Repetitive Behaviour and Stimming – the Autism Files

Repetitive Behaviour and Stimming – the Autism Files

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.

Sensory Issues: The Autism Files

Sensory Issues: The Autism Files

_

_

Sensory Issues

The sensory world is perceived differently by people who have Autism Spectrum Disorder (ASD).

People with ASD can be

  • insensitive to sensory information (don’t feel enough) or are
  • oversensitive to sensory information (feel too much).

One sense can be highly tuned while another is muted. Sometimes they find it hard to turn off the channels and too much information is coming through at the same time. Filtering out irrelevant information becomes difficult. Sometimes the channels are mixed.

It can become so overwhelming that they have a meltdown or temper tantrum.

Imagine living in a world where:

  • the sound of a refrigerator humming (500 metres away) grates on your nerves.
  • the smell of a person’s perfume is like bleach and makes you want to vomit.
  • you are oblivious to physical pain, so that you are unaware of burning your hands when the tap water is too hot.
  • you would rather starve than eat some foods because their texture or smell is unbearable (like being forced to eat meat that has been rotting for days).
  • the frequency of light from a fluorescent tube is like a strobe light at a nightclub.
  • you are not sure where your body ends and other objects begin.
  • you can feel like you are dizzy and falling.
  • it is painful to feel the light touch of a hand.

Every child with ASD is different and needs to be assessed as an individual. An Occupational Therapist can complete a sensory profile for children to map the problem areas. They will assess the outer senses (taste, touch, sight, sound, smell) and the inner senses (vestibular and proprioceptive). I hadn’t heard of those last two either!

The vestibular sense helps you keep your balance (it’s the thing that goes haywire when you are on a rocking boat for too long and you get seasick).

The proprioceptive sense lets you know where your body parts are in space (eg., an awareness that your arm is at your side or how close you are to furniture) and how much force is needed to do a task.

Parents can do their own sensory profile. List each of the senses and try to work out if your child is under-sensitive (actively avoids) or over-sensitive (seeks out) in that area. Try to step into the child’s body and ‘feel’ the world through their senses. Think of specific problem behaviours and consider whether a sensory issue may be the cause. Here is an example of a profile that I put together for my son Michael (3 years old)**:

_

Senses

Sensitivity

Behaviour or Reaction

Taste Under sensitive Seeks out strong taste eg. vegemite, salty foods (now loves curry)
Touch Over sensitive in head/neck area Avoids being touched at back of neck and head, hates haircuts, getting hair wash, teeth cleaning. Insistent on wearing the same soft t-shirt every day.
Sound Over sensitive Covers ears in shopping centres and playgroup, meltdowns. Hates some sounds (eg., vacuum cleaner, hair dryer, hand dryer). Upset at birthday parties.
Smell Over sensitive Food refusal. Hates the smell of most fruit (phenolic smell – probably smells like nail polish to him) and has meltdowns when confronted with foods.
Sight Over sensitive Avoids or looks away from bright lights (especially fluorescent light), agitated, covers eyes. Difficulty finding things right in front of him.
Vestibular Under-sensitive Seeks out swinging, spinning, trampolining,
Proprioceptive Under-sensitive or reduced awareness Never sits straight, always leaning on things for support, falls over when support moved.Loves being supported from all sides (eg., heavy blanket, inside boxes, deep pressure hugs, wearing weighted vest). Always getting into small spaces.

I believe that dealing with sensory issues is very important for people with ASD and there is so much that can be done in this area to help.

Some strategies are simple (eg., earplugs, iPods, movement/exercises such as trampolining, dark sunglasses, Irlen lenses, removal of fluorescent lights, weighted vests, movement cushions, chew sticks, squidgy balls).

Some strategies are more complex (sensory integration therapy, auditory integration, behavioural optometry, desensitisation).

An Occupational Therapist can guide you in this area or you can find out more in the many books that are available.

** Leith Johnston, Michael’s speech pathologist at the Wesley Hospital in Brisbane, showed me how to do this type of sensory profile (there are also questionnaires that can be used). Thanks Leith.