Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2021

Open Access 01-12-2021 | Obsessive-Compulsive Disorder | Protocol

Repetitive and restricted behaviours and anxiety in autism spectrum disorder: protocol for a systematic review and meta-analysis

Authors: Tegan Sellick, Alexandra Ure, Katrina Williams

Published in: Systematic Reviews | Issue 1/2021

Login to get access

Abstract

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by persistent deficits in social functioning and the presence of restricted and repetitive behaviours (RRBs). RRBs refer to four subtypes of behaviour including repetitive movements, speech, or use of objects; insistence on sameness; restricted interests; and sensory processing abnormalities. Many individuals with ASD also experience anxiety, which compounds ASD-related difficulties and inhibits daily functioning. RRBs have been found to be positively associated with anxiety; however, our understanding of the interplay between RRB subtypes and anxiety remains unclear. Thus, the current review aims to clarify the association between RRBs and anxiety by conducting a systematic review and meta-analysis.

Methods

To identify relevant studies, we will search five databases: CINAHL Plus, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, PsycINFO, and Scopus. Articles included in the review will have their titles, abstracts, and full texts reviewed by two independent authors and their methodological quality assessed via the modified Newcastle-Ottawa Scale. Random-effects meta-analyses will then be conducted to calculate the pooled association between RRB subtypes and anxiety. Sensitivity analyses will also be conducted to assess the potential impact of bias, missing data, outliers, and methodological differences on this relationship. Additionally, this review will collate the factors which may influence the anxiety-RRB relationship to help identify who is most vulnerable to developing anxiety.

Discussion

This will be the first review to examine the association between the four subtypes of RRBs and anxiety in individuals with ASD. Understanding this relationship, and the factors associated with this, may help clinicians understand the different underpinnings and presentations of anxiety within this population with potential implications for assessment and treatment.

