Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults

“The OCI-R is an 18-item self-report measure of the symptoms of obsessive-compulsive disorder, with items such as ‘I feel I have to repeat certain numbers’, ‘I find it difficult to control my own thoughts’ and ‘I collect things I don’t need’ (Foa et al., 2002).”

“Another factor to consider is the evidence for high rates of co-occurring autism and ObsessiveCompulsive Disorder (OCD; Lai et al., 2019).”

“Repetitive, restricted behaviours, interests and activities are a core feature of Autism Spectrum Disorder (ASD), as outlined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.”

“…and participants were able to use the alert system to notice and report thought form and content in the moment, allowing us to gain insights into the internal experience of autistic people, as in previous studies (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016).”

“In autistic children, insistence on sameness has been found to be associated with anxiety (Russell et al., 2019; Wigham et al., 2015).”

“Higher order behaviours are often referred to as insistence on sameness, that is, a preference for routine and ritualised behaviours, and lower order as repetitive sensory motor behaviours (Bishop et al., 2013).”

“The AQ-10, while helpful as a screening tool and a means of characterising participants, does not have diagnostic validity (Ashwood et al., 2016) and studies have raised questions about the reliability of this measure in capturing characteristics of autism that do not reach clinical significance (Bertrams & Shah, 2021…”

“This method has been used with autistic participants in the past; originally by Hurlburt et al. (1994), who used the method with three adults with Asperger’s syndrome and found that participants reported more visual thinking than non-autistic people.”

“In typical development, executive functioning tasks have been found to be verbally mediated from the age of 7 years (Hitch et al., 1989).”

“Clinical and experimental research has sought to ensure a careful delineation of restricted and repetitive behaviour-related internal content and the intrusive, unwanted obsessional thoughts characteristic of OCD (e.g. Russell et al., 2013).”

“It is consistent with findings of higher levels of rumination, that is, repetitive thinking about distress, in autistic people compared with controls in other studies (e.g. Crane et al., 2013; Gotham et al., 2014).”

“Studies have established an association between the latter and a general developmental delay, while insistence on sameness behaviours is specific to autism (Harrop et al., 2014).”

“For example, social stories, which use words and pictures to teach autistic children how to navigate new situations, have been found to be effective (Karkhaneh et al., 2010).”

“The RBQ-2A is a self-report measure of repetitive behaviours with 20 questions such as ‘Do you insist that aspects of daily routine must remain the same?’, ‘Do you insist on doing things in a certain way or re-doing things until they are “just right”?’, and ‘Do you insist on eating the same foods, or a very small rang…”

“Other research has demonstrated that children with higher insistence on sameness had lower inhibitory control (Bos et al., 2019) and associations between executive function, insistence on sameness and anxiety (Uljarević et al., 2017).”

“As the research question was primarily about repetition, the focus of coding was the content of the inner experience rather than form, although we included some aspects of previously reported typologies (Hurlburt & Heavey, 2006) in our coding system.”

“In autistic children, insistence on sameness has been found to be associated with anxiety (Russell et al., 2019; Wigham et al., 2015).”

“Previous research has therefore found this method to be feasible with autistic participants (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016) and has provided an insight into the inner world of participants which could not have been acquired through a cross-sectional design.”

“, 2013), and the overall scale and subscales have good internal consistency and discriminant validity (Cadman et al., 2015).”

“The method was feasible, and participants were able to use the alert system to notice and report thought form and content in the moment, allowing us to gain insights into the internal experience of autistic people, as in previous studies (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016).”

“In autistic people, there is evidence that many of these tasks are visually, rather than verbally mediated (for a review see Williams et al., 2016).”

“…and participants were able to use the alert system to notice and report thought form and content in the moment, allowing us to gain insights into the internal experience of autistic people, as in previous studies (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016).”

“Other research has demonstrated that children with higher insistence on sameness had lower inhibitory control (Bos et al., 2019) and associations between executive function, insistence on sameness and anxiety (Uljarević et al., 2017).”

“…and participants were able to use the alert system to notice and report thought form and content in the moment, allowing us to gain insights into the internal experience of autistic people, as in previous studies (Chen et al., 2016; Hare et al., 2016; Hintzen et al., 2010; Kovac et al., 2016).”

“This methodology has been used to capture in the moment experiences of typical and atypical or clinical phenomena across a wide range of populations (Lapping-Carr & Heavey, 2017).”

“15 As an autistic person (and researcher), I was delighted to see mention of this measure appearing in the literature; but I was disappointed when I saw the actual report.”

“Research has highlighted how these traits may contribute to higher rates of repetitive thinking among autistic individuals [125] with studies showing that autistic people tend to experience more negative repetitive thinking compared to their non-autistic counterparts [25, 81].”

“Autistic participants and researchers have commented on some previous EMA designs, both positively and negatively, and co-produced suggestions for future implementation of EMA with autistic people (e.g. Cooper et al., 2022; Cordier et al., 2016; Dallman et al., 2022).”

“First, restricted, repetitive patterns of behavior (RRB) are diagnostic criteria of ASD and in some cases manifest as an insistence on sameness, preference for routines, and ritualized behaviors (Cooper et al., 2022).”

“In an earlier study, we used descriptive experience sampling methods (DESM; Cooper et al., 2022) to investigate cognitive repetition.”

“Thus, no differences are apparent in ecological observations of repetitive negative thinking between non-depressed autistic and non-autistic adults, and of note, repetitive negative thinking in autism is not related to the presence of other repetitive behaviors [57].”

“Perhaps, instead of helping autistic self-identified adults to understand themselves more, being more prone to nostalgia leads to increased repetitive thinking, which is common in autistic individuals (Cooper et al., 2022; Williams et al., 2021).”

“Compared to non-autistic peers, autistic adults report increased RNT, especially in relation to depression, as captured by questionnaire (Cooper & Russell, 2025) and diary methods (Cooper et al., 2022).”

“As rumination is a form of repetitive thinking which is common in autistic people (Cooper et al., 2022), this may be an especially important avenue of research in this population.”

“One speculative interpretation is that this pattern could relate to the repetitive behavior and processing often described in ASD (Tian et al., 2022; Cooper et al., 2022), though this remains to be empirically tested.”

“This downscaling a ff ects neurodivergent patterns to the extent that some studies suggest that they di ff er from typical complex cognitive patterns (Lage et al. 2024; Cooper et al. 2021).”