Are restricted and repetitive behaviours in two- and six-year-olds associated with emotional and behavioural difficulties?

Sarah Carrington*, Mirko Uljarević, Elizabeth Meins, Charles Fernyhough, Helen McConachie, Ann Le-Couteur, Susan R. Leekam

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Restricted and repetitive patterns of behaviour (RRBs) serve an adaptive role in development. Elevated levels of RRBs beyond the early years, however, are associated with poorer outcome in language, cognition, and wellbeing, and are seen across a range of neurodevelopmental conditions. This study aimed to characterize the association of distinct RRB subtypes at two and six years of age, with internalising and externalising difficulties in a community sample of children. Methods: 485 parents reported on their child’s insistence on sameness (IS) and repetitive sensory and motor (RSM) RRBs at two and six years of age using the Repetitive Behaviour Questionnaire (RBQ-2). Emotional and behavioural difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ) at age six. Results: Consistent with previous research, RRBs later in development better predicted emotional and behavioural difficulties at age six than RRBs earlier in development. Moreover, IS RRBs were selectively associated with internalising behaviours and RSM RRBs with externalising behaviours. Importantly, these selective associations depended on when RRBs were measured. Only IS RRBs at age six were significantly associated with internalising behaviour. By contrast, while more RSM RRBs at age six were associated with higher rates of externalising behaviours, higher rates of RSM RRBs at age two were associated with fewer externalising behaviours, adding further support to the previously reported adaptive role of RRBs in early behaviour regulation. Conclusion: Although there is a need for further research to provide a detailed profile of the adaptive periods for IS and RSM RRBs, the present findings support the potential utility of elevated RRBs as a signal for emotional and behavioural difficulties at age six.
Original languageEnglish
Article numbere12209
Number of pages10
JournalJCPP Advances
Early online date3 Nov 2023
Publication statusE-pub ahead of print - 3 Nov 2023

Bibliographical note

© 2023 The Authors. JCPP Advances published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Funding: Northern and Yorkshire NHS R&D. Grant Number: R aCRC/CH11LG
Leverhulme Trust. Grant Number: EM-2021-053\10
Economic and Social Research Council. Grant Numbers: R000222771, R000239456


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