1 - (SYM 20) Supporting Young Autistic Children in the Context of Maladaptive Rrbs: The Potential Role of Family Accommodation

Background: Restricted and repetitive behaviors (RRBs) in autism emerge in early childhood. While some function as adaptive self-regulation strategies, others negatively impact adaptive functioning and reduce children’s wellbeing (e.g., self-injury, behaviors that prevent participation in daily routines). Family accommodation (FA), an established mechanistic treatment target for anxiety, associates with RRB expression and adaptive functioning in autistic children, indicating that FA may be a treatment target for maladaptive (i.e., interfering) RRBs. These associations have not yet been studied in young autistic children and previous studies rely on parent-report or diagnostic measures which do not distinguish adaptive from maladaptive RRBs. To consider clinical relevance of these associations, we must develop novel, nuanced frameworks to assess RRBs, FA, and their consequences in young autistic children.

Objectives: (1) Examine associations between FA, RRBs, and adaptive functioning in young autistic children. (2) Operationalize a novel framework for identifying maladaptive RRBs, utilizing ecological momentary assessment (EMA).

Methods: Participants were 59 autistic children (46 males; mean age = 40 months), with gold-standard assessments of development (Mullen), autism traits (ADOS-2, RBS-R) and adaptive functioning (ABAS-3). Parents self-reported FA of RRBs (FAS-RRB; Feldman et al., 2019). A subset (N = 5; 4 males; mean age = 50 months) participated in an EMA study, wherein a mobile platform sends twice daily reminders for two weeks to complete online measures of RRBs, FA, and subsequent parent/child functioning.

Results: 60% of parents of young autistic children accommodate their child’s RRBs daily. FA correlated p</span>ositively with RRB expression (RBS-R total score; r(48) = .65, p <  .001) and negatively with adaptive functioning (ABAS-3; r(48) = -.31, p < .05). The EMA of RRBs and FA is feasible (compliance = 58.3%-95.8%) and provides patterns of daily FA, RRB expression, and functioning. Data collection is ongoing.

Conclusion: This study establishes the presence of FA and its association with RRB expression and adaptive functioning in young autistic children and offers a novel, feasible EMA framework for differentiating adaptive from maladaptive RRBs in the context of individual children. Combining these findings with recent work reducing anxiety in autistic children via the reduction of FA (Rozenblat et al., 2023) shows the potential of utilizing FA of maladaptive RRBs as a mechanism of support in autistic children.