Restricted and repetitive behaviours disappeared?

A new paper by Eva Troyb and colleagues* based at the University of Connecticut, USA adds to the growing literature identifying a subgroup on the autism spectrum who present with ‘optimal outcome’ (OO) characterised by a movement outside of the diagnostic boundaries which make up an autism spectrum disorder (ASD).

Researchers observed that alongside previous reports of a resolution of social and communication issues in some children historically diagnosed as being on the autism spectrum, restricted and repetitive behaviours (RRBs) “had almost totally disappeared in the OO group”.

RRBs can include a wide variety of behaviours ranging from a preoccupation with a certain topic or area of interest to more disabling behaviours such as an insistence on sameness or the presence of often rigid routines or rituals. For some on the autism spectrum, such behaviours can be a significant source of comfort and enjoyment as per reports on the the use of hand-flapping. In other cases, even small alterations to set routines can conversely be a significant source of distress as described following changes to elements of the physical surroundings or when daily routines are unexpectedly amended.

Troyb and colleagues examined current and historical RRBs in a group of individuals who had achieved OO compared with a group of “high-functioning” individuals with an ASD and asymptomatic controls. They reported that most in the OO group had previously met diagnostic cut-off points for RRBs in early childhood but analysis of current behaviour revealed only minimal residual RRBs to be present.

Whilst a contentious topic in some quarters, there is a growing appreciation that OO is a real and valid part of the autism spectrum. Discussions continue as to how many people could be included under the banner of OO and whether they represent a distinct type of autism. Whether their symptom remission is a natural process or influenced by external forces such as intervention is another question yet to be answered, as are the long-term consequences of losing an autism diagnosis and whether this impacts on other areas such as employment and securing social and financial independence.


* Troyb E. et al. Restricted and Repetitive Behaviors in Individuals with a History of ASDs Who Have Achieved Optimal Outcomes. J Autism Dev Disord. 2014 Jul 17.


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