The Measurement of Restricted and Repetitive Behaviors in Autism Spectrum Disorder

The image of the non-verbal child, flapping and spinning, totally absorbed in their own obsessive interests, as described by Kanner (Nerv Child 2:217–250, 1943), represents the more traditional view of Autism Spectrum Disorder (ASD) and the stereotypical behaviors that accompany this condition. However, with the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994 (4th edition; DSM-IV; American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: Author, 1994), the spectrum was expanded to include persons with a milder variant of the disorder (i.e. Asperger’s syndrome). With this came a broader interpretation of the presentation of these restricted and repetitive behaviors and interests (RRBI) in the current edition of the DSM, the DSM-5 (American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edn. Washington, DC: Author, 2013). As a result, the DSM-5 now includes heterogenic behaviors such as motor stereotypies, sensory-related behaviors, circumscribed interests, rituals, excessive sensitivity to change, and echolalic speech. While it is agreed that these behaviors are pervasive in this condition, and form part of the ASD diagnostic criteria, there remains a lack of consensus regarding a definition of RRBI (Leekam et al. Psychol Bull 137:562–593, 2011) and how pervasive these behaviors must be to be considered deviant and of diagnostic significance. This, therefore, creates challenges for researchers and clinicians in designing valid and reliable assessments of RRBI that are sensitive to this disorder, yet specific to ASD. The purpose of this chapter is to operationalize these behaviors and review the currently available tools so that we may determine whether these tools are valid measures of these behaviors.