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. 2023 Jan 27:1-16.
doi: 10.1007/s41252-023-00317-6. Online ahead of print.

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment

Catharine Lory  1 , Mandy Rispoli  2 , Brandon Keehn  3   4 , Rose A Mason  5 , Benjamin A Mason  5 , Sungwoo Kang  5 , Amanda M Borosh  5 , Eric Shannon  5 , Hannah Crosley  5
Affiliations

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment

Catharine Lory et al. Adv Neurodev Disord. .

Abstract

Objectives: Prior research has established assessment methodologies, such as functional analysis to identify specific contexts in which restricted and repetitive behavior (RRB) occurs, and measures of heart rate variability (HRV) to index the level of autonomic arousal in individuals with autism spectrum disorder (ASD). Yet, a gap remains in integrating multiple assessment methodologies to examine the complex underlying mechanisms of RRB. This study piloted a multi-disciplinary approach to assess both the functional behavioral and neurophysiological factors that may underlie occurrences of RRB. The study (a) evaluated the effect of a modified functional analysis protocol on delineating functional subtypes of RRB and (b) explored the effect of using a wearable technology within a functional analysis on identifying the relationship between RRB and HRV.

Method: A single-case alternating treatment design was used to randomly alternate noncontingent low-stimulation and high-stimulation conditions in a modified functional analysis protocol. Simultaneous measurement of RRB and HRV was obtained through direct behavioral observations and a wristband that collects blood volume pulse, respectively. Visual analysis of time series data was used to determine the functional subtypes of RRB, and nonparametric correlational analyses were conducted to determine the association between HRV and RRB.

Results: Findings from a sample of six participants suggest preliminary effectiveness of the assessment protocol in identifying subtypes of RRB and a significant correlation between HRV and RRB.

Conclusions: This study demonstrates the potential effect and usability of a wearable technology-aided biobehavioral approach to assess RRB and HRV in individuals with ASD.

Keywords: Autism; Autonomic arousal; Functional analysis; Stereotypy; Wearable technology.

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Conflict of interest statement

Competing InterestsThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study design and hypothesized outcomes with corresponding functional subtypes
Fig. 2
Fig. 2
Results of the modified functional analysis for six participants. Asterisks (*) indicate sessions with a change in staff who implemented the session. For Cassie, a medication change occurred before session 3, and staff changes occurred in sessions 17, 19, 20, 23, and 24. For Roger, a 1-month break occurred between sessions 5 and 6, a staff change occurred in session 6, and a time change (from morning to afternoon) occurred beginning from session 6. For Aubrey, study sessions were implemented in a different clinic room beginning from session 10
Fig. 3
Fig. 3
Scatterplot of correlation of heart rate variability (RMSSD/s) and repetitive behavior across modified functional analysis sessions of five participants (Cassie, Greta, Roger, Marc, and Griffin); r = .552; *p < .001; data points were categorized based on automatic reinforcement subtypes including positive, negative, and mixed
See this image and copyright information in PMC

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