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Perseveration: Stereotypic Behaviors in Aspergers Kids

Question

My 10-year-old son with Aspergers has a variety of stereotypical behaviors (e.g., he flaps his arms, hops, makes some odd writhing movements). They get worse when he is excited or over-stimulated. At age 10, these behaviors are really sticking-out and can be quite annoying and embarrassing to the rest of the family when we are out with him, in particular his older sister. Do you have any suggