Symptoms of restricted and repetitive behaviors and interests in autism are theoretically linked to executive functioning, which includes problem-solving abilities such as inhibition and cognitive flexibility. This study examined whether inhibition and flexibility are related to higher order restricted and repetitive behaviors and interests (e.g. circumscribed interests and ritualistic behavior) and sensorimotor behaviors (e.g. stereotyped and repetitive movements and sensory preoccupations) among 102 school-aged children with autism spectrum disorder who had cognitive abilities in the average or above average range. The ability to inhibit interfering information and shifting ability were related to higher order restricted and repetitive behaviors and interests, and each uniquely accounted for variance. This suggests that the ability to suppress interfering information as well as the ability to flexibly shift between patterns of responding is protective against higher order restricted and repetitive behaviors and interest symptoms in autism. In addition, the ability to proactively slow one’s reaction time in order to respond more carefully was related to sensorimotor restricted and repetitive behaviors. These results support the importance of distinguishing between higher order and sensorimotor symptoms due to their distinct relationships to executive functioning abilities.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th ed.Washington, DC: American Psychiatric Association.
2.
AmodeoDAJonesJHSweeneyJAet al. (2012) Differences in BTBR T+ tf/J and C57BL/6J mice on probabilistic reversal learning and stereotyped behaviors. Behavioral and Brain Research227: 64–72.
3.
BandGPVan Der MolenMWLoganGD (2003) Horse-race model simulations of the stop-signal procedure. Acta Psychologica112: 105–142.
4.
BarkleyRA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin121(1): 65–94.
5.
BieleninikLPosserudMBGeretseggerMet al. (2017) Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the autism diagnostic observation schedule: a systematic review and meta-analysis. PLoS ONE12(9): e0183160.
6.
BishopSLHusVDuncanAet al. (2013) Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. Journal of Autism and Developmental Disorders43(6): 1287–1297.
7.
BoydBAMcDonoughSGBodfishJW (2012) Evidence-based behavioral interventions for repetitive behaviors in autism. Journal of Autism and Developmental Disorders42(6): 1236–1248.
8.
BreretonAVTongeBJEinfeldSL (2006) Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders36(7): 863–870.
9.
BurgessPWSimonsJS (2005) Theories of frontal lobe executive function: clinical applications. In: HalliganPWWadeDT (eds) Effectiveness of Rehabilitation for Cognitive Deficits. Oxford: Oxford University Press, pp.211–232.
10.
CashinAYorkeJ (2018) The relationship between anxiety, external structure, behavioral history and becoming locked into restricted and repetitive behaviors in autism spectrum disorder. Issues in Mental Health Nursing39: 533–537.
11.
ChamberlainSRFinebergNABlackwellADet al. (2006) Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. American Journal of Psychiatry163(7): 1282–1284
12.
ChanASHanYMYLeungWWet al. (2011) Abnormalities in the anterior cingulate cortex associated with attentional and inhibitory control deficits: a neurophysiological study on children with autism spectrum disorders. Research in Autism Spectrum Disorders5(1): 254–266.
13.
ChanRCKShumDToulopoulouTet al. (2008) Assessment of executive functions: review of instruments and identification of critical issues. Archives of Clinical Neuropsychology23(2): 201–216.
14.
ChristensenDLBaioJVan Naarden BraunKet al. (2016) Prevalence and characteristics of autism spectrum disorder among children aged 8 years: autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR Surveillance Summaries65(3): 1–23.
15.
CroneEAVan Der MolenMW (2004) Developmental changes in real life decision making: performance on a gambling task previously shown to depend on the ventromedial prefrontal cortex. Developmental Neuropsychology25: 251–279.
16.
CuccaroMLShaoYGrubberJet al. (2003) Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry and Human Development34(1): 3–17.
De JongRColesMGLoganGD (1995) Strategies and mechanisms in nonselective and selective inhibitory motor control. Journal of Experimental Psychology: Human Perception and Performance21: 498–511.
19.
DemetriouEALampitAQuintanaDSet al. (2017) Autism spectrum disorders: a meta-analysis of executive function. Molecular Psychiatry23: 1198–1204.
20.
De VriesMGeurtsHM (2012) Cognitive flexibility in ASD: task switching with emotional faces. Journal of Autism and Developmental Disorders42(12): 2558–2568.
21.
De VriesMGeurtsH (2015) Influence of autism traits and executive functioning on quality of life in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders45(9): 2734–2743.
22.
DiamondA (2013) Executive functions. Annual Review of Psychology64: 135–168.
23.
