A greater focus on very early repetitive behaviors may help identify more babies and toddlers who would benefit from early intervention for autism, a new study suggests.
"We found that, on average, children who developed autism exhibited four to eight types of repetitive behavior at age 12 months,” says researcher Jason Wolff, of the University of North Carolina, Chapel Hill. “It's exciting because these differences may be present before other symptoms and may help identify children who would benefit from early intervention.”
Dr. Wolff presented his team’s findings this week at the International Meeting for Autism Research (IMFAR).
See all our IMFAR 2014 news and perspective here.
Dr. Wolff and his colleagues are part of Autism Speaks Baby Siblings Research Consortium. Its investigators study the infant siblings of children already diagnosed with autism because the disorder tends to run in families. Their investigation of early repetitive behaviors is also part of the larger Infant Brain Imaging Study (IBIS), which Autism Speaks helps support with a collaborative research grant.
Restricted and repetitive behaviors have long been recognized as a core symptom of autism. 
However they were once believed to develop later than autism’s social-communication symptoms, Dr. Wolff says.
In their study, the IBIS team tracked the behaviors in 243 toddlers from ages 12 to 24 months using parent questionnaire. “We found that all forms of restricted and repetitive behavior were significantly increased in the group of children who developed autism,” Dr. Wolff says. “And they were evident starting at age 12 months – years before the average age of diagnosis.”
Though behavioral therapy doesn’t help all children with autism, research suggests that earlier intervention with high-quality therapy generally improves outcomes.
In the new study, the toddlers who went on to be diagnosed with autism exhibited between four and eight types of repetitive behavior, on average. Examples of such behaviors include hand flapping, spinning and rocking. Those who did not develop autism averaged just one or two types. To a limited degree, repetitive behaviors are a normal part of early development, experts agree.
“It’s notable that we found this clear difference using a simple parent report that took 5 to 10 minutes to complete,” Dr. Wolff says. “This suggests that parents can detect these behaviors early on, making them a practical target for early screening and intervention programs.”
Developmental-behavioral pediatrician Paul Wang, Autism Speaks head of medical research, concurs: “We should be thinking about whether current early screening tools give adequate attention to this domain of symptoms,” he says. “These behaviors may also be easier to measure than social deficits.” At the same time, parents should remember that not every child who will develop autism will have early repetitive behaviors, Dr. Wang adds. And not every baby or toddler who shows increased repetitive behaviors will develop autism.
If you have concerns about repetitive or restricted behaviors in your baby or toddler, please see these resources on the Autism Speaks website:
* The Autism Speaks Video Glossary (illustrating differences between typical and “red flag” behaviors)
* Screen Your Child (Take an automated version of the M-CHAT autism screen for toddlers)
* The Autism SpeaksFirst Concern to Action Tool Kit
* Autism Speaks Early Access to Care Initiative