Restricted, Repetitive Patterns of Behavior Characteristics

The DSM-5™ states that the child must exhibit at least two of the following (currently or by history):

1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

Also refer to the B List attachment printed earlier in this exercise.

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior  

When you get ready in the morning, do you have a routine, that is, an order in which you shower, eat breakfast, brush teeth, dress, etc.?

These routines are functional--they help us get to work or appointments on time.  Nonfunctional routines are things that are added.  For example, one student went to the bathroom by first stopping at one water fountain and getting a drink.  This may not seem like a problem.  However, on the way back to the classroom, she had to stop at a different drinking fountain.  We did not know that this was a routine until the second water fountain was broken and she had a meltdown.  This reaction is the key to knowing that a routine is not functional.  Another student had a particular work area.  Every day he worked with a different assistant, the teacher or the speech/language pathologist.  This was okay.  However, when the teacher tried to work with him when the aide was present, he became very upset.  When another staff member entered his work area, the student also became upset and quickly learned to say, “Please leave,” to make her leave.

Other routines include screaming in the car when the parent turned left instead of right at a certain intersection (McDonald’s and Burger King were to the right) and not letting his mother back up out of the driveway.  Verbal rituals also are included here.  For example, one student is interested in children and adults who are only children. He has a younger sister. He walks up to a teacher, looks her directly in the eye, touches her, and says, “Do you have a brother?”  When the teacher asks the same question in return he laughs and says, “No.”  He then asks, “Do you have a sister or brother?”  He also wants to know if the teacher’s sibling is younger or older than the teacher.  Although he remembers this information, he likes to ask it every time he sees the teacher and enjoys these conversational exchanges.  His educational team is helping him to not touch others when he approaches them. 
 
Temple Grandin has said that she used to ask the same questions over and over again because she liked hearing the answer over and over.  Some just like to hear the question!  Another student asked his teacher the same question about playing with a certain toy before indoor recess began.  He learned that his teacher does not want him to ask this question every day.  Now he asks whether he can ask a question, thereby resulting in a new ritual.  Typically, we stumble upon rituals.  We don’t usually notice them until the student cannot perform the ritual and has a meltdown.

Now look at list item from the BList Attachment number 9 (makes sure papers are not hanging off the edges of tables or desks) and 10 (straightens shelves in grocery stores).  These are compulsive behaviors that fall under this characteristic.  I hope I did not worry you with number 9 -- many people do the same thing.  When they do, some of us joke that their autism is showing.  When it comes to the person with autism, we picture some individuals having a job in a grocery store straightening the products on the shelves.

4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

This includes reactions to sensory information as well as intense visual interests (list item 8) or visually inspecting objects and other unusual sensory interests.

Some students with autism spectrum disorder over react to sensory information. For example, they flinch when someone touches them or cannot touch certain items such as Play-Doh or glue. Others are very aware of smells and sounds. One student attended a school that was near a train station. He could hear the train horns before any of the adults! Many students with autism spectrum disorder including Asperger’s are hypersensitive to sounds. When they hear certain sounds, they cover their ears. These sounds could include vacuum cleaners, motorcycles, or the high-pitch voice of an adult.

For some students, they may not feel pain or cold temperatures. A young student fell at recess and got back up to play. When she lined up at the end of recess, she looked down at her leg and saw blood from the scrape that resulted from the fall. She cried because she saw the blood and not because she was in pain. One student refused to wear long pants during the cold weather and snow. When he wore sweat pants, he rolled them over his knee. He sat with bare legs in the snow! School staff could not get him to not sit in the snow. One winter his parents gave him snow skiing lessons and he skied while wearing shorts.

Sensory and visual interests look a bit different. One student had put together a toy train.  He found an edge to the toy, bent over it, and turned his head sideways to look at the edges.  This is visual inspection.  Sometimes, students with autism spectrum disorder bring the toy or object to their eyes and look at it from the corner of their eye.  One student liked to arrange Bristle Blocks at eye level and stare at them while excitedly shaking his arms.  Another loved the wheels on a toy truck.  He sat on the floor, put the truck on a table, and watched the wheels as he pushed it back and forth.  Other children have lain on the floor watching the wheels of the moving truck. 

Some twirl, twiddle or spin objects.  Others smell objects or move them to hear a sound.  Repetitively rubbing a table top or seat cushion are other examples of unusual interests.