The Repetitive behavior spectrum : from autism to obsessive compulsive disorder

Thesis (Ph. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, 2009.While repetitive behavior in obsessive compulsive disorder (OCD) has been extensively researched, systematic study comparing repetitive behaviors in autism with those observed in OCD and other DSM-IV-TR diagnoses has been lacking despite the diagnostic significance of such behavior. The current dissertation hypothesizes that repetitive behavior may be viewed as existing on a spectrum characterized by five functional sub-spectra. The dissertation outlines the methodology for research using a sample of individuals diagnosed with an autism spectrum disorder (ASD), OCD, or both an ASD and OCD. Measure development analyses are outlined for the purpose of determining the psychometric properties of a new assessment tool intended to assist mental health practitioners in understanding what motivates and sustains repetitive behavior in their clients. As part of the measure development process it is hypothesized that repetitive behaviors defined as stereotypies, perseverations, and preoccupations will correspond more with functional characteristics defined as pleasure-seeking, soothing, internalized, metaphoric, and adaptive while the repetitive behaviors defined as obsessions and compulsions will correspond more with functional characteristics defined as risk-avoiding, distressing, intrusive, concrete, and disruptive. Exploratory factor analyses were conducted separately in the data collected from parents, therapists, and individuals using the self developed repetitive behavior scale. When the structural coefficients (direct correlations between each item and the extracted factors) from these analyses were compared across the three sources of information (i.e., parents, therapists, and individuals), four larger factors emerged demonstrating reasonable consistency across the three types of informants. These assessed: 1) intrusive effects; 2) soothing effects; 3) level of distress, and pleasure-seeking qualities. Reliability for the new scales was then calculated separately for each source of information revealing high internal consistency as evidenced by Cronbach’s alpha scores mostly in the 0.7 and higher range. Validity Analyses were completed, first by examining bi-variate correlations among the new scales and then by examining correlations between the new scales and established measures of functioning. As hypothesized, the new scales measuring soothing and pleasure-seeking qualities of repetitive behavior correlated more with measures of ASD and the new scales measuring level of distress and intrusiveness in repetitive behavior correlated more with measures of OCD. The author suggests that the results of the current study should be considered by all mental health professionals supporting people with OCD and/or an ASD