Repetitive behavior in 12-month-olds later classified with autism spectrum disorder

Jed T. Elison, Jason J. Wolff, J. Steven Reznick, Kelly N. Botteron, Annette M. Estes, Hongbin Gu, Heather C. Hazlett, Adriane J. Meadows, Sarah J. Paterson, Lonnie Zwaigenbaum, Joseph Piven

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Objective: As compared to the utility of early emerging social communicative risk markers for predicting a later diagnosis of autism spectrum disorder (ASD), less is known about the relevance of early patterns of restricted and repetitive behaviors. We examined patterns of stereotyped motor mannerisms and repetitive manipulation of objects in 12-month-olds at high and low risk for developing ASD, all of whom were assessed for ASD at 24 months. Method: Observational coding of repetitive object manipulation and stereotyped motor behaviors in digital recordings of the Communication and Symbolic Behavior Scales was conducted using the Repetitive and Stereotyped Movement Scales for 3 groups of 12-month-olds: low-risk infants (LR, n = 53); high-familial-risk infants who did not meet diagnostic criteria for ASD at 24 months (HR-negative, n = 75); and high-familial-risk infants who met diagnostic criteria for ASD at 24 months (HR-ASD, n = 30). Results: The HR-ASD group showed significantly more stereotyped motor mannerisms than both the HR-negative group (p =.025) and the LR group (p =.001). The HR-ASD and HR-negative groups demonstrated statistically equivalent repetitive object manipulation scores (p =.431), and both groups showed significantly more repetitive object manipulation than the LR group (p <.040). Combining the motor and object stereotypy scores into a Repetitive and Stereotyped Movement Scales (RSMS) composite yielded a disorder-continuum effect such that each group was significantly different from one another (LR < HR-negative < HR-ASD). Conclusion: These results suggest that targeted assessment of repetitive behavior during infancy may augment early ASD identification efforts.

Original languageEnglish
Pages (from-to)1216-1224
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number11
StatePublished - 2014


  • Autism
  • Development
  • Infant siblings
  • Motor stereotypies
  • Repetitive behavior


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