DuvekotJVan Der EndeJVerhulstFCet al. (2017) Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism21(6): 646–658.
24.
EstesAShawDWWSparksBFet al. (2011) Basal ganglia morphometry and repetitive behavior in young children with autism spectrum disorder. Autism Research4(3): 212–220.
25.
FajaSDawsonGSullivanKet al. (2016) Executive function predicts the development of play skills for verbal preschoolers with autism spectrum disorders. Autism Research9(12): 1274–1284.
26.
FeilJSheppardDFitzgeraldPBet al. (2010) Addiction, compulsive drug seeking, and the role of frontostriatal mechanisms in regulating inhibitory control. Neuroscience and Biobehavioral Reviews35(2): 248–275.
27.
FlessnerCAFrancazioSMurhpyYEet al. (2015) An examination of executive functioning in young adults exhibiting body-focused repetitive behaviors. Journal of Nervous and Mental Disease203: 555–558.
28.
FusterJM (2008) Overview of prefrontal functions: the temporal organization of action. In: FusterJM (ed.) The Prefrontal Cortex. 4th ed.San Diego, CA: Academic Press, pp.333–385.
29.
GeorgiadesSPapageorgiouVAnagnostouE (2010) Brief report: repetitive behaviours in Greek individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders40(7): 903–906.
30.
GeurtsHMCorbettBSolomonM (2009) The paradox of cognitive flexibility in autism. Trends in Cognitive Sciences13(2): 74–82.
31.
GeurtsHMVan den BerghSFRuzzanoL (2014) Prepotent response inhibition and interference control in autism spectrum disorders: two meta-analyses. Autism Research7: 407–420.
32.
GeurtsHMVertéSOosterlaanJet al. (2004) How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism?Journal of Child Psychology and Psychiatry45: 836–854.
33.
GillottAFurnissFWalterA (2001) Anxiety in high-functioning children with autism. Autism5(3): 277–286.
GuBMParkJYKangDHet al. (2007) Neural correlates of cognitive inflexibility during task-switching in obsessive-compulsive disorder. Brain131(1): 155–164.
36.
HanYMYChanAS (2017) Disordered cortical connectivity underlies the executive function deficits in children with autism spectrum disorders. Research in Developmental Disabilities61: 19–31.
37.
HogeveenJKrugMKElliottMVet al. (2018) Proactive control as a double-edged sword in autism spectrum disorder. Journal of Abnormal Psychology127: 429–435.
38.
HollanderEAnagnostouEChaplinWet al. (2005) Striatal volume on magnetic resonance imaging and repetitive behaviors in autism. Biological Psychiatry58(3): 226–232.
39.
HoneyEMcConachieHTurnerMet al. (2012) Validation of the repetitive behaviour questionnaire for use with children with autism spectrum disorder. Research in Autism Spectrum Disorders6(1): 355–364.
40.
KenworthyLYerysBEAnthonyLGet al. (2008) Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychological Review18(4): 320–338.
41.
KimJASzatmariPBrysonSEet al. (2000) The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism4(2): 117–132.
42.
LamKSLBodfishJWPivenJ (2008) Evidence for three subtypes of repetitive behavior in autism that differ in familiality and association with other symptoms. Journal of Child Psychology and Psychiatry49(11): 1193–1200.
43.
LeungRCVoganVMPowellTLet al. (2016) The role of executive functions in social impairment in autism spectrum disorder. Child Neuropsychology22(3): 336–344.
44.
LiebRWBohnertAM (2017) Relations between executive functions, social impairment, and friendship quality on adjustment among high functioning youth with autism spectrum disorder. Journal of Autism and Developmental Disorders47(9): 2861–2872.
45.
LopezBRLincolnAJOzonoffSet al. (2005) Examining the relationship between executive functions and restricted, repetitive symptoms of autistic disorder. Journal of Autism and Developmental Disorders35(4): 445–460.
MarriageSWolvertonAMarriageK (2009) Autism spectrum disorder grown up: a chart review of adult functioning. Journal of the Canadian Academy of Child and Adolescent Psychiatry18(4): 322–328.
48.
MatsonJLShoemakerM (2009) Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities30(6): 1107–1114.
49.
MillerHLRagozzinoMECookEHet al. (2015) Cognitive set shifting deficits and their relationship to repetitive behaviors in autism spectrum disorder. Journal of Autism and Developmental Disorders45(3): 805–815.
50.
MiyakeAFriedmanNPEmersonMJet al. (2000) The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychology41(1): 49–100.
51.
