Behavioral interventions for higher-order restricted and repetitive behaviors in autism: A systematic review and meta-analysis.

Although higher-order restricted and repetitive behaviors (H-RRBs) are associated with social, emotional, and behavioral difficulties in individuals with Autism Spectrum Disorder (ASD), there is a paucity of literature on behavioral interventions to treat this core symptom. Through a systematic search, 29 intervention studies that target H-RRBs were identified and analyzed in terms of (a) participant characteristics, (b) setting, (c) targeted behaviors, (d) intervention procedures, (e) experimental design, (f) outcomes and certainty of evidence, and (g) generalization and maintenance of outcomes. Overall, 41% of studies (n = 12) yielded large effect sizes, 34% yielded medium effects (n = 10), and 17% yielded small effects (n = 5). Results suggest that studies yielding large effect sizes were more likely to be rooted in applied behavior analysis (ABA) than cognitive behavioral therapy (CBT), more likely to use function-based than non-function-based interventions, more likely to use both antecedent- and consequence-based interventions versus either one alone, more likely to use single-subject designs than group designs, and were more likely to be classified as focused intervention practices than comprehensive treatment models or manualized treatment programs. Overall, results suggest that ABA and CBT approaches to treating H-RRBs show promise. Directions for future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)