Determining the Relationship Between Executive Functioning and Repetitive Behaviors for Children with ASD vs. Typically Developing Justin Cohen

Introduction Autism is a disorder in brain development; it is a specific disorder among the autistic spectrum. Its severity can vary from low functioning to high functioning. Over the past 40 years, there has been a ten fold increase in the diagnoses of Autism Spectrum Disorder (ASD). ASD affects over 3 million Americans and over 10 million individuals worldwide. The reason for the recent increase in the diagnoses of autism is not completely known, however it is thought that this is due to improved diagnosis protocols and environmental factors such as heavy metals like lead and mercury.

Introduction A significant difficulty that children with autism have is with their Executive Function (EF) skills. EF is a set of skills that helps get things accomplished such as estimating how much time a project will take to complete. Repetitive behaviors are also a known action associated with autism. It is not uncommon for children with autism to participate in ritualistic behavior such as hand flapping, rocking, and head banging.

Review of Literature Lam, Kristen S.L., and Michael G. Aman. “The Repetitive Behavior Scale-Revised: Independent Validation in Individuals with Autism Spectrum Disorders.” Journal of Autism and Developmental Disorders 37.5 (2006): 855-66. The RBS-R (Repetitive Behavior Scale - Revised) is an accurate tool that can be used to measure a child’s repetitive behaviors.

Review of Literature Ponitz, Claire Cameron, Megan M. Mcclelland, J. S. Matthews, and Frederick J. Morrison. "A Structured Observation of Behavioral Self-regulation and Its Contribution to Kindergarten Outcomes." Developmental Psychology 45 (2009): 605-19. The Head Toe Knee Shoulder (HTKS) task can be used to measure a child’s EF. This allowed for EF to be correlated to other traits. Kidwell, Katherine. "Trees and Traffic: Restorative Environments and Children's Executive Functioning." (2012). The HTKS task demonstrates the child’s ability to show self control and a working memory of the instructions and thus their EF skills.

Hypothesis There will be a stronger trend between the scores for children with autism compared to that of TD children. There is a reason to believe this hypothesis to be true because a higher HTKS score shows an increase in EF and thus a better ability to control oneself and participate in less repetitive behaviors. This study also aims to look at what happens to this trend between the scores as both groups age from preschool to early school.

Purpose The implications of there being a relationship between the scores are very useful. If it is found that increased executive functioning leads to less repetitive behaviors for children with autism, then therapies can be geared towards improving the child's executive functioning to indirectly limit their repetitive behaviors.

Methodology The data from the participants in this study were all stored in the database at Weill Cornell Medical College. The data for each participant was recorded at different times and each participant had individually chosen variables recorded. To retrieve the data specifically for this study, the database was sorted through, only retrieving participants who met these criteria: 29-96 months of age, had scores for the HTKS task and RBS-R and either diagnosed with autism or typically developing.

Methodology Participants:

Methodology Age Groups:

Methodology To analyze the difference in HTKS scores for children with autism and typically developing, 3 bar graphs were created. The first graph was for all participants, ASD vs. TD. The other 2 graphs were broken down by age; one was for preschool and the other was for the early school aged children. For comparing RBS-R scores between the two groups, the same 3 graphs were created.

Methodology Then to address the hypothesis, the HTKS and RBS-R scores were compared directly. A total of 6 line graphs were constructed to analyze the relationship. The first group of 3 graphs was for the ASD group only. One graph looked at the trend for the whole group and the other 2 were dissected further into the age groups. Similarly 3 graphs were constructed for the TD group. To determine the statistical significance of each correlation, independent t-tests were run to get p values.

Results – HTKS ASD vs. TD P>.05 P>.05 P<.01

Results - RBS-R ASD vs. TD P<.01 P<.01 P<.01

Results – ASD HTKS vs. RBS-R P>.05 P>.05 P>.05

Results – TD HTKS vs. RBS-R P>.05 P>.05 P>.05

Conclusion No statistical significance was found between HTKS and RBS-R scores for either children with autism or typically developing children in any age group. Children with autism statistically scored lower on the RBS-R compared to that of typically developing children, which was also expected and consistent with other studies. Children with autism did statistically score lower on the HTKS task compared to that of typically developing children.

Discussion The idea of expecting a child who has higher EF to exhibit less repetitive behaviors does seem to be sound, however the data suggest that there is no correlation between the scores. One possible reason for the no correlation is that the sample size was fairly small and the TD group far out weighed the ASD group, perhaps yielding an unreliable statistical analysis.

Discussion Also, it is not very accurate to compare HTKS and RBS-R scores for TD children because they tend to not score at all or perhaps have very small composite scores on the RBS-R Future research should further analyze the relationship between the scores, particularly in children with autism because of the fact that typically developing children tend not to score significantly on the RBS-R.

References Croen, Lisa, Judith Grether, Jenny Hoogstrate, and Steve Selvin. "The Changing Prevalence of Autism in California." Journal of Autism and Developmental Disorders 32.3 (2002): 207-15. Howlin, Patricia, Susan Goode, Jane Hutton, and Michael Rutter. "Adult Outcome for Children with Autism." Journal of Child Psychology and Psychiatry J Child Psychol & Psychiat 45.2 (2004): 212-29. Kidwell, Katherine. "Trees and Traffic: Restorative Environments and Children's Executive Functioning." (2012). Lan, Xuezhao, Cristine H. Legare, Claire Cameron Ponitz, Su Li, and Frederick J. Morrison. "Investigating the Links between the Subcomponents of Executive Function and Academic Achievement: A Cross-cultural Analysis of Chinese and American Preschoolers." Journal of Experimental Child Psychology 8 (2011): 677-92. Mandell, D. S. "Factors Associated With Age of Diagnosis Among Children With Autism Spectrum Disorders." Pediatrics 116.6 (2005): 1480-486. Ponitz, Claire Cameron, Megan M. Mcclelland, J. S. Matthews, and Frederick J. Morrison. "A Structured Observation of Behavioral Self-regulation and Its Contribution to Kindergarten Outcomes." Developmental Psychology 45 (2009): 605-19.

Acknowledgments I’d like to thank Mrs. Kleinman, Mrs. Foisy, Mrs. O’Hagan, my parents, and my mentor Dr. Rebecca Jones for their continued support throughout my research.

Determining the Relationship Between Executive Functioning and Repetitive Behaviors for Children with ASD vs. Typically Developing Justin Cohen