MosconiMWKayMD’CruzAMet al. (2009) Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders. Psychological Medicine39(9): 1559–1566.
52.
Mostert-KerckhoffsMALStaalWGHoubenRHet al. (2015) Stop and change: inhibition and flexibility skills are related to repetitive behavior in children and young adults with autism spectrum disorders. Journal of Autism and Developmental Disorders45(10): 3148–3158.
53.
MurphyFCSahakianBJRubinszteinJSet al. (1999) Emotional bias and inhibitory control processes in mania and depression. Psychological Medicine29(6): 1307–1321.
54.
NiggJT (2000) On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin126(2): 220–246.
55.
PadmanabhanAGarverKO’HearnKet al. (2015) Developmental changes in brain function underlying inhibitory control in autism spectrum disorders. Autism Research8(2): 123–135.
56.
PearsonBLPobbeRLDefensorEBet al. (2011) Motor and cognitive stereotypies in the BTBR T+tf/J mouse model of autism. Genes, Brain, and Behavior10: 228–235.
57.
PenningtonBFOzonoffS (1996) Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry37: 51–87.
58.
PerlsteinWMCarterCSBarchDMet al. (1999) The Stroop task and attention deficits in schizophrenia: a critical evaluation of card and single-trial Stroop methodologies. Neuropsychology12: 414–425.
59.
RattazCMichelonCBaghdadliA (2015) Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. Journal of Intellectual Disability Research59(8): 730–740.
60.
RidderinkhofKRSpanMMVan Der MolenMW (2002) Perseverative behavior and adaptive control in older adults: performance monitoring, rule induction, and set shifting. Brain and Cognition49(3): 382–401.
61.
RutterMLe CouteurALordC (2003) Autism Diagnostic Interview—Revised. Los Angeles, CA: Western Psychological Services.
62.
SchmittLMWhiteSPCookEHet al. (2017) Cognitive mechanisms of inhibitory control deficits in autism spectrum disorder. Journal of Child Psychology and Psychiatry59: 586–595.
63.
SchmitzNRubiaKDalyEet al. (2006) Neural correlates of executive function in autistic spectrum disorders. Biological Psychiatry59(1): 7–16.
64.
ShaoYCuccaroMLHauserERet al. (2003) Fine mapping of autistic disorder to chromosome 15q11-q13 by use of phenotypic subtypes. The American Journal of Human Genetics72(3): 539–548.
65.
StroopJR (1935) Studies of interference in serial verbal reactions. Journal of Experimental Psychology18: 643–662.
66.
SungYJDawsonGMunsonJet al. (2005) Genetic investigation of quantitative traits related to autism: use of multivariate polygenic models with ascertainment adjustment. American Journal of Human Genetics76: 68–81.
67.
SzatmariPGeorgiadesSBrysonSet al. (2006) Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry47(6): 582–590.
68.
TchanturiaKAnderluhMBMorrisRGet al. (2004) Cognitive flexibility in anorexia nervosa and bulimia nervosa. Journal of the International Neuropsychological Society10(4): 513–520.
69.
TchanturiaKDaviesHRobertsMet al. (2012) Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin card sorting task. PLoS ONE7(1): e28331.
70.
TurnerM (1999) Annotation: repetitive behaviour in autism: a review of psychological research. Journal of Child Psychology and Psychiatry40(6): 839–849.
71.
TurnerM (1997) Towards an executive dysfunction account of repetitive behaviour in autism. In: RussellJ (ed.) Autism as an Executive Disorder. Oxford: Oxford University Press, pp.57–100.
72.
UzefovskyFAllisonCSmithPet al. (2016) Brief report: the Go/No-Go task online: inhibitory control deficits in autism in a large sample. Journal of Autism and Developmental Disorders46(8): 2774–2779.
73.
Van Den BerghSFScheerenAMBegeerSet al. (2014) Age related differences of executive functioning problems in everyday life of children and adolescents in the autism spectrum. Journal of Autism and Developmental Disorders44: 1959–1971.
74.
Van EylenLBoetsBSteyaertJet al. (2011) Cognitive flexibility in autism spectrum disorder: explaining the inconsistencies?Research in Autism Spectrum Disorders5(4): 1390–1401.
75.
WechslerD (2011) Wechsler Abbreviated Scale of Intelligence—Second Edition. San Antonio, TX: Pearson Assesements.
76.
YerysBEWallaceGLHarrisonBet al. (2009) Set-shifting in children with autism spectrum disorders: reversal shifting deficits on the intradimensional/extradimensional shift test correlate with repetitive behaviors. Autism13(5): 523–538.
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