Understanding the Complexity of Repetitive Behaviors in Children: A Transdiagnostic Approach


Repetitive behaviors encompass a wide range of actions characterized by frequent repetition and an intense preference for sameness. They can manifest as motor stereotypies, repetitive speech, routines, and rituals, and are often observed in various neurodevelopmental and psychiatric conditions, including autism. In a new study published in the peer-reviewed Journal Frontiers in Behavioral Neuroscience, Dr. Jennifer Keating, Professor Stephanie Van Goozen, Emerita Professor. Dale Hay, and Emerita Professor Susan Leekam from Cardiff University, in collaboration with Assistant Professor Mirko Uljarević at Stanford University investigated the developmental and demographic correlates of restricted and repetitive behaviors (RRBs) in young children and shed light on the broader nature of these behaviors. Previous research on RRBs has mainly focused on specific diagnosed clinical groups, making it challenging to discern their broader nature and independence from other symptoms. The new study addressed this limitation by employing a transdiagnostic approach, examining RRBs in a diverse non-clinical sample of 260 children aged 4 to 8 years with behavioral, cognitive, or emotional difficulties at school.

The researchers included children who were identified by teachers in mainstream schools as having behavioral, emotional, and/or cognitive difficulties. They assessed the children using a battery of tests including the Repetitive Behavior Questionnaire-2 (RBQ-2), the British Picture Vocabulary Scale (BPVS), Lucid Ability Scale, the Welsh Index of Multiple Deprivation (WIMD), and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Recruitment excluded children with diagnosed clinical conditions. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children’s difficulties.

The research team examined two subtypes of RRBs: repetitive motor behaviors (RMB) and insistence on sameness (IS). The authors found that RRBs were prevalent in the sample, with higher scores observed for the insistence on IS subtype compared to repetitive sensory and motor behaviors (RSMB). The severity of anxiety symptoms and male sex were significantly associated with both RRB subtypes, while younger age and socioeconomic status (SES) scores were associated with IS. Elevated RRB scores were also related to difficulties in emotion, conduct, hyperactivity, and peer relations as measured by the SDQ. Contrary to previous research proposing subtype-specific associations, the authors did not find selective associations. Instead, both RMB and IS subtypes were positively correlated with anxiety, with anxiety making the largest contribution to the regression model.

The association between RRBs and mental health was also studied, revealing moderate to high correlations with internalizing and externalizing difficulties on the SDQ. This finding highlights the importance of considering RRBs within the wider context of mental health and well-being.

The authors’ findings challenge previous assumptions about RRBs and provide new directions for future research. By taking a transdiagnostic approach, the study establishes that RRBs are not restricted to specific clinical categories but exist along a continuum of severity. The correlations between RRBs and mental health measures further support this notion, emphasizing the need to understand RRBs beyond conventional diagnostic categories. To enhance understanding, the authors recommended future research exploring the adaptive nature of RRBs in the light of individual developmental potential. Additionally, investigating the relationship between RRBs and language, particularly social pragmatics, can provide deeper insights into RRB development. The study’s limitations, such as a single RRB measure and informant, age range constraints, and an imbalanced sex ratio, underscore the necessity for broader, more representative research.

The Cardiff University study significantly advances our knowledge of repetitive behaviors in young children. By adopting a transdiagnostic approach, the research offers a comprehensive perspective on RRBs, revealing their associations with mental health and well-being beyond conventional diagnostic labels. These findings encourage researchers and practitioners to view RRBs on a continuum of severity, acknowledging their potential adaptive functions while recognizing the need for interventions that promote behavioral flexibility and variety.

Senior author Susan Leekam, Emerita Professor and Leverhulme Emeritus Fellow, Cardiff University said:

This study provides us with the first evidence that restricted and repetitive behaviors (RRBs) are highly frequent in children with behavioural, cognitive and/or emotional difficulties. We have also learned that RRBs are associated with broader indices of mental health difficulty than previously thought. Future research on the impact of RRBs in development, will be made possible by a transdiagnostic research framework and by unique and comprehensive neurodevelopmental assessments that can characterize children’s psychological profiles”.


First author Dr Jennifer Keating, Research Fellow Cardiff University said:“ Through this study we extended what was known about RRBs and their relevance not only to children with a diagnosis such as autism but much more broadly to other children. Our results show the need to develop methods to capture change and development of RRBs across children of all ages and with all types of strengths and difficulties”.

Recommended reading



Keating J, Van Goozen S, Uljarevic M, Hay D, Leekam SR. Restricted and repetitive behaviors and their developmental and demographic correlates in 4-8-year-old children: A transdiagnostic approach. Front Behav Neurosci. 2023 ;17:1085404. doi: 10.3389/fnbeh.2023.1085404

Go To Front Behav Neurosci.