Repetitive Behaviours Questionnaire–3 (RBQ-3)

The Repetitive Behaviours Questionnaire–3 (RBQ-3) is a 20-item scale that comes in both self-report and informant-report versions, enabling measurement across the lifespan. The scale is designed to measure restricted and repetitive behaviours, a core feature of autism (Jones et al. 2024).  It has reliability and validity in measuring a wide range of restricted and repetitive behaviours (Wing et al., 2002) including items defined by ICD-10 (Leekam et al., 2002) and DSM-5 (Kent et al., 2013).  The self-report version is currently recommended for persons aged 13 and above and without co-occurring intellectual disability. The informant-report version is designed for completion by someone who knows the person well, such as a parent, carer or partner. It can be completed for someone of any age, from 15 months upward.

The complex constellation of restricted and repetitive behaviours can be divided into two broad types, structured, specialised interests and repeated self-expressive sensory-motor behaviours, which is well-supported by research (Tian et al., 2022). 

The RBQ-3 contains two primary subscales​:

• Insistence on Sameness (IS): reflects resistance to change, adherence to routines, and focused, intense interests. Individuals high on IS prefer structured, predictable environments and find comfort in routines, with example behaviours including a preference for eating the same foods daily and experiencing distress over unexpected schedule changes.
• Repetitive Sensory-Motor Behaviours (RSMB): captures repeated self-expressive sensory-motor behaviours, that are sensory-seeking and self-stimulatory in nature. Specific self-expressions and sensory interests include hand-flapping, rocking, lining up objects, or fascination with certain sounds or textures.

RBQ-3 scores can provide valuable insights into specialised interests and self-expressive sensory-motor behaviours that can make up part of a more comprehensive assessment for autism. Jones et al. (2024) demonstrated that RBQ-3 scores distinguish autistic individuals from neurotypical individuals​, supporting its use in assisting with preliminary evaluation.

For autistic Individuals, the RBQ-3 offers assistance to clinicians in identifying whether a client’s needs or challenges may be related more to self-expressive sensory-motor behaviours or to specialised interests. Distinctions are relevant when informing a therapeutic approach, for example, a high IS score might indicate the need for support around significant life transitions and managing anxiety related to change, while a high RSMB score might suggest addressing sensory challenges or needs.

Where appropriate, using both the self- and informant-report versions of the RBQ-3 together can add additional robustness to an assessment. When the pattern of responses closely align then they provide important corroborative information. However, important insights can also be gained when reports differ. For example, an autistic person might mask or internalise certain repetitive behaviours, leading informants  to under-report them​. Conversely, the RBQ-3 informant-report version can capture behaviors that individuals themselves might not recognise or may underreport due to limited self-awareness. Some behaviors may have become so routine that the individual has difficulty consciously registering them, while observers can provide an outside perspective.

Restricted and repetitive behaviors can be seen across the general population (e.g. Evans et al., 2017), as well as in a range of neurodevelopmental and psychiatric conditions (e.g. Jiujias et al., 2017; Moss et al., 2009). Therefore, they are not only observed in autistic people. Someone who scores highly on the RBQ-3 may benefit from support and understanding regardless of whether they are autistic or not. Restricted and repetitive behaviours may serve a range of purposes and functions, including self-regulation in the context of overwhelming environments, sensory overload, and difficult emotions or thoughts (Kapp et al., 2019).

Restricted and repetitive behaviors can also be considered a means by which certainty can be introduced into a person’s world (Lung et al., 2024), reflecting a strong association between restricted and repetitive behaviours and anxiety in autistic people (e.g. Lidstone et al., 2014).  They may also help individuals make sense of their world and be an important part of positive self-identity (Lung et al., 2024). Importantly, some restricted and repetitive behaviours have been described as enjoyable by autistic people (Collis et al., 2022), whilst stigma and judgement of the behaviours can be a cause of distress (Turnock et al., 2022). Understanding the function(s) that a person’s restricted and repetitive behaviors serve, and the impact they have, may help the individual understand themselves better and receive appropriate support.

