DOI: https://doi.org/10.53350/pjmhs22164153 ORIGINAL ARTICLE P J M H S Vol. 16, No. 04, APR 2022 153 Presentation of Restrictive and Repetitive Behaviors in Autism Spectrum Disorder MUHAMMAD BASIT 1 , ALLAH NAWAZ SULTAN 2 , SHABIR AHMED 3 , NOSHEEN IFTIKHAR 4 , WAHEED AHMAD 5 , , MUHAMMAD HAFEEZ 6 1 Consultant , Deptt of Paediatrics. THQ Hospital Kulachi Dera Ismail Khan 2 Assistant Professor, Deptt of Paediatrics Sharif Medical City Hospital Lahore 3 Associate Professor , Deptt of Paediatrics Azra Naheed Medical College Lahore 4 Associate Professor, Deptt of Paeditrics Sharif Medical City Hospital Lahore 5 Assistant Professor , Deptt of Paediatrics Azra Naheed Medical College Lahore 6 Senior Registrar, Deptt Paeds Medicine Holy Family Hospital Rawalpindi Correspondence to Email: ashabir76@yahoo.com Cell 03004353171 ABSTRACT Background: Autism spectrum disorders (ASDs) are lifelong developmental disabilities characterized by marked difficulties in social reciprocal interaction and communication, along with restricted and repetitive interests, attitudes and behaviors. Aim: To determine the frequency and spectrum of restrictive and repetitive interests, attitudes and behaviors in patients with ASD. Methods: A Descriptive cross sectional study was carried out at The Children’s Hospital & Institute of Child Health, Lahore for six months. A total of 190 cases were enrolled in this study, Patients assessed for presence of restrictive and repetitive interests, attitudes and behaviors and its types including; Stereotyped or repetitive motor movements, insistence on sameness, highly restricted, fixated interests and Hyper or Hypo reactivity to sensory input. All the data was entered and analyzed on SPSS. Results: The mean age of patients was 6.54±2.29 years. Male to female ratio was 1.63:1. The mean CARS score was 42.12±7.31. The restricted and repetitive interests, attitudes and behaviors were noted in 180(94.7%) patients. Conclusion: Repetitive behavior was noted in 94.7% patients, stereotypies, insistence on sameness, highly restricted interests and hyper of hypo reactivity to sensory input was found in 42.6%, 30.5%, 10.5% and 11.05% respectively Keywords: Repetitive, Behavior, Restricted Interests, Sensory Input INTRODUCTION Autism spectrum disorder is characterized by persistent deficits in reciprocal social communication and interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors issued for social interaction, and skills in developing, maintaining, and understanding relationship 1 . In 2014, the centers for disease control and prevention (CDC) released new data on the prevalence of autism in the united states. The overall prevalence of ASD was 14.7 per 1000 (one in 68) children aged 8 years. ASD prevalence estimates varied by sex and racial/ethnic group also. ASD is almost 5 times more common among boys (1 in 42) than among girls (1 in 189). Non- hispamic white children were approximately 30% more likely to be identified with ASD than non-hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. 2 Studies in Asia, Europe and North America have identified individuals with ASD with an average prevalence of about 1%. A study in South Korea reported a prevalence of 2.6%. 3 Nazish et al diagnosed autism in 3.2% of all the children referred to a tertiary care hospital in Pakistan with developmental delay 4 . Most scientists agree that genes are one of the risk factors that can make a person more likely to develop ASD 5 . Children who have a sibling with ASD are at a higher risk of having ASD 6 Restricted and repetitive behaviors (RRBs) associated with autism spectrum disorders (ASD) comprise a heterogeneous group of behaviors, but research during the last decade suggests that they can be divided into at least two dimensions or subcategories. Repetitive Sensory Motor behaviors include motor mannerisms, sensory seeking behavior, and repetitive use of objects whereas insistence on Sameness behaviors are characterized by compulsions and rituals and difficulties with changes in routine 7 . Behavioral subcategories such as these are of particular interest to researchers investigating biological processes that may underlie ASD, because they provide a means by which to organize the larger ASD population into smaller group of individuals with more similar behavioral profiles. Ultimately, it is hoped that identifying more phenotypically homogenous subgroups will facilitate effort to understand etiologies of ASD. ---------------------------------------------------------------------------------------- Received on 14-09-2021 Accepted on 24-09-2022 As restrictive and repetitive behaviors are an important part of diagnostic criteria (DSM-V) in ASD and are seen in 98% of children with ASD 8 Therefore this study is planned to determine spectrum of different restrictive and repetitive behaviors, that will lead to administration of proper intervention program for management of ASD. This study was carried out to determine the frequency and spectrum of restrictive and repetitive behaviors in patients with ASD. Operational Definitions Autism Spectrum Disorder: ASD was defined as per CARS as detailed in Annexure (cut off value 29). Range 15-60 Restrictive and Repetitive Behaviors: Spectrum of restrictive and repetitive behaviors include any one of these from 1 to 4 Stereotyped or repetitive motor movements: Hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases, spending hours lining up toys in a specific way instead of using them for playing, having household in a fixed order or place. Insistence on sameness: Extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat specific food every day Highly restricted interests: Strong attachment to or preoccupation with unusual objects e.g. stick, stones strings etc Hyper or hypo reactivity to sensory input: Apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement. MATERIAL AND METHODS After IRB permission a descriptive cross sectional study was conducted at development outpatient Department of Children’s Hospital and Institute of Child Health, Lahore during a period of six months. A total of190 cases is calculated with 95% confidence level, 2% margin of error and taking expected percentage of restrictive and repetitive behaviors i.e., 98% in patients with ASD 8 . Non probability consecutive sampling was employed Inclusion Criteria 1. Age range 3-10 years. 2. Both males and females included. 3. Patients diagnosed as ASD on CARS. 4. The subject’s parents should read and sign the informed consent form.