anxiety – Gabe Feathers McGee

Children with Autism Spectrum Disorder (ASD) often insist on repeating certain behaviours. They may for example spin around in circles, rock back and forward, hand flap, flick fingers, rub certain textures, pick at the skin, twist and pull on their hair, and repeat songs, and segments from television and movies.

These behaviours are known as stimming – a shorthand term for self-stimulatory behaviour. It is thought that the movement or stimming behaviour stimulates or regulates one or more senses.

It is useful to remember that there is a purpose to all behaviour and there is a purpose to stimming.

Some reasons for stimming include:

to reduce anxiety (repetition is calming)

to deal with an overactive nervous system

to deal with sensory issues such as proprioception (to re-establish awareness of one’s body in space).

Often stimming behaviours alert parents to the idea that their child may have autism. At the age of 3, my son Michael engaged in endless spinning (without getting dizzy), constant picking at the skin and scabs, hand flapping when distressed, chewing on everything (including clothes, pencils, and furniture), rubbing material between his fingers, turning lights on and off, and echolalia (repeating back dialogue, lyrics etc).

Michael’s stimming behaviours would increase dramatically when he was under stress or more anxious than usual. For example, I failed to notice the hand flapping until the day we went to a paediatrician for an assessment and Michael started madly waving his hands back and forth in distress.

Another example – Michael is a picky eater (a common ASD trait) and when I dared to put a piece of unauthorised food on his plate he would start to tantrum and proceed to do circuits around the outside of our house. He wasn’t just running around like most upset kids, he was retracing his exact route, round and round the house until he’d calmed down or self-regulated.

Neurotypical people (or your average person without ASD) also engage in self-stimulatory or self-regulatory behaviours. For example, it is common to stim when we are in a boring meeting and we need to wake up a bit (up-regulate the nervous system) or to fiddle with things or put things in our mouths when we are getting stressed (down-regulate the nervous system).

Who hasn’t twirled their hair, jiggled their leg, fiddled with a pen, bit finger-nails, chewed on a pencil, or rocked slightly in the chair. And have you noticed that most people when extremely distressed or over-excited will still resort to hand flapping (I’m sure that’s where the expression ‘they were in such a flap’ came about).

The difference between a person with ASD and a neurotypical person stimming is simply a matter of degree. The person with ASD has more anxiety and sensory issues and therefore has a greater need to stim. Most adults, even those with ASD, learn how to stim in a socially acceptable manner (behind closed doors or in a less obvious manner such as hand clapping rather than hand flapping).

What can you do about stimming?

Stimming serves a purpose so sometimes the best thing to do is nothing – let them stim until they feel better.

Let them stim in private or at a certain time of day or let them stim as a reward for other behaviours.

Try to stop stimming if it puts the child or others in danger (e.g. head banging). You can try redirecting them into another activity or reward non-stimming behaviours.

Try to stop stimming if it is interfering with a particular therapy.

Try to work out the purpose of the stimming behaviour and deal with the cause (e.g., address the underlying anxiety or sensory issues)

Don’t make the child feel guilty about stimming.

Don’t physically stop the child from stimming, unless you want a meltdown.

Try to find a balance between the amounts of time spent stimming and spent engaging with the outside world.

I must admit it’s all easier said than done and I should know, as Michael’s legs and arms are covered in sores from the excessive scratching and picking that he engages in. The good news is that he no longer flaps his hands or spins on the spot; has stopped turning lights on and off, and no longer repeats speech.

therapy for proprioceptive issues (or just a big hug!)

An Iceberg: The Autism Files

My son Michael has Autism Spectrum Disorder (ASD) and would be described as high functioning. Some people ask ‘what is high functioning – does that mean he’s super intelligent?’

No, this is not what it means and I think ‘higher functioning autism’ is a better descriptor. Autism is on a spectrum from less severe to severe. The ASD’s fall under the umbrella classification of Pervasive Developmental Disorders – that means the disorder affects a great many aspects of the person’s life and functioning.

It is important to remember that autism is:

PERVASIVE

When Michael began speech therapy at the age of three, I told the speech pathologist that he had mild autism. She looked at me, shaking her head and said ‘there is no such thing as mild autism’. That statement hit me like a brick. Now, 6 years later, I have a far greater appreciation of what it means.

I now think of high functioning autism or asperger’s syndrome as like an iceberg. Most of the difficulties are not obvious to others, they are hidden under the surface but still have a major impact on the person’s day to day life.

A child with ASD may be sitting quietly at their desk at school and may seem at ease, but on the inside they may be feeling confused, anxious, angry or agitated. They may be overwhelmed by sensory issues (e.g., noise, smell,), confused by an unstructured learning environment, annoyed by disruptive fellow students, have difficulty with processing instructions and self organisation, dread the social nightmare which is the school playground at lunchtime, and be afraid of bullies. The list goes on and on.

The child usually knows it is important to hold it all together at school and they make an extra effort to cope. This can result in hyper vigilance – the ASD child feels like they are under attack and is constantly on the lookout for danger. Hyper vigilance is very tiring.

They usually save up all the tantrums for the safety of the home environment. I have had a number of teachers say to me that my son is generally well behaved at school and I am quick to inform them that this does not always translate to the home front.

Michael’s speech pathologist Leith Johnston use to make school visits to observe my son in situ and to advise on problems and solutions. She was a keen observer and could list all the subtle signs that not all was well (signs that the teachers usually missed). These signs would include things like excessive chewing (on shirt collars, pencils, rubbers etc.,), obsessive picking at scabs, lining up objects, hand flapping and wringing, avoiding eye contact, body slumping and leaning on supports, peculiar verbal noises/tics, echolalia (repetitive speech), uneaten lunch.

It is these types of behaviours that may be signalling anxiety and distress in the person with autism.

If you provide a supportive environment for a person with ASD, you can minimise their distress. We chose to move to a small village so the whole family could live in a healthy environment and Michael could go to a small school. We address problems as they arise. It makes life easier for Michael but there is still a lot of ice under the water.

Today I am writing this as Michael works quietly at his desk (completing homework which should have been done yesterday – did I tell you I hate homework). He was supposed to go to his sports day but refused this morning because his shirt was too small (that’s just the excuse for ‘it’s all too much for me’).

Sports days are generally hated by most kids with autism (noisy, chaotic, competitive etc.) and it’s one of those issues that we haven’t yet been able to deal with satisfactorily .

Staying at home is as good a solution as any.