Repetitive Stress


Rocking, head banging, echolalia, spinning, toe walking, arm flapping, scratching. These “stereotypic” mannerisms are among the criteria for a diagnosis on the autism spectrum. Although these behaviors have been casually known as “stimming,” in reference to the role that such stimulatory actions play in the sensory system of the kids engaging in them, child development professionals shun this colloquial term in favor of the more appropriate “repetitive behaviors” or “stereotypy.”

Most people occasionally engage in repetitive actions that soothe or help them stay alert, be it an infant sucking his thumb or an adult jiggling her leg, biting a pencil or twirling her hair. A distinction between these typical behaviors and those associated with autism is the extent to which the mannerisms are persistent and disrupt the individual’s social relationships, learning and other productive activities. That’s why it’s vital to schedule a comprehensive assessment to explore any underlying medical or neurobiological issues if a child starts displaying stereotypy, says Joel Bregman, MD, medical director and director of psychiatry at The Center for Autism in Philadelphia.

What's behind the repetitive behaviors?

Sometimes behaviors that seem to be nonfunctional are actually communicating something, notes Suzanne Buchanan, PsyD, board-certified behavior analyst and executive director of Autism New Jersey.

She emphasizes that many complex factors drive these behaviors, including a need for escape or attention — or both. Stereotypies tend to be exacerbated by joy, fatigue, stress, frustration, anger and unpredictable conditions. Close attention to the patterns of circumstances and environmental triggers may help clarify what message the child is sending.

Many professionals see stereotypic behavior as a coping mechanism for sensory integration problems. Some kids are overwhelmed by routine sensory conditions, while others require greater levels of sensory input, explains Barbara Berman, OTR/L, MSc in Yardley, PA. Therefore, stereotypies may indicate ways these youngsters respond to and try to self-regulate visual, auditory, tactile, vestibular, taste and smell sensations.

“These behaviors allow the individual to go to a happy place and calm himself,” says Heidi Mizell, resource coordinator and parent mentor at Autism Delaware, who’s also a parent of an adult child with autism. The problem comes when the behaviors keep the person from engaging in the world around him.

Observations & interventions for stereotypy

When strangers see a person engaging in stereotypic behaviors, they often infer — incorrectly — that parents aren’t doing a good job, notes Dr. Bregman. “A lot of observers say not nice things,” says one mom of a child with autism. Mizell urges parents to resist feeling embarrassed, as such behaviors are not a reflection on them.

What can concerned parents do to reduce the frequency of repetitive behaviors? Although it’s not always necessary to intervene, it is often desirable to replace stereotypies with more socially appropriate and productive activity. According to Dr. Bregman, the way to do that depends on the behavior’s root cause and what might catch the child’s interest and attention.

Evidence-based modification approaches, such as Applied Behavior Analysis (ABA), help teach children and their families effective behavior modification skills. These methods employ positive reinforcement to take a long-term perspective, slowly building on small successes with positive reinforcement over the long term. For impatient loved ones, the incremental pace can be quite difficult, experts say, but the progress is rewarding.

Distraction can sometimes briefly avert inappropriate behaviors. Take the child’s hand or provide a fidget toy or other reward to help redirect her focus. Doing so differs from bribery, says Dr. Buchanan, because the rewards are in the child’s best interest, not that of an inappropriate goal. Replacement interventions — vigorous physical activity to release tension, art to satisfy sensory interest — can also benefit.

When in an environment that poses challenges for a child with sensory integration or motor planning deficits, such as a supermarket, keep your time there short and efficient. Aisles of products, carts, music, lighting, different temperatures and crowds can set off all sorts of stereotypies, from knocking over displays to engaging in full tantrums. Consider in advance how to help your child deal with aspects of the environment that most disturb him.

Stereotypies should not be handled in isolation from the broader context, emphasizes Berman, and safety comes first; any behavior in the wrong environment could be dangerous, observes Mizell. Therefore, interventions should be individualized to your parenting styles and your child’s tolerance levels, culture and emotional variables.

Ann L. Rappoport, PhD, is a contributing writer to MetroKids.


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