What is Perseveration?
If you're the parent or teacher of an autistic child, you may have heard of the concept of perseveration, or stimming. But exactly what is perseveration? A child who perseverates repeats a meaningless action over and over again, seemingly unable to stop doing so. For example, autistic children may perseverate by saying a sentence (or asking a question) over and over again, clasping their hands together, spinning small objects near their eyes, or putting toys in a perfect line.
The “Whys” of Perseveration
Why do some children with autism perseverate? There are two main possibilities. One is that they use perseverations to control what seems to them to be a chaotic existence. The perseveration is something that they can control, as opposed to the rest of the world that they believe is arbitrary and confusing. Other children may receive sensory input from their perseverations that is easy to integrate. For autistic children who have symptoms of Sensory Integration Disorder, perseverations may give them visual or auditory stimulation that can calm them down, especially when they are overwhelmed by normal (in our eyes) sounds or situations.
Rather than trying solely to treat perseverations in autistic children, parents and teachers should try to focus on preventing them. For example, they may notice that specific activities set off perseverative behavior in a child. If this is the case, they should avoid this activity as much as possible. If, however, the main motivation for the perseveration is the fact that the child feels anxiety towards a situation or activity, the adult should try to catch this in advance, give reassurance to the child, and then move forward.
There are several methods that can help minimize perseverative actions in children with autism. One of the most commonly used methods is redirection, in which the caregiver helps the child transition away from the perseveration. There are three main techniques of redirection, including abrupt and smooth variations.
The caregiver can also set limits on the perseverative activity. For example, a caregiver might say, "You can do that one more time, and then it's time to stop" or "If you need to do that, you can do it in your bedroom. When you're ready to stop, you can come back and play." For more extreme or offensive examples of perseveration, the caregiver might need to stop it dramatically by drawing a picture of the perseveration and then ripping it up, saying sternly, "It's gone now; it's time to stop right away!" And of course, if the perseveration does not seem to be interfering with social interactions or schoolwork, the caregiver could simply ignore it.
In situations where the above treatment techniques do not appear to work, medication may be necessary. SSRIs (selective serotonin reuptake inhibitors) can help treat perseverations, and they may even be used in addition to the other interventions outlined in this article. SSRIs that may help include Paxil, Prozac, and Zoloft.