Stimming in Autism: What it is and How to Treat It

autism, autism spectrum disorder, stimming, autism behaviors
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Autism spectrum disorders (ASD) is a term for a group of complex disorders of brain development characterized by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors – including something called “stimming”. These are self-stimulatory behaviors, such as flapping, rocking, spinning or repetition of words and phrases. Like everyone else, people with autism stim to help themselves manage anxiety, fear, anger and other negative emotions.

Here are some examples of stimming:

  • Visual: Staring at lights or ceiling fans; repetitive blinking; moving fingers in front of the eyes; hand-flapping, gazing at nothing in particular; tracking eyes; peering out of the corners of eyes; lining up objects; turning on and off light switches.
  • Auditory: Vocalizing in the form of humming, grunting, or high-pitched shrieking; tapping ears or objects; covering and uncovering ears; snapping fingers; making vocal sounds; repeating vocal sequences; repeating portions of videos, books or songs at inappropriate times.
  • Tactile: Scratching or rubbing the skin with one’s hands or with another object; opening and closing fists; tapping surfaces with fingers.
  • Vestibular: Rocking front to back; rocking side-to-side; spinning; jumping; pacing.
  • Taste: Placing body parts or objects in one’s mouth; licking objects.
  • Smell: Sniffing or smelling people or objects

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It is unknown why persons with autism develop stimming behaviors, but it is thought to be part of a sensory processing dysfunction, where persons have difficulty with sensory input (lights, noise, heat, etc.) Another explanation is that it releases opiate-like substances in the brain called beta-endorphins which can produce either a euphoric or anesthetic effect.

Some stimming is basically harmless. Temple Grandin, for example, says that when she was a child, she used to let sand dribble through her fingers. It calmed her in “an overwhelming sensory environment,” she says in Autism Digest. Most experts agree that it really isn’t necessary to eliminate these behaviors, especially when they provide comfort.

But stimming can also interfere with everyday life, including the ability to interact with others, take part in ordinary activities, or even be included in typical classrooms or work situations. For example, a child who regularly needs to pace the floor or bang their heads would be a distraction to other students. It is also definitely a problem with the self-stimulation becomes harmful.

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Decreasing or eliminating unwanted stim behaviors can be accomplished through a variety of methods.

Applied Behavior Analysis
A combination of positive reinforcement for functional responses with redirection to more appropriate responses during negative behaviors can help teach an autistic child how to better calm himself without harm.

Nancy Konigsberg, a licensed occupational therapist, describes Applied Behavior Analysis (ABA) as a technique that can help with this. When working with children with autism, appropriate behaviors are rewarded and therefore reinforced. Negative or undesirable stimming behaviors are rewarded once they are stopped.

Replacing Behavior
Since a child uses stimming as a way to calm himself when he is stressed or frustrated, another option is to teach a replacement behavior that is less noticeable but provides the same sensory input. For example, a child who flaps his hands can be taught to tap his leg with his finger or squeeze a stress ball instead. This approach tends to work best with younger children, notes Konigsberg.

Medications
Medications alone will not reduce stimming behaviors but may help with the anxiety associated with them. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed. These include Prozac (fluoxetine), Luvox (fluvoxamine), and Zoloft (sertraline).

Physical Exercise
Activity may help redirect behavior, plus it can produce the beta-endorphins that can reduce the need to engage in stimming. Plus it may also help to improve focus and attention span and promote self-esteem.

Resources include:
BBC.com
North Shore Pediatric Therapy

Journal References:
S. Goldman et al. "Motor stereotypies in children with autism and other developmental disorders." Dev Med Child Neurol. 2009 Jan;51(1):30-8.
RL Koegel. "Extended reductions in stereotypic behavior of students with autism through a self-management treatment package." J Appl Behav Anal. 1990 Spring;23(1):119-27.
KS Lam et al. "Evidence for three subtypes of repetitive behavior in autism that differ in familiality and association with other symptoms." J Child Psychol Psychiatry. 2008 Nov;49(11):1193-200.

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