Children on the autism spectrum engage in restrictive repetitive behaviors for various reasons. Also referred to in the literature as “self stimulatory" – these stereotypic actions will be described in this article as “autism stimming". What follows are effective treatments for autism stimming.
What is Autism Stimming?
Restrictive repetitive behavior or autism stimming may involve gross motor movements such as spinning or rocking and hand movements such as spinning objects. Or it could be verbal when the autistic person repeats phrases over and over.
The stimming actions may involve moving objects within the peripheral field of vision to stimulate the visual system or there could be a preoccupation with object arrangement-perhaps lining up blocks. Typically, a developing child may demonstrate these behaviors at times since they learn by moving their bodies and manipulating objects. However, children with autism demonstrate limited object exploration and creative interaction with objects and their environment.
Anxiety and Obsessive-Compulsive Disorder
When autism stimming is caused by anxiety or an obsessive compulsive disorder (OCD) a physician may recommend an anti-anxiety medication. The child may also benefit from environmental adaptations and self-management strategies that may decrease anxiety. For example, visual schedules help the child follow routines and know what to expect. Reducing clutter makes it easier to organize tasks and taking “time outs" from stressful work activities may help prevent sensory overload that contributes to anxiety.
Individuals who engage in autism stimming may be attempting to maintain focused, and a behavior such as repeatedly sifting sand may help to self-regulate the nervous system. Rocking may help a child remain calm whereas flapping the arms may help a person to remain alert. Many people with or without autism realize that movement helps focus and simply chewing gum, squeezing a stress ball or being allowed to pace during a lesson may help a student self-regulate.
The “Alert Program" described in the book “How Does Your Engine Run?" teaches children how to recognize the types of sensory stimulation their brains need in order to focus and learn. Providing the appropriate stimulation may decrease repetitive behaviors.
Sensory Integration Therapy
Sensory Integration or sensory processing refers to the brain’s ability to take in environmental information such as what a person feels, hears and sees and interpreting these in order to use them in a purposeful manner. This interpretation is called “perception". Individuals with autism often have perceptual deficits which is seen when they over-respond or under-respond to stimuli. For example, they may cover their ears to avoid sounds, withdraw from touch or engage in stereotypical behaviors when in a crowd.
Sensory integration therapy is designed to alter the nervous system using sensory motor activities. Occupational therapists who provide sensory integration therapy work on therapeutic goals that increase function- such as motor control to walk up stairs, eye hand coordination to throw a ball at a target or visual attention to remove toy fish from a bucket of water. These functional activities provide alternatives to autism stimming.
Sensory Activities and Reinforcement
Treatment for autism stimming should also center on providing sensory activities that are engaging and motivating but are also designed for the person's developmental level. Children with severe cognitive deficits may simply not know what to do with their hands and bodies. For example, a five-year-old boy who is functioning in the 12-18 month range might be taught how to stack rings. Using a musical ring stack or adapting one to vibrate would make the activity more stimulating and increase his motivation to use it.
A reinforcer is anything that makes a person repeat an action. Children with autism may particularly benefit from “sensory reinforcers" such as jumping on a trampoline or squeezing toys that make sounds after performing a less preferred, but functional task. Sensory reinforcers can decrease autism stimming because they reward the alternative behaviors (i.e. not stimming) while at the same time providing the sensory stimulation that helps regulate their nervous systems.
“Autism: A comprehensive Occupational Therapy Approach"; Heather Miller Kuhaneck & Renee Watling; 2010.
“Building Bridges through Sensory Integration"; Ellen Yack, Paula Aquilla & Shirley Sutton; 2004.
“Sensory Integration and the Child"; A. Jean Ayres; 2005.
“How Does Your Engine Run?"; Mary Sue Williams & Sherry Shellenberger; 1994.