Development of the Behavioral Inflexibility Scale for Children with Autism Spectrum Disorder and Other Developmental Disabilities

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Lecavalier, L., Bodfish, J., Harrop, C., Whitten, A., Jones, D., Pritchett, J., Faldowski, R., & Boyd, B. A. (2020). Development of the Behavioral Inflexibility Scale for Children with Autism Spectrum Disorder and Other Developmental Disabilities. Autism Research, 13(3), 489-499. https://doi.org/10.1002/aur.2257

Publication date: 6 Jan 2020 Added to AutiHub: 23 Oct 2026 Type: Article Article language: English

This publication is integrated into AutiHub through:

Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)

Abstract

Behavior inflexibility (BI) refers to rigid patterns of behavior that contrast with the need to be adaptable to changing environmental demands. We developed a parent‐reported outcome measure of BI for children with autism spectrum disorder (ASD) and other developmental disabilities with a multi‐step iterative process. A pool of 62 candidate items was generated through expert panel feedback, review of existing scales and focus groups. A consensus process was used to generate the final 38 items. Parents of 943 children (age range, 3–18 years; average, 11.4 years; 79% boys) with ASD completed an online survey. One hundred thirty‐three parents rated their child twice within 3 weeks (average = 16.5 days). A series of factor analyses suggested that the 38 items measured a single construct. Scores had a weak correlation with level of functioning (−0.12) and did not differ based on sex. Scores had a negligible correlation with age (−0.07), although measurement invariance was not supported. The mean total score for the Behavioral Inflexibility Scale (BIS) was normally distributed. Internal consistency was α = 0.97 and temporal stability was r = 0.92. Correlations with parent ratings on the subscales of the Repetitive Behavior Scale—Revised varied from 0.48 to 0.89. The correlation with parent ratings on the Social Communication Questionnaire total score was 0.52. Our data show that BI in children with ASD ranges significantly from mild to severe and that the 38‐item BIS is valid and reliable. Autism Res 2020, 13: 489–499. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary We developed a parent‐completed rating scale of behavior inflexibility (BI) for children with developmental disabilities using a multistep process. The Behavioral Inflexibility Scale (BIS) contains 38 questions rated on a 6‐point scale. Parents of 943 children with autism spectrum disorder (ASD) completed an online survey. We examined associations between the BIS and other scales and demographic variables. The BIS is valid and reliable. BI in children with ASD ranges from mild to severe.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 23 Oct 2026 17:25.

Cited references
68
With a DOI
57
Without a DOI, from raw bibliography text
10
0 / 68 (0.0%) cited references include at least one author identified as autistic.
References with data to complete
1 / 68 (1.5%)
References with detected author names
67 / 68 (98.5%)
Without detected author names
1
Without a structured title
1
Without a stable identifier
9
References with raw author names still to review
1
References with external metadata lookup issues
3
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
357
From DOI or external metadata
357
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
95 / 357 (26.6%) names are linked to an author already present in AutiHub. 262 / 357 (73.4%) names are not yet linked.
Names linked to a person identified as autistic
0 / 357 (0.0%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 0 / 95 (0.0%). Distinct people identified as autistic: 0 / 261 (0.0%).
  1. Michael L. Cuccaro , Yujan Shao , Janet Grubber , Michael Slifer , Chantelle M. Wolpert , Shannon L. Donnelly et al. (2003). Factor Analysis of Restricted and Repetitive Behaviors in Autism Using the Autism Diagnostic Interview-R . Child Psychiatry and Human Development, 34(1), 3-17. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  2. Michael G. Aman , Christopher J. McDougle , Lawrence Scahill , Benjamin Handen , L. Eugene Arnold , Cynthia Johnson et al. (2009). Medication and Parent Training in Children With Pervasive Developmental Disorders and Serious Behavior Problems: Results From a Randomized Clinical Trial . Journal of the American Academy of Child & Adolescent Psychiatry, 48(12), 1143-1154. Elsevier BV.
    Crossref OpenAlex OpenCitations
  3. Megan Norris , Luc Lecavalier (2010). Screening Accuracy of Level 2 Autism Spectrum Disorder Rating Scales . Autism, 14(4), 263-284. SAGE Publications.
    Crossref OpenAlex OpenCitations
  4. James Bodfish , Frank J. Symons , Dawn E. Parker , Mark H. Lewis (2000). Varieties of Repetitive Behavior in Autism: Comparisons to Mental Retardation . Journal of Autism and Developmental Disorders, 30(3), 237-243. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  5. Aman M. G. (2017). Aberrant behavior checklist manual . Aberrant behavior checklist manual.
    Type: Other
    Crossref
  6. Michael W. Browne , Robert Cudeck (1992). Alternative Ways of Assessing Model Fit . Sociological Methods & Research, 21(2), 230-258. SAGE Publications.
    Crossref OpenAlex OpenCitations
  7. Benjamin L. Handen , Michael G. Aman , L. Eugene Arnold , Susan L. Hyman , Rameshwari V. Tumuluru , Luc Lecavalier et al. (2015). Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder . Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 905-915. Elsevier BV.
    Crossref OpenAlex OpenCitations
  8. Evdokia Anagnostou , Nancy Jones , Marisela Huerta , Alycia Halladay , Paul Wang , Lawrence Scahill et al. (2015). Measuring social communication behaviors as a treatment endpoint in individuals with autism spectrum disorder . Autism, 19(5), 622-636. SAGE Publications.
    Crossref OpenAlex OpenCitations
  9. Emma Honey , Jacqui Rodgers , H. McConachie (2012). Measurement of restricted and repetitive behaviour in children with autism spectrum disorder: Selecting a questionnaire or interview . Research in Autism Spectrum Disorders, 6(2), 757-776. Elsevier BV.
    Crossref OpenAlex OpenCitations
  10. Katherine Gotham , Somer Bishop , Steven M. Brunwasser , Catherine Lord (2014). Rumination and Perceived Impairment Associated With Depressive Symptoms in a Verbal Adolescent–Adult ASD Sample . Autism Research, 7(3), 381-391. Wiley.
    Type: Article DOI: 10.1002/aur.1377 OpenAlex: https://openalex.org/W1943369087
    Crossref OpenAlex OpenCitations
  11. Karen Bearss , Cynthia Johnson , Tristram Smith , Luc Lecavalier , Naomi Swiezy , Michael Aman et al. (2015). Effect of Parent Training vs Parent Education on Behavioral Problems in Children With Autism Spectrum Disorder . JAMA, 313(15), 1524. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  12. Emma Honey , H. McConachie , Michelle Turner , Jacqui Rodgers (2012). Validation of the repetitive behaviour questionnaire for use with children with autism spectrum disorder . Research in Autism Spectrum Disorders, 6(1), 355-364. Elsevier BV.
    Crossref OpenAlex OpenCitations
  13. Gordon B. Willis , Patricia Royston , Deborah Bercini (1991). The use of verbal report methods in the development and testing of survey questionnaires . Applied Cognitive Psychology, 5(3), 251-267. Wiley.
    Crossref OpenAlex OpenCitations
  14. Somer Bishop , Jennifer Richler , Catherine Lord (2006). Association Between Restricted and Repetitive Behaviors and Nonverbal IQ in Children with Autism Spectrum Disorders . Child Neuropsychology, 12(4-5), 247-267. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  15. Clare Harrop , Matthew McBee , Brian A. Boyd (2016). How Are Child Restricted and Repetitive Behaviors Associated with Caregiver Stress Over Time? A Parallel Process Multilevel Growth Model . Journal of Autism and Developmental Disorders, 46(5), 1773-1783. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  16. Bengt Muthén (1984). A General Structural Equation Model with Dichotomous, Ordered Categorical, and Continuous Latent Variable Indicators . Psychometrika, 49(1), 115-132. Cambridge University Press (CUP).
    Crossref OpenAlex OpenCitations
  17. Tom Muskett , Mick Perkins , Judy Clegg , Richard Body (2010). Inflexibility as an interactional phenomenon: Using conversation analysis to re-examine a symptom of autism . Clinical Linguistics & Phonetics, 24(1), 1-16. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  18. Amy M. Daniels , Rebecca E. Rosenberg , Connie Anderson , J. Kiely Law , Alison R. Marvin , Paul A. Law (2012). Verification of Parent-Report of Child Autism Spectrum Disorder Diagnosis to a Web-Based Autism Registry . Journal of Autism and Developmental Disorders, 42(2), 257-265. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  19. Virginia Braun , Victoria Clarke (2006). Using thematic analysis in psychology . Qualitative Research in Psychology, 3(2), 77-101. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  20. Haylie L. Miller , Michael E. Ragozzino , Edwin H. Cook , John A. Sweeney , Matthew W. Mosconi (2015). Cognitive Set Shifting Deficits and Their Relationship to Repetitive Behaviors in Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 45(3), 805-815. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  21. Vanessa Hus , Andrew Pickles , Edwin H. Cook , Susan Risi , Catherine Lord (2007). Using the Autism Diagnostic Interview—Revised to Increase Phenotypic Homogeneity in Genetic Studies of Autism . Biological Psychiatry, 61(4), 438-448. Elsevier BV.
