Evaluating a novel approach-avoidance model of repetitive behaviors in autistic adolescents: A multi-method study

摘要 重复行为是自闭症谱系障碍的两个核心症状之一 诊断（以下简称“自闭症”），以及自闭症患者的生活经验表明，这些行为有助于 这些重要功能在很大程度上被误解，临床上也没有得到很好的解决。自闭症患者报告说， 出于与享受有关的原因和与痛苦有关的原因而从事重复行为（即，到 减少压力和焦虑）。该领域缺乏一个有效的模型，包括这些似乎两极分化 生活经历，这对我们提供适当支持和教育公众的能力产生了负面影响 以更好地适应自闭症患者。这个R21的指导性科学前提是自闭症患者 通过接近（享受）和回避（回避/放松）驱使参与重复行为 暴露于负面刺激）机制。该模型的方法部分由一个新兴的 文献和我们的初步工作表明，从研究领域标准的积极措施， 配价系统与特殊兴趣重复行为有关。模型的回避部分 是由一个强大的文献和我们的初步数据相关联的感觉反应和坚持， 相同的重复行为与研究领域标准的负价系统的措施。 本研究的目的是对重复性学习的趋避模型进行初步的评估 在一项针对自闭症青少年的研究中，青春期是一个发育期，许多自闭症青少年 可以反思他们重复行为的驱动因素。Aim 1将招募250名自闭症青少年， 年龄为13岁和17岁的儿童和护理人员，以提供他们从事的重复行为类型的评级，方法 和/或回避动机，以及情绪效价的强度 与每一个重复的行为。作为一种新的方法，我们将推导出重复行为的潜在轮廓 用于解析重复行为的异质临床表现。目标2将从目标招募60名青少年 1完成与研究领域标准阳性相关的神经影像学和行为方案 价（接近）和负价系统（避免）;目标是将这些维度联系起来 评估接近和回避机制与自我报告的效价方向和强度 重复的行为。我们假设目标1将产生3个独特的潜在轮廓-主要方法， 主要是回避，和混合方法/回避-目标2的典型相关分析将 显示正价系统与接近重复行为和负价相关 与避免重复行为相关的系统。这项研究有可能重新定义 重复行为的模型，以配合自闭症的生活经验，并加强临床支持，通过 确定可延展的新目标机制，或通过对公众的教育， 满足自闭症患者的需求。

ABSTRACT Repetitive behaviors comprise one of the two core domains of symptoms for an autism spectrum disorder diagnosis (hereafter ‘autism’), and the lived experience of autistic individuals suggests that these behaviors serve important functions that are largely misunderstood and poorly addressed clinically. Autistic individuals report engaging in repetitive behaviors for reasons related to enjoyment and reasons related to distress (i.e., to decrease stress and anxiety). The field lacks a validated model that encompasses these seemingly polarized lived experiences, which negatively impacts our ability to provide appropriate supports, and educate the public to better accommodate autistic individuals. The guiding scientific premise of this R21 is that autistic individuals are driven to engage in repetitive behaviors via both approach (enjoyment) and avoidance (avoiding/easing exposure to negative stimuli) mechanisms. The approach component of the model is supported by a burgeoning literature and our preliminary work demonstrating that measures from the Research Domain Criteria’s Positive Valence System are implicated for special interest repetitive behaviors. The avoidance component of the model is supported by a robust literature and our preliminary data associating sensory reactivity and insistence on sameness repetitive behaviors with measures from the Research Domain Criteria’s Negative Valence System. The objective of this project is to take the first step in evaluating the approach-avoidance model of repetitive behaviors in a study with autistic adolescents. Adolescence is a developmental period when many autistic youth can reflect on the drivers of their repetitive behaviors. Aim 1 will recruit 250 autistic adolescents between the ages of 13 and 17 and a caregiver to provide ratings on the type of repetitive behaviors they engage in, approach and/or avoidance motivations for engaging in the behavior(s), and the intensity of the emotional valence associated with each repetitive behavior. We will derive latent profiles of repetitive behaviors as a novel method for parsing the heterogeneous clinical presentations of repetitive behaviors. Aim 2 will recruit 60 teens from Aim 1 to complete neuroimaging and behavioral protocols associated with the Research Domain Criteria’s Positive Valence (approach), and Negative Valence systems (avoidance); the goal is to link these dimensional assessments of approach and avoidance mechanisms with self-report of valence direction and intensity of repetitive behaviors. We hypothesize that Aim 1 will yield 3 unique latent profiles—Predominantly Approach, Predominantly Avoidant, and Mixed Approach/Avoidant—and that Aim 2’s canonical correlation analyses will show the Positive Valence System to be associated with approach repetitive behaviors and Negative Valence System to be associated with avoidance repetitive behaviors. This line of research has the potential to redefine models of repetitive behavior to align with the autistic lived experience, and to enhance clinical supports through identifying novel target mechanisms that are malleable or through education to the general public to better accommodate the needs of autistic people.