Why stereotypic or repetitive behaviors help a child with autism cope
It's not a job; It's a mission
By Pamela Najor
This blog is written by Centria Autism's Senior Healthcare Writer and mom of 2,
including a 9-year-old son with Autism Spectrum Disorder.
Self-stimulatory, or stereotypic behavior, sometimes called stimming, is the repetition of physical movements, sounds, words, or moving of objects in repeated sometimes rhythmic patterns. It is common and often comforting to people with developmental disabilities such as Autism Spectrum Disorder (ASD).
Why do people with autism engage in stereotypic behaviors?
There are generally three reasons why this is a common function for those with ASD—to self regulate in response to stress and/or anxiety, to seek sensory input, or to express oneself.
When a neurodiverse child with ASD is in an environment that may be overwhelmed with bright lights, or sounds or intellectual pressure, he or she may flap their hands, or rock their upper body back and forth, or rub the eraser end of a pencil or twist a fidget or even their own hands or fingers together repeatedly to calm themselves in an overstimulated environment or situation.
Beginning around age 3, whenever my son—diagnosed with ASD at age 4— found himself in a stressful situation, he struggled to express himself in a way that didn't lead to a greater communication-based misunderstanding. His frustrations were then manifested by biting down hard on chairs, table edges, sometimes even his own arm. After many years of Applied Behavior Analysis (ABA) Therapy, he learned how to improve that communication deficit and didn't rely on expressing that frustration with Self Injurious Behavior (SIB). But over time he still needed a physical output when such anxieties presented themselves.
Fast forward a couple of years when I was taking my son to his psychiatrist appointment—to a doctor he saw very infrequently—and as soon as he saw my son walk in the door he asked me when he started his stereotypic behavior? I asked, "his what?" He said, "his twisting of his hands and fingers, his self-stimulatory behavior." While it may have changed somewhat over the years, he has depended on physical outputs, such as twisting his fingers, to respond to stressful or over-excitable situations.
Ask clinicians about observations of your child's behaviors
Interestingly, I had that very question listed on my "Ask The Doctor About This" list on my notepad that day he asked about my son's finger-twisting. I just didn't know at the time it was called a stereotypy. I had wondered over the years why my son seemed to develop what I thought were tics, which he would do daily, mostly when he was most uneasy or intensely involved with something—what I refer to as "spending time in his own world." Those times are typically extreme on the other end—not out of frustration, but rather he is elated such as when he is overly excited to be immersed in something he really enjoys, like reading.
Stereotypy can also be done to seek sensory input not only from any of the five senses: touch, smell, hearing, seeing, or tasting, but even the proprioceptive senses generated as a result of our own actions. These senses give humans a sense of where you are in space. This sense allows us to know our sense of effort, weight, and pressure relative to our surroundings.
I have learned that my son, more often than not, can't walk down a hallway without running his hands down the wall or for that matter across any object in his path, which has given his mom a fear of splinters (or rather a fear of removing them) every time we walk along any outside path with railings.
Sensory input can be also achieved through the vestibular sense, which arises in our inner ear and affects balance and motion. In my son's case, I've misinterpreted this as his frequency to "never sit still." But, this sensory overload is an example of how it is beneficial for someone with ASD to prefer a wobbly or spinning chair or exercise balls to use if they have to sit for long periods instead of sitting on a traditional chair.
Despite your worries, don't squelch such behaviors
These behaviors may depend on one's ability to express emotions on anything from pure joy to utter anxiety and any expression in between. That is why it is important not to squelch these types of behaviors, even if you worry about public perceptions. Unless the stereotypy leads to a SIB or interferes with learning, interpersonal relationships, or social situations, it is important that a child with ASD express these emotions in self-satisfying ways as their method of coping within a neurotypical world. There may be a societal benefit as well. The more they are done openly by the autistic community, perhaps, the less likely a child with ASD may be perceived as a social outcast.
"When it comes to ‘self-stimulatory behavior,' one important thing to recognize is that most of us engage in these sorts of behavior to some degree," said Brian Kaminski, MA, BCBA. "Humming, twirling hair, cracking knuckles. All of these behaviors often produce the same reinforcing properties that individuals with autism experience."
When it becomes time for a specialist to intervene is when these behaviors become dangerous or interfere with an individual's daily living.
In these cases, our goal is not simply to reduce these behaviors, but rather to teach alternative skills which serve the same effect, always in such a way that promotes dignity and respects the individuality of the person."
Steps for how to evaluate, impact stimulatory behaviors
First, take note to identify what appears to be stereotypy and discuss it with your child's doctor and/or his or her specialized Board Certified Behavior Analyst (BCBA) clinician if he or she is in ABA Therapy. ABA practitioners can determine what function or feeling it serves your child, whether it is self-soothing and beneficial or self-injurious or harmful to your child or others.
Second, when working with your child's clinical team on the safety factor, it is also important to determine if it is best to reduce or eliminate these actions using a behavior intervention plan with ABA techniques or not. ABA can be employed to determine the trigger and address the underlying deficit. As with my son, we learned it was at first an outcome of his communication deficits. So while addressing those deficits in ABA Therapy sessions, it was also important not to eliminate entirely the thing he did to learn how to cope with his deficit. But out of fear my son could hurt himself, we determined it was important to allow him several replacement behavior choices to self-regulate when he was stressed in social settings where communication was a struggle. Some of his stressors also elevated his anxiety to the point of triggering panic attacks that also raised his blood pressure. Through years of ABA therapy as well as medications such as clonidine, use of replacement behaviors that were more comforting like finger-twisting has allowed him to self-regulate in more beneficial ways.
Third, your child's therapy team can conduct a functional analysis to determine if stereotypy is a sensory replacement or if it can be addressed by positive or negative reinforcement intervention therapy such as ABA Therapy. Doctors and clinicians can also determine if the stimming is a neurotypical tic such as biting one's fingernails or something more clinically identified as a stereotypy, according to the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the standard reference that healthcare providers use to diagnose behavioral conditions such as autism.
Even though my son's stereotypy manifested differently in different situations and over time, repetitive or rhythmic motor movements, or use of objects, or speech—are a sign of Autism and can't be just stopped at will or when reminded.
Other examples of simple motor stereotypies are lining up toys or flipping objects, echolalia, idiosyncratic or quirky phrases or sounds.
If your child does any activities you are unsure of, it may be an important symptom to consider or use to rule-out ASD or other disorders and should be discussed with professionals in the behavioral health field.
If you suspect your child demonstrates stereotypy or would like to learn more about how Centria Autism can help your family seek evaluation and get help from our BCBAs, or if you are interested in insurance coverage or positions available in the behavioral health field, please contact Centria Autism at (855) 772-8847 and get more information at www.centriaautism.com.