Characterizing subdomains of insistence on sameness in autistic youth.
Emily Spackman, Luke D Smillie, Thomas W Frazier and 2 others
PMID 37735979WHAT IT FOUND
Insistence on sameness splits into three distinct types: arranging things 'just right', following routines for a goal, and imposing rituals on other people.
Anxiety was the strongest predictor for all three types.
Key findings
01The analysis identified three distinct subdomains of insistence on sameness: IS-Ritualistic/Sameness (arranging objects or repeating actions until they feel 'just right'), IS-Routines (performing actions in a specific order to achieve a goal), and IS-Individuals (insisting that other people also follow specific routines or rituals).
02Anxiety was the strongest unique predictor for all three subdomains, with higher anxiety associated with higher insistence on sameness.
03Sensory hypersensitivity was associated with IS-Ritualistic/Sameness and IS-Routines, but not with IS-Individuals.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Diagnosis and IQ were based on parent report rather than independent clinical confirmation. All measures were informant-rated (parent report), which may introduce bias and lacks the perspective of the autistic individuals themselves. Emotional and behavioral dysregulation were measured using proxies (SDQ subscales) rather than dedicated executive function or emotion regulation measures. The study is cross-sectional, so it identifies associations but cannot determine if anxiety causes insistence on sameness or vice versa.
Declared interests
None declared. The research was supported by the Simons Foundation Powering Autism Research for Knowledge (SPARK) cohort.
The easy way to misread this
Do not assume that anxiety reduction will directly decrease all insistence on sameness behaviors. While anxiety was the strongest predictor, the study only shows an association, not a causal link. Furthermore, the subdomains behave differently: sensory issues predicted ritualistic and routine behaviors but not social rituals, so a one-size-fits-all approach may miss the specific driver for each child's presentation.