretical and empirical
literature relevant to young children’s object play and suggests implications of research findings for practitioners. The
review emphasizes the cognitive prerequisites for object play, the sequential development of object play, the relationship
between play and language, and the characteristics of object play in young children with developmental disabilities.
This review addresses the issues and challenges related to the differential diagnosis of autism in preschool children with significant cognitive impairment. Issues affecting differential diagnosis include the use of traditional diagnostic guidelines for preschoolers with developmental delays, developmental changes in behavioral characteristics, the involvement of cognitive factors in symptom expression, and the overlap between autism and mental retardation in individuals with significant cognitive impairment. The usefulness of autistic features for differential diagnosis is explored in terms of the core deficits of autism.
Antipsychotic medications have been used to treat a variety of behavioral and psychiatric disturbances in persons with mental retardation. Given the well-documented side effects of traditional antipsychotics, newer "atypical" antipsychotics have been well received in this population due to initial reports of a more favorable side effect profile. We compared the side effect profiles of both the typical and atypical antipsychotics using a comprehensive instrument, the Matson Evaluation of Drug Side Effects (MEDS) scale. Participants taking atypical antipsychotics did not differ in overall side effects from a matched control group taking no psychotropic medication, and both groups showed significantly fewer overall side effects than participants taking typical antipsychotics. Subscales designed to measure involuntary movements (e.g., akathisia, tardive dyskinesia) detected differences between participants taking either atypical or typical antipsychotics with respect to akathisia only. Implications of these findings and directions for future research are discussed.
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