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症状的两个核心领域之一 诊断(以下称为自闭症)，自闭症患者的生活经验表明，这些行为 在临床上很大程度上被误解和处理不当的重要功能。自闭症患者报告 出于与快乐有关的原因和与痛苦有关的原因而从事重复的行为(即 减少压力和焦虑)。该领域缺乏一个有效的模型来涵盖这些看似两极分化的 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。R21的指导性科学前提是自闭症患者 被驱使通过接近(享受)和回避(避免/放松)从事重复的行为 暴露于负面刺激)机制。该模型的方法组件由一个新兴的 文献和我们的初步工作表明，测量从研究领域标准的积极 配价系统涉及到特殊利益的重复行为。模型的回避组件 得到了强有力的文献和我们的初步数据的支持，这些数据将感觉反应性和坚持 相同、重复的行为与研究领域标准的负价系统中的度量。 本项目的目标是在评估重复行为的接近-回避模型方面迈出第一步。 一项针对自闭症青少年的研究中的行为。青春期是许多自闭症青年的发育期 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 13岁和17岁，并由照顾者对他们从事的重复行为类型进行评级，方法 和/或回避行为动机(S)，以及情绪效价的强度 与每个重复的行为相关联。作为一种新的方法，我们将得到重复行为的潜在轮廓 用于分析重复行为的不同临床表现。AIM 2将从AIM招募60名青少年 1完成与研究领域标准阳性相关的神经成像和行为方案 价(方法)和负价系统(避免)；目标是将这些维度联系起来 使用价方向和强度的自我报告对接近和避免机制的评估 重复的行为。我们假设目标1将产生3个独特的潜在轮廓-主要是方法， 主要是回避，以及混合方法/回避-目标2‘S典型相关分析将 说明正价系统与接近、重复行为和负价有关 与回避重复行为相关联的系统。这一系列研究有可能重新定义 重复性行为模型，以符合自闭症患者的生活体验，并通过 确定新的目标机制，这些机制可伸展或通过教育普通公众来更好地 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.