What is Stimming?
November 30, 2020
November 30, 2020
Stereotypy, stimming, repetitive behaviors – what do these terms mean, and what do they mean for our kiddos?
Many parents within the autism community have felt the stares associated with these terms, from a side-eye in the grocery store to a disapproving comment from another adult who rushes to judgement. This is especially unfortunate because while stimming may seem “different” to others, it can be calming or soothing to the person participating in it. The challenges of self-stimulatory behaviors can go beyond social stigma, however. In order to help children manage them, we must first get to the root of the cause.
In our centers, our goal is never to suppress these feelings and behaviors, but rather to help parents set up their children for success and create more of a life balance with stimming. We turned to Hopebridge Board Certified Behavior Analyst (BCBA) Justina Benzan for guidance on this stereotypy. With more than a decade in the field of applied behavior analysis (ABA therapy), she has experience working on these goals with dozens of kiddos across the country from New Jersey to our autism therapy center in University Hills, Colorado.
Hand-flapping, rocking, scripting (sometimes referred to as echolalia), repetitive singing and non-contextual babbles and squeals – specifically those not directed at another person – are common behaviors for many children with autism spectrum disorder (ASD).
These repetitive motor movements and vocal utterances are examples of stereotypy. “Stimming” is the most common layman’s term, which is short for self-stimulatory behavior. It is not unique to autism, though it is part of the diagnostic criteria for ASD.
Other less common stimming examples include excessive blinking, constant jumping or spinning, and some self-injurious behaviors like head-banging or hair-pulling, though this is not an exhaustive list and the behaviors are not always clear to others. Stereotypy can appear in a number of ways that do not fall into a specific box.
The obvious challenges families face are related to social stigma. People are aware that something is different and stereotypy can lead to a lot of attention. For instance, vocal stims can be viewed as inappropriate or an annoyance in places like a movie theater or library.
While stigma is one piece of the struggle, it’s not the main reason behind most of our children’s stereotypy-related goals. A big reason why we choose to work on decreasing these interfering behaviors is because they can impede on learning. For example, if an individual experiences hand-flapping during a high percentage of their day, it is competing with their ability to learn and socially engage with others.
All behaviors happen for a reason, so the first step to managing these behaviors is determining the “why” behind the occurrences, which is known as the “function of behavior” in ABA terms. As behavior analysts, we never want to assume the reason, so we do our due diligence and collect data to determine the clear function.
More often than not, stimming serves an automatic function. In these cases, the individuals engaging in this behavior are either seeking sensory input that is pleasing to them, or they are trying to remove some sort of sensory input that is displeasing.
Once we discover the origin, we can begin to help the child manage the behavior. Rather than focusing on decreasing it to zero levels, we focus on teaching when stimming is appropriate, such as downtime, and when it’s not, such as when they are socializing, learning or out in the community. For whatever reason, this person is using it to seek some sort of sensation, so if it’s not causing harm, to eliminate it completely might not be the most ethical. And if stimming is not impeding on learning and the child is able to sit, focus and engage with others, then decreasing it may not be a high priority.
To help children through these goals, we often use signals to show when they are able to engage in stereotypy and when it is not available. To do this, we must also provide times of day when they can have access, though we usually teach them how to stim in more appropriate, functional ways. For example, we might provide opportunities to use a rocking chair for children who typically rock their torsos back and forth.
I’ve worked with many children who experienced challenges with stimming, but there is one case that sticks out. This little girl engaged in vocal stereotypy, singing and scripting to herself 75 percent of her day. She did it during work sessions, so much that she was unable to pay attention to her therapists or instructors, which is why it was such a concern.
As part of our therapy, we used an intervention called response interruption and redirection (RIR). We signaled her teaching trials with red and green cards. Green meant she could engage in stereotypy without anyone stopping or redirecting her. When the card was red, it meant we would work and have conversations with one another. If she tried stim during this time, we would interrupt it by engaging in functional communication.
Over time, she was able to decrease these behaviors to only 30 percent of her day, which was a big success for all of us. It’s important to note that we did not try to completely nix the act of stereotypy, and rather tried to give her a more functional life where she could learn from herself and others.
At home, her mother observed more social interaction with her child, which was a huge win. They had many more positive social and appropriate interactions with her daughter, who began to seek out and express interest in direct communication with her family. Stereotypy is one of the more challenging behaviors, so it was exciting when our intervention proved to be effective.
Similar to how we approach it in ABA therapy, it’s imperative caregivers identify the reason for stereotypy. This answer will lead to the proper response.
Unless working with a BCBA or therapy team, parents will not likely be able to collect data in the same manner, but there are some key cues they can follow. For instance, if a child engages in this behavior throughout the day, even when they are alone or have access to preferred toys or activities, it’s a good possibility the stim serves as an automatic function.
From there, determine when it’s appropriate for them to have access and when to interrupt the behavior. We do not want to tell them they cannot access the stim at all. Instead, let them know it is appropriate in their room, but not in a grocery store, for instance. Having some sort of visual or cue to go along with this is key. Something as simple as a red bracelet or green bracelet can work, if the child will tolerate it.
Next, choose a method of interruption that will achieve a similar sensation for them. With vocal stereotypy, parents can use functional conversation to intervene. With motor stimming, provide a competing item, like a fidget, to hold. Examples include putty, fidget cubes, fidget spinners, stress balls and things like toy snakes that move in fun ways. It is important to figure out what might provide a stimulation or motion that is similar to what they are seeking.
For children in ABA who are working on stereotypy-related goals, we encourage parents to have an open mind and collaborate with their therapy team. As BCBAs, we might suggest a method that you already tried three years ago, and though it didn’t work then, it could be beneficial now. Or maybe we want to try something that you’re unsure will work. We want parents to understand that if an intervention does not work, we will try something else. We individualize programs for our kiddos and are not going to give up. The process can sometimes look a little bit like trial and error, but we’re going to keep advocating for you and your child, and we want to work with you to figure out the puzzle piece that will be the right fit.
If you feel your child is held back by stereotypy, more support may be necessary for them to lead a more fulfilling life. Through ABA therapy, our team can work with your kiddo to determine the underlying reason and help introduce replacement behaviors so they can find joy in other ways. For more information about Hopebridge’s therapy services in Denver or one of our many other centers across the country, please fill out our easy online form to schedule a diagnostic or ABA evaluation.
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