Scores are typically reported in the literature as averages (range 1-4). An average across all 20 items represents a Total score. The two subscales were based on factor analysis of items 1-19 (Barrett et al., 2018; Jones et al., 2024). 

Scores can also be understood as raw scores, with the total raw score ranging from 20-79, for example. Higher total scores indicate a greater presence of structured, specialised interests and repeated sensory-motor behaviours. Subscale raw score ranges differ and are listed below:

• Insistence on Sameness (IS) (9 items: 7, 9, 12, 13, 14, 15, 16, 17, 18) subscale ranges from 9-36. Higher scores reflect stronger preference for stability and routine, collecting, and heightened interest in specific objects.
• Repetitive Sensory-Motor Behaviours (RSMB) (8 items: 2, 3, 4, 5, 6, 8, 10, 19) subscale ranges from 8-32. Higher scores indicate more frequent repeated sensory-motor behaviours and specific sensory interests, such as rocking, spinning, and hand movements.  

Percentiles are presented that are based upon a sample of autistic adults (n = 110) for the total and subscale scores. Presented percentiles change based on whether the self report or informant-report version is used, differences can be observed in table 2 and 2.2 of the technical review. Percentiles give context to a client’s score, showing how they compare to others, for example, a percentile of 50 represents the typical level of specialised interests and repeated sensory-motor behaviours among autistic adults.

On the first administration, a stacked bar graph shows the total, IS and RSMB results in average scores (1-4).

A horizontal comparison graph is also presented showing the respondent’s score in comparison to autistic and non-autistic adult samples.

When administered more than once, a line graph is presented for the subscale average scores over time.

In addition, a new stacked bar graph and comparison horizontal bar graph are included reflecting the current scores.

Jones et al. (2024) examined the RBQ-3 alongside the Diagnostic Interview for Social and Communication Disorders-Abbreviated (DISCO-Abbreviated; Carrington et al., 2014). They observed moderate correlations (r= .45–.54) between RBQ-3 total scores and the DISCO-Abbreviated restricted and repetitive behavior domain, indicating good convergent validity. Furthermore, Jones et al. (2024) compared autistic and non-autistic adults, finding the autistic group scored significantly higher on RBQ-3 total scores and on the two subscales (RSMB, IS) compared to the non-autistic group, with large effect sizes. This is in line with earlier findings from the previous version, the RBQ-2A (Barrett et al., 2015). 

The RBQ-3 is yet to be investigated for its factor structure and is assumed to retain the established two-factor structure of repeated motor-sensory behaviours and insistence on sameness that analyses earlier versions of the RBQ-3 had demonstrated in both children (RBQ-2, Leekam, 2007, Lidstone et al., 2014) and adults (RBQ-2A; Barrett et al., 2015; 2018).

Jones et al. (2024) reported good to excellent internal consistency for total scores (α=.89, .82) in autistic and non-autistic adults. The RSMB and IS subscales also showed acceptable-to-good alpha values (α=.68–.85). McDonald’s ω coefficients were comparable, indicating that items on each subscale measure coherent underlying constructs.

Normative data is provided for the initial sample of n=110 autistic adults without intellectual disability. Observed average scores (1-4) and standard deviations are reported for the total M=2.48(.61), RSMB subscale M=2.25(.68), IS subscale M=2.68(.69). Converted from average scores to raw scores based on their respective ranges these are: total (range 20-79) M=47.12(11.59), RSMB subscale (range 8-32) M=18.0(5.54), IS subscale (range 9-36) M=24.12(6.21). Additionally, data from a sample of non-autistic adults is available, with raw score means for the total M=25.65(4.75), and subscales RSMB M=10.32(2.64), IS M=12.24(2.7). Further normative data is reported for n=151 self-reported autistic adults and n=151 self-reported non-autistic adults sampled online (Jones et al., 2024). 

Clinicians can use the available normative data on autistic adults for comparison. If using the RBQ-3 with a child or adolescent, one might cautiously compare their score to the adult autistic benchmark.

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This measure was produced by Cardiff University’s Wales Autism Research Centre. Comprehensive information about the RBQ-3 including the Administration Manual is available from their website.