Restricted and repetitive behaviors and association with cognition and adaptive functioning in children with autism spectrum disorder in Singapore

Wanyun Lin; Yiong Huak Chan; Jennifer S H Kiing; Tammy S H Lim; Shang Chee Chong; Ying Qi Kang; Ramkumar Aishworiya; Kalyani Vijayakumar Mulay; Mae Yue Tan

doi:10.3389/fpsyt.2023.1249071

Restricted and repetitive behaviors and association with cognition and adaptive functioning in children with autism spectrum disorder in Singapore

Front Psychiatry. 2023 Nov 16:14:1249071. doi: 10.3389/fpsyt.2023.1249071. eCollection 2023.

Authors

Wanyun Lin^{1

2}, Yiong Huak Chan³, Jennifer S H Kiing^{1

2}, Tammy S H Lim^{1

2}, Shang Chee Chong^{1

2}, Ying Qi Kang^{1

2}, Ramkumar Aishworiya^{1

2}, Kalyani Vijayakumar Mulay^{1

2}, Mae Yue Tan^{1

2}

Affiliations

¹ Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
² Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
³ Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract

Background: One of the core features of autism spectrum disorder (ASD) is restricted, repetitive patterns of behavior, interests and activities (RRBs). RRBs are known to adversely affect cognition and adaptive functioning. We explored the relationship of RRBs with cognition and adaptive functioning in children with ASD in an Asian setting.

Methods: This cross-sectional study was conducted at a tertiary developmental pediatrics center in Singapore from September 2019 to October 2021. Parent-child dyads (parents and their children ≤7 years old diagnosed with ASD) were recruited. Parents completed the Repetitive Behavior Questionnaire-2 (RBQ-2), which reports total score and two subscales - Motor/Sensory Behaviors (RBQ-2 MS) and Rigidity/Routines/Preoccupation with Restricted Interests (RBQ-2 RRPRI). Standardized assessments included Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS-II). Data analysis utilized descriptive statistics and Pearson's correlation.

Results: Parents of 113 children [75.2% male, mean (SD) age 5.0 (1.2) years] participated. Median (IQR) RBQ-2 score was 29.0 (11.0). Significant negative correlations (adjusted for age, gender and family history of ASD) were observed for total RBQ-2 scores with MSEL ELC scores (r = -0.248, n = 101, p = 0.014) and VABS-II ABC scores (r = -0.281, n = 88, p = 0.009). Specifically, these correlations of fair strength were seen only with the RBQ-2 MS subscale for both ELC (r = -0.321, n = 101, p = 0.001) and ABC (r = -0.3478, n = 88, p = 0.001).

Conclusion: In children with ASD, severity of RRBs correlated with adverse cognition and adaptive functioning measures in our study, consistent with Western literature. While our study does not show causality, it adds to literature serving as a foundation for further research for both clinicians and researchers to target RRBs in improving outcomes with children in ASD.

Keywords: Asian; Singapore; adaptive functioning; autism spectrum disorder; children; cognition; restricted and repetitive behaviors.