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Repetitive Behavior in 12-Month-Olds Later Classified With Autism Spectrum Disorder

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Objective

As compared to the utility of early emerging social communicative risk markers for predicting a later diagnosis of autism spectrum disorder (ASD), less is known about the relevance of early patterns of restricted and repetitive behaviors. We examined patterns of stereotyped motor mannerisms and repetitive manipulation of objects in 12-month-olds at high and low risk for developing ASD, all of whom were assessed for ASD at 24 months.

Method

Observational coding of repetitive object manipulation and stereotyped motor behaviors in digital recordings of the Communication and Symbolic Behavior Scales was conducted using the Repetitive and Stereotyped Movement Scales for 3 groups of 12-month-olds: low-risk infants (LR, n = 53); high–familial-risk infants who did not meet diagnostic criteria for ASD at 24 months (HR-negative, n = 75); and high−familial-risk infants who met diagnostic criteria for ASD at 24 months (HR-ASD, n = 30).

Results

The HR-ASD group showed significantly more stereotyped motor mannerisms than both the HR-negative group (p = .025) and the LR group (p = .001). The HR-ASD and HR-negative groups demonstrated statistically equivalent repetitive object manipulation scores (p = .431), and both groups showed significantly more repetitive object manipulation than the LR group (p < .040). Combining the motor and object stereotypy scores into a Repetitive and Stereotyped Movement Scales (RSMS) composite yielded a disorder-continuum effect such that each group was significantly different from one another (LR < HR-negative < HR-ASD).

Conclusion

These results suggest that targeted assessment of repetitive behavior during infancy may augment early ASD identification efforts.

Section snippets

Method

This study took place in the context of an ongoing Autism Center of Excellence Network study (the Infant Brain Imaging Study [IBIS]) prospectively investigating longitudinal brain and behavioral trajectories in high- and low-risk infants. The institutional review boards at all sites approved the research protocol, and parents provided informed consent for their infants to participate. Additional information on the study design is provided by Elison et al.26 and Wolff et al.27

Results

No statistically significant differences were observed among the 3 groups in chronological age at the 12-month assessment (p = .709), weeks gestation (p = .296), race/ethnicity (p = .140), maternal education level (p = .200), family income (p = .653), or chronological age at the 24-month visit (p = .413). The sex ratio of the groups differed significantly (p = .036), with a higher proportion of males in the ASD group, as would be expected. A MANCOVA with the body cluster subscale, object

Discussion

We used a standardized behavioral coding scheme to characterize repetitive object and motor stereotypies in infants at low and high familial risk for developing ASD, a subset of whom met diagnostic criteria for ASD at 24 months of age. RSMS composite scores significantly differentiated the 3 groups from one another (LR < HR-neg < HR-ASD). Decomposing this finding revealed that the HR-ASD and the HR-neg groups did not differ on the object cluster subscale, but that both groups differed from the

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    • Clinical guidance is available at the end of this article.

    The Infant Brain Imaging Study (IBIS) Network is a National Institutes of Health (NIH)-funded Autism Center of Excellence project and consists of a consortium of 7 universities in the US and Canada. Clinical Sites: University of North Carolina: J. Piven, MD (IBIS Network PI), H.C. Hazlett, PhD, J.C. Chappell, MS; University of Washington: S. Dager, MD, A. Estes, PhD, D. Shaw, MD; Washington University: K. Botteron, MD, R. McKinstry, MD, PhD, J. Constantino, MD, J. Pruett, MD, PhD; Children’s Hospital of Philadelphia: R. Schultz, PhD, S. Paterson, PhD; University of Alberta: L. Zwaigenbaum, MD; Data Coordinating Center, Montreal Neurological Institute: A.C. Evans, PhD, D.L. Collins, PhD, G.B. Pike, PhD, P. Kostopoulos, PhD, S. Das, BSc; Image Processing Core, University of Utah: G. Gerig, PhD; University of North Carolina: M. Styner, PhD; Statistical Analysis Core, University of North Carolina: H. Gu, PhD; Genetics Analysis Core, University of North Carolina: P. Sullivan, MD, F. Wright, PhD.

    This research was supported by grants awarded to J.P. from NIH/National Institute of Child Health and Human Development (NICHD) (R01 HD055741, HD055741-S1, P30 HD03110, T32 HD40127) Autism Speaks, and the Simons Foundation. J.T.E. was supported by NIH/NICHD grant 5-T32-HD007376, and aspects of this work contributed to his PhD dissertation while affiliated with UNC. J.T.E. had full access to the data and takes full responsibility for the integrity and accuracy of the data analysis.

    Drs. Elison and Gu served as the statistical experts for this research.

    The authors thank the IBIS children and families for their ongoing participation in this longitudinal study. They also thank Chad Chappell, MS, from UNC-Chapel Hill, Samir Das, BSc, and Penelope Kostopoulos, PhD, both from the Montreal Neurological Institute, for their contributions, and Amy Wetherby, PhD, and Lindee Morgan, PhD, both from Florida State University, for training J.T.E on the Repetitive and Stereotyped Movement Scales (RSMS) coding scheme.

    Disclosure: Dr. Elison has received grant or research funding from the National Children’s Study and the National Institute of Mental Health (NIMH). Dr. Wolff has received grant or research funding from NIMH. Dr. Reznick has received grant or research funding from the National Children’s Study. Dr. Botteron has received grant or research support from NICHD, the National Institute of Biomedical Imaging and Bioengineering, NIMH, and Autism Speaks. Dr. Gu has received grant or research funding from NIMH. Dr. Hazlett has received grant or research funding from NIMH. Dr. Paterson has received grant or research funding from the National Children’s Study. Dr. Zwaigenbaum is the site principal investigator of a study sponsored by SynapDx (receives operating funds but no honoraria) and has received grant or research support from the Canadian Institutes of Health Research, NeuroDevNet, Alberta Innovates – Health Solutions, Stollery Children’s Hospital Foundation, and Autism Intervention Research – Physical Health. Dr. Piven has received grant or research funding from NIMH and has served as a consultant to the John Merck Foundation and the Mindich Foundation. Dr. Estes and Ms. Meadows report no biomedical financial interests or potential conflicts of interest.

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