What are Rituals?

You will see the terms “RRB” and “Rituals” mentioned throughout the intake questionnaire and within the recommendations. RRB stands for Repetitive and Ritualized Behavior. This is the “official” behavioral science term used in the diagnostic criteria for Autism Spectrum Disorder to describe behavior that a person may do over and over, repeatedly, and often without regard for the social context and environment they are in. We have used the term “Ritual” and RRB interchangeably. 

For example, some common rituals are hand flapping, body rocking, spinning objects, unusual use of objects like peering at the wheels of toy cars while spinning them, or lining up objects like crayons, blocks or books in rows. Some autistic individuals may also have linguistic RRBs and rituals. For example, they might repeat specific speech words, phrases, or vocal sounds. 

Some characteristics used to describe Repetitive and Ritualized Behavior (RRB) include excessive inflexibility, invariance, and rigidity. An autistic individual may become anxious or upset if they are not allowed or redirected from doing their preferred ritual. RRBs may lack an obvious purpose to you as an observer, but they seem extremely important to your child. Some research suggests that many autistic rituals may in fact serve a purpose from soothing anxiety, to integrating stimulus, to simply pleasure.  

Another characteristic of ritualized behaviour is insistence on sameness. For example, needing to take the same route to school or shopping every day, or requiring that activities be done in exactly the same order each time, even with the exact same language, actions, and outcome. In more extreme cases, RRBs can appear like obsessive compulsive behavior (OCD) such as tapping a finger on the counter four times before washing hands, or always jumping through door frames with both feet. A psychiatrist can assess these behaviors using differential diagnosis for ASD vs OCD. 

Repetitive and Ritualistic behaviors can remain a part of your child’s daily routine from a short week to years. Stress, anxiety, uncertainty, change in routine, and other factors can trigger RRBs. They can start and stop suddenly and then reappear months later.

You may notice that the need to do these rituals interferes with your child’s ability to engage in daily life such as personal care, learning, and social activities. RRBs can negatively impact social relationships in large part because they are misunderstood and can be interpreted as the autistic individual not wanting to interact. Jonathan Alderson wrote insightfully about the latest research and a positive reframing of RRBs in his book Challenging the Myths of Autism.