Clinical Assessment of Repetitive and Restricted Behaviors in Toddlers on the Autism Spectrum

Repetitive and restricted behaviors (RRBs) are core symptoms of ASD and often emerge in the first year of life. It is important to understand how best to integrate diagnostically relevant information from multiple methods of assessment in clinical settings. The study aims to characterize the association between parent report and clinical observation of RRBs, compare the utility of each method for eliciting information on RRBs, and characterize the presentation of RRBs in toddlers at the time of initial diagnosis. Participants were 65 children ages 18-39 months diagnosed with ASD. Associations between a parent report rating scale, clinician-driven parent interview, and clinician observation were determined. Correlations were run for each of six behavioral subdomains. Rate of behavior endorsement on each measure was compared. Correlations were used to determine association between age and rate of RRBs. In most behavioral subdomains, parent report of RRBs on a behavioral rating scale and clinical interview were consistent. Overall, parent report offers valuable information on RRBs that go beyond what is typically observed by clinicians in an evaluation. However, clinical observation appears to be particularly important for identifying sensory behaviors. Results indicate that both parent report and observation contribute to a more complete representation of RRBs and should be included in diagnostic assessment