Restricted, Repetitive, and Stereotyped Patterns

of Behavior, Interests, and Activities

Within the sensory and behavioral domains, developmentally immature and

atypical perceptions, reactions, and behaviors occur. For example, many
children with autism continue to experience the proximal senses of touch,
taste, and smell as highly salient long after they have become overshadowed
by the distal senses of sight and hearing among typically developing children.
This might account for the predominance of olfactory, tactile, and oral forms
of exploration among some children and adolescents with autism. In some
cases, the salience of proximal sensation persists well into adulthood.
Another sensory feature is hypersensitivity to various stimuli (auditory,
tactile, visual, and olfactory). Even low-intensity exposures can result in
1. DEFINITIONS AND CHARACTERISTICS 13

distress, agitation, and discomfort. Such unexpected reactions may convey

the impression of physical pain or a marked overload of the central nervous
system pathways responsible for modulating and neutralizing excessive
stimulation (both negative and positive).
One of the denning features of autism and Asperger syndrome (as conceived
by Kanner and Asperger) is that of rigidity and inflexibility in response
to minor change and transition in the environment and daily routines.
This insistence on sameness and invariance can be highly impairing,
because the precipitants of these reactions often are of little social significance
and do not disturb the smooth functioning of the social world. It
is as though persons with autism depend on these inanimate markers of
space and time because the social priorities that typically direct schedules
and routines have little meaning and significance for them.
A range of repetitive stereotyped, compulsive, and ritualistic behaviors
occur in autism, although no one behavioral symptom or symptom cluster
is present among the majority of individuals. Compulsive behaviors include
ordering and rearranging, ritualistic patterns of walking and pacing, repetitive
actions (e.g., turning on and off lights, mechanical devices, and electronic
equipment), and insistence on keeping all doors or cabinets closed.
Stereotypic movements also occur in ASD (particularly among those with
classic autism accompanied by significant cognitive impairment). A variety
of different movements can be present, such as hand and arm flapping,
toe walking, repetitive jumping, head shaking and weaving, and side-to-side
rocking.
Interests and preferred activities are generally narrow and restricted.
Among those with more classic forms of autism, a great deal of sensory exploration
may occur, often involving minor details or parts of toys and objects.
Often there is a fascination with subtle physical characteristics of toys and objects,
such as texture, shading, and hue. The relationship among the parts of
objects may also be of interest, such as the manner in which moving parts rub
against one another or the distance that objects maintain from one another
when they are spun independently. Exploration using combined senses also
occurs, such as the intense visual scrutiny of light diffraction patterns as a
prismlike stone is twirled in the sunlight. There also appears to be an apparent
dissociation between the parts and the whole. Children and adults
with autism often seem to be unaware of the significance and relevance of
the whole toy or object (functional, symbolic, and emotional). Individuals
with AS (less often with HFA) pursue highly restricted, nonfunctional, and

often unusual interests, pastimes, and preoccupations. Factual information,

concrete perceptions, and the processes of classification, categorization,
and taxonomy are of particular interest and importance. Depending on the
cognitive level, reading ability, and motivation of the individual, these interests
can involve complex, detailed topics on which a great deal of time is
14 BREGMAN

spent memorizing facts, numbers, and visual patterns. In AS, these intense
preoccupying interests can include such topics as the exhaustive categorization
of water heaters, downspouts, highway guardrails, meteorological
forecasts, television program ratings, architectural styles and details, and
battle formations over the centuries. Such individuals literally can become
world experts on such topics, yet resist suggestions to transform this interest
and knowledge into functional, meaningful, or marketable skills. The sole
appeal seems to be the very process of memorization, categorization, and
classification.