Systematic review registration

PROSPERO CRD42020185434
Appendix
Available only for authorised users
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
2.
van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17.CrossRef
3.
Russell K, Frost K, Ingersoll B. The relationship between subtypes of repetitive behaviors and anxiety in children with autism spectrum disorder. Res Autism Spectr Disord. 2019;62:48–54.CrossRef
4.
Kring AM, Kyrios M, Fassnacht D, Lambros A, Mihaljcic T, Teesson M. Abnormal psychology. Milton: Wiley; 2018.
5.
Vasa R, Carroll L, Nozzolillo A, Mahajan R, Mazurek M, Bennett A, et al. A systematic review of treatments for anxiety in youth with autism spectrum disorders. J Autism Dev Disord. 2014;44(12):3215–29.CrossRef
6.
Top DN Jr, Luke SG, Stephenson KG, South M. Psychophysiological arousal and auditory sensitivity in a cross-clinical sample of autistic and non-autistic anxious adults. Front Psychiatry. 2019;9:1–12.
7.
Zaboski BA, Storch EA. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31–7.CrossRef
8.
Kerns CM, Kendall PC, Berry L, Souders MC, Franklin ME, Schultz RT, et al. Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(11):2851–61.CrossRef
9.
Adams D, Young K, Simpson K, Keen D. Parent descriptions of the presentation and management of anxiousness in children on the autism spectrum. Autism. 2019;23(4):980–92.CrossRef
10.
Rodgers J, Glod M, Connolly B, McConachie H. The relationship between anxiety and repetitive behaviours in autism spectrum disorder. J Autism Dev Disord. 2012;42(11):2404–9.CrossRef
11.
Australian Psychological Society. Evidence-based psychological interventions in the treatment of mental disorders: a literature review; 2018.
12.
Baribeau DA, Vigod S, Pullenayegum E, Kerns CM, Mirenda P, Smith IM, et al. Repetitive behavior severity as an early indicator of risk for elevated anxiety symptoms in autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2020;59(7):890–9.CrossRef
13.
Lidstone J, Uljarević M, Sullivan J, Rodgers J, McConachie H, Freeston M, et al. Relations among restricted and repetitive behaviors, anxiety and sensory features in children with autism spectrum disorders. Res Autism Spectr Disord. 2014;8(2):82–92.CrossRef
14.
Muskett A, Capriola-Hall N, Radtke S, Factor R, Scarpa A. Repetitive behaviors in autism spectrum disorder: associations with depression and anxiety symptoms. Res Autism Spectr Disord. 2019;68:101449.CrossRef
15.
Rodgers J, Riby DM, Janes E, Connolly B, McConachie H. Anxiety and repetitive behaviours in autism spectrum disorders and Williams syndrome: a cross-syndrome comparison. J Autism Dev Disord. 2012;42(2):175–80.CrossRef
16.
Baird K, Szatmari P, Georgiades S, Duku E, Bryson S, Fom-Bonne E, et al. Investigating the association between anxiety and fixed interests, repetitive behaviours in preschool children with ASD. Ontario: Paper presented at: International Meeting for Autism Research; 2012.
17.
Green SA, Ben-Sasson A, Soto TW, Carter AS. Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: bidirectional effects across time. J Autism Dev Disord. 2012;42(6):1112–9.CrossRef
18.
Spiker MA, Lin CE, Van Dyke M, Wood JJ. Restricted interests and anxiety in children with autism. Autism. 2012;16(3):306–20.CrossRef
19.
Haruvi-Lamdan N, Horesh D, Golan O. PTSD and autism spectrum disorder: co-morbidity, gaps in research, and potential shared mechanisms. Psychol Trauma. 2018;10(3):290–9.CrossRef
20.
Mazurek M, Vasa R, Kalb L, Kanne S, Rosenberg D, Keefer A, et al. Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. J Autism Dev Disord. 2013;41(1):165–76.
21.
Factor R, Condy E, Farley J, Scarpa A. Brief report: insistence on sameness, anxiety, and social motivation in children with autism spectrum disorder. J Autism Dev Disord. 2016;46(7):2548–54.CrossRef
22.
Joyce C, Honey E, Leekam SR, Barrett SL, Rodgers J. Anxiety, intolerance of uncertainty and restricted and repetitive behaviour: insights directly from young people with ASD. J Autism Dev Disord. 2017;47(12):3789–802.CrossRef
23.
Wigham S, Rodgers J, South M, McConachie H, Freeston M. The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder. J Autism Dev Disord. 2015;45(4):943–52.CrossRef
24.
Bishop S, Hus V, Duncan A, Huerta M, Gotham K, Pickles A, et al. Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. J Autism Dev Disord. 2013;43(6):1287–97.CrossRef
25.
Hooker JL, Dow D, Morgan L, Schatschneider C, Wetherby AM. Psychometric analysis of the repetitive behavior scale-revised using confirmatory factor analysis in children with autism. Autism Res. 2019;12(9):1399–410.CrossRef
26.
Lam KSL, Bodfish JW, Piven J. Evidence for three subtypes of repetitive behavior in autism that differ in familiality and association with other symptoms. J Child Psychol Psychiatry. 2008;49(11):1193–200.CrossRef
27.
Glod M, Riby DM, Rodgers J. Short report: relationships between sensory processing, repetitive behaviors, anxiety, and intolerance of uncertainty in autism spectrum disorder and Williams syndrome. Autism Res. 2019;12(5):759–65.CrossRef
28.
Black K, Stevenson R, Segers M, Ncube B, Sun S, Philipp-Muller A, et al. Linking anxiety and insistence on sameness in autistic children: the role of sensory hypersensitivity. J Autism Dev Disord. 2017;47(8):2459–70.CrossRef
29.
Hwang YI, Arnold S, Srasuebkul P, Trollor J. Understanding anxiety in adults on the autism spectrum: an investigation of its relationship with intolerance of uncertainty, sensory sensitivities and repetitive behaviours. Autism. 2020;24(2):411–22.CrossRef
30.
Gotham K, Bishop SL, Hus V, Huerta M, Lund S, Buja A, et al. Exploring the relationship between anxiety and insistence on sameness in autism spectrum disorders. Autism Res. 2013;6(1):33–41.CrossRef
31.
Maclennan K, Roach L, Tavassoli T. The relationship between sensory reactivity differences and anxiety subtypes in autistic children. Autism Res. 2020;13(5):785–95.CrossRef
32.
Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016;11(1):1-21.
33.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed; 2020.
Metadata
Title
Repetitive and restricted behaviours and anxiety in autism spectrum disorder: protocol for a systematic review and meta-analysis
Authors
Tegan Sellick
Alexandra Ure
Katrina Williams
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2021
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-021-01830-2

Other articles of this Issue 1/2021

Systematic Reviews 1/2021 Go to the issue

Protocol

Evacuation solutions for individuals with functional limitations in the built environment: a scoping review protocol

Protocol

Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews

Protocol

Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol

Protocol

Adolescent alcohol consumption: protocol for a scoping review of screening and assessment tools used in Africa

Protocol

Substance use and substance use disorder, in relation to COVID-19: protocol for a scoping review

Protocol

Mesenchymal stromal cells as a therapeutic intervention for COVID-19: a living systematic review and meta-analysis protocol