    Crossref OpenAlex OpenCitations
  22. Cynthia R. Johnson , Kylan Turner , Patricia A. Stewart , Brianne Schmidt , Amy Shui , Eric Macklin et al. (2014). Relationships Between Feeding Problems, Behavioral Characteristics and Nutritional Quality in Children with ASD . Journal of Autism and Developmental Disorders, 44(9), 2175-2184. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  23. Pamela Campanelli (1997). Testing Survey Questions: New Directions in Cognitive Interviewing . Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique, 55(1), 5-17. SAGE Publications.
    Crossref OpenAlex OpenCitations
  24. Luc Lecavalier , Jeffrey J. Wood , Alycia Halladay , Nancy E. Jones , Michael G. Aman , Edwin H. Cook et al. (2014). Measuring Anxiety as a Treatment Endpoint in Youth with Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 44(5), 1128-1143. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  25. Raymond B. Cattell (1966). The Scree Test For The Number Of Factors . Multivariate Behavioral Research, 1(2), 245-276. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  26. Hilde M. Geurts , Blythe Corbett , Marjorie Solomon (2009). The paradox of cognitive flexibility in autism . Trends in Cognitive Sciences, 13(2), 74-82. Elsevier BV.
    Crossref OpenAlex OpenCitations
  27. Robin Gabriels , Michael L. Cuccaro , Dina E. Hill , Bonnie J. Ivers , Edward Goldson (2005). Repetitive behaviors in autism: relationships with associated clinical features . Research in Developmental Disabilities, 26(2), 169-181. Elsevier BV.
    Crossref OpenAlex OpenCitations
  28. Shawn E Christ , Daniel D. Holt , Desirée A. White , Leonard Green (2007). Inhibitory Control in Children with Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 37(6), 1155-1165. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  29. Margot Prior , Malcolm B. Macmillan (1973). Maintenance of sameness in children with Kanner's syndrome . Journal of Autism and Childhood Schizophrenia, 3(2), 154-167. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  30. Constantino J. N. (2005). Social responsiveness scale (SRS) . Social responsiveness scale (SRS).
    Type: Other
    Crossref
  31. Pere Ferrando , Urbano Lorenzo-Seva (2017). Program FACTOR at 10: Origins, development and future directions . Psicothema, 2(29), 236-240. Grupo Editorial Psicofundación.
    Crossref OpenAlex OpenCitations
  32. Emma Honey , Sue Leekam , Michelle Turner , H. McConachie (2007). Repetitive Behaviour and Play in Typically Developing Children and Children with Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 37(6), 1107-1115. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  33. Peter Szatmari , Xiao‐Qing Liu , Jeremy Goldberg , Lonnie Zwaigenbaum , Andrew D. Paterson , Marc Woodbury-Smith et al. (2012). Sex differences in repetitive stereotyped behaviors in autism: Implications for genetic liability . American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 159B(1), 5-12. Wiley.
    Crossref OpenAlex OpenCitations
  34. Christine DiStefano , Grant B. Morgan (2014). A Comparison of Diagonal Weighted Least Squares Robust Estimation Techniques for Ordinal Data . Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 425-438. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  35. Thomas W. Frazier , Stelios Georgiades , Somer Bishop , Antonio Hardan (2014). Behavioral and Cognitive Characteristics of Females and Males With Autism in the Simons Simplex Collection . Journal of the American Academy of Child & Adolescent Psychiatry, 53(3), 329-340.e3. Elsevier BV.
    Crossref OpenAlex OpenCitations
  36. Jorieke Duvekot , Jan van der Ende , Frank C. Verhulst , Kirstin Greaves‐Lord (2018). Examining bidirectional effects between the autism spectrum disorder (ASD ) core symptom domains and anxiety in children with ASD . Journal of Child Psychology and Psychiatry, 59(3), 277-284. Wiley.
    Crossref OpenAlex OpenCitations
  37. Michael J. Kozak , Bruce N. Cuthbert (2016). The NIMH Research Domain Criteria Initiative: Background, Issues, and Pragmatics . Psychophysiology, 53(3), 286-297. Wiley.
    Crossref OpenAlex OpenCitations
  38. LAWRENCE SCAHILL , Christopher J. McDougle , SUSAN K. WILLIAMS , ANASTASIA DIMITROPOULOS , MICHAEL G. AMAN , JAMES T. MCCRACKEN et al. (2006). Children's Yale-Brown Obsessive Compulsive Scale Modified for Pervasive Developmental Disorders . Journal of the American Academy of Child & Adolescent Psychiatry, 45(9), 1114-1123. Elsevier BV.
    Crossref OpenAlex OpenCitations
  39. Pere J. Ferrando , Urbano Lorenzo-Seva (2018). Assessing the Quality and Appropriateness of Factor Solutions and Factor Score Estimates in Exploratory Item Factor Analysis . Educational and Psychological Measurement, 78(5), 762-780. SAGE Publications.
    Crossref OpenAlex OpenCitations
  40. Robert Poulin (1997). Species Richness of Parasite Assemblages: Evolution and Patterns . Annual Review of Ecology and Systematics, 28(1), 341-358. Annual Reviews.
    Crossref OpenAlex OpenCitations
  41. Li‐tze Hu , Peter M. Bentler (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives . Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  42. Lawrence Scahill , Michael G Aman , Luc Lecavalier , Alycia Halladay , Somer Bishop , James Bodfish et al. (2015). Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder . Autism, 19(1), 38-52. SAGE Publications.
    Crossref OpenAlex OpenCitations
  43. Peter Szatmari , Stelios Georgiades , Susan Bryson , Lonnie Zwaigenbaum , Wendy Roberts , William Mahoney et al. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism . Journal of Child Psychology and Psychiatry, 47(6), 582-590. Wiley.
    Crossref OpenAlex OpenCitations
  44. Lauren M. Turner-Brown , Kristen S.L. Lam , Tia N. Holtzclaw , Gabriel S. Dichter , James Bodfish (2011). Phenomenology and measurement of circumscribed interests in autism spectrum disorders . Autism, 15(4), 437-456. SAGE Publications.
    Crossref OpenAlex OpenCitations
  45. Helena Chmura Kraemer (1992). Measurement of reliability for categorical data in medical research . Statistical Methods in Medical Research, 1(2), 183-199. SAGE Publications.
    Crossref OpenAlex OpenCitations
  46. J. Rojahn , L. Barnard‐Brak , K. Medeiros , S. R. Schroeder (2016). Stereotyped behaviours as precursors of self‐injurious behaviours: a longitudinal study with infants and toddlers at risk for developmental delay . Journal of Intellectual Disability Research, 60(2), 156-166. Wiley.
    Crossref OpenAlex OpenCitations
  47. R. J. Wirth , Michael C. Edwards (2007). Item factor analysis: Current approaches and future directions. Psychological Methods, 12(1), 58-79. American Psychological Association (APA).
    Crossref OpenAlex OpenCitations
  48. Kristen S.L. Lam , James Bodfish , Joseph Piven (2008). Evidence for three subtypes of repetitive behavior in autism that differ in familiality and association with other symptoms . Journal of Child Psychology and Psychiatry, 49(11), 1193-1200. Wiley.
    Crossref OpenAlex OpenCitations
  49. Mirko Uljarevic , Amanda Richdale , David W. Evans , Ru Ying Cai , Susan Leekam (2017). Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD) . Molecular Autism, 8(1), 36-36. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  50. Brian A. Iwata , Gary M. Pace , Robert C. Kissel , Paul A. Nau , Jon M. Farber (1990). THE SELF‐INJURY TRAUMA (SIT) SCALE: A METHOD FOR QUANTIFYING SURFACE TISSUE DAMAGE CAUSED BY SELF‐INJURIOUS BEHAVIOR . Journal of Applied Behavior Analysis, 23(1), 99-110. Wiley.
    Crossref OpenAlex OpenCitations
  51. Chetna Sethi , Clare Harrop , Wanqing Zhang , Jill Pritchett , Allison Whitten , Brian A. Boyd (2019). Parent and professional perspectives on behavioral inflexibility in autism spectrum disorders: A qualitative study . Autism, 23(5), 1236-1248. SAGE Publications.
    Crossref OpenAlex OpenCitations
  52. Jason J. Wolff , Kelly N. Botteron , Stephen R. Dager , Jed T. Elison , Annette M. Estes , Hongbin Gu et al. (2014). Longitudinal patterns of repetitive behavior in toddlers with autism . Journal of Child Psychology and Psychiatry, 55(8), 945-953. Wiley.
    Crossref OpenAlex
  53. Alexandre J. S. Morin , A. Katrin Arens , Herbert W. Marsh (2016). A Bifactor Exploratory Structural Equation Modeling Framework for the Identification of Distinct Sources of Construct-Relevant Psychometric Multidimensionality . Structural Equation Modeling: A Multidisciplinary Journal, 23(1), 116-139. Informa UK Limited.
    OpenCitations
  54. Léo Kanner (1943). Autistic disturbances of affective contact . The Nervous Child, 2(3), 217.
    Type: Article OpenAlex: https://openalex.org/W2255119171
    Crossref OpenAlex
  55. Urbano Lorenzo-Seva , Marieke E. Timmerman , Henk A. L. Kiers (2011). The Hull Method for Selecting the Number of Common Factors . Multivariate Behavioral Research, 46(2), 340-364. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  56. C. Richards , Chris Oliver , L. Nelson , J. Moss (2012). Self‐injurious behaviour in individuals with autism spectrum disorder and intellectual disability . Journal of Intellectual Disability Research, 56(5), 476-489. Wiley.
    Crossref OpenAlex OpenCitations
  57. Catherine Lord (2002). Autism Diagnostic Observation Schedule: ADOS . Autism Diagnostic Observation Schedule: ADOS.
    Type: Other
    Crossref
  58. Lorenzo‐Seva U. (2019). Manual of the program FACTOR . Manual of the program FACTOR.
    Type: Other
    Crossref
  59. Alexandre J. S. Morin , A. Katrin Arens , Herbert W. Marsh (2016). A Bifactor Exploratory Structural Equation Modeling Framework for the Identification of Distinct Sources of Construct-Relevant Psychometric Multidimensionality . Structural Equation Modeling: A Multidisciplinary Journal, 23(1), 116-139. Informa UK Limited.
    Crossref OpenAlex
  60. Robert Schultz , Annette M. Estes , Hazlett, Heather C. , Dager, Stephen R. , Elison, Jed T. , Juhi Pandey et al. (2020). Longitudinal patterns of repetitive behavior in toddlers with autism . Carolina Digital Repository (University of North Carolina at Chapel Hill).
    OpenCitations
  61. Muthén B. (2002). Latent variable analysis with categorical outcomes: Multiple‐group and growth modeling in Mplus [Web Note No.4] . Latent variable analysis with categorical outcomes: Multiple‐group and growth modeling in Mplus [Web Note No.4].
    Type: Other
    Crossref
  62. Lawrence Scahill , Luc Lecavalier , Robert Schultz , Andrea Nichole Evans , Brenna Maddox , Jill Pritchett et al. (2019). Development of the Parent-Rated Anxiety Scale for Youth With Autism Spectrum Disorder . Journal of the American Academy of Child & Adolescent Psychiatry, 58(9), 887-896.e2. Elsevier BV.
    Crossref OpenAlex OpenCitations
  63. Muthén L. K. (2017). Mplus user's guide . Mplus user's guide.
    Type: Other
    Crossref
  64. L Kanner (1968). Autistic disturbances of affective contact. Acta Paedopsychiatr, 35(4), 100.
    Type: Article OpenAlex: https://openalex.org/W2192638454
    OpenAlex
  65. Rebecca Sutherland , Antoinette Hodge , Susan Bruck , Debra Costley , Helen Klieve (2017). Parent-reported differences between school-aged girls and boys on the autism spectrum . Autism, 21(6), 785-794. SAGE Publications.
    Crossref OpenAlex OpenCitations
  66. Rutter M. (2003). Social Communication Questionnaire (SCQ) . Social Communication Questionnaire (SCQ).
    Type: Other
    Crossref
  67. Rutter M. (2003). Autism Diagnostic Interview, Revised (ADI‐R) . Autism Diagnostic Interview, Revised (ADI‐R).
    Type: Other
    Crossref
  68. SAS Institute Inc. (2013). SAS/STAT® 14. 3User's guide. Cary NC: SAS Institute Inc.
    Type: Other
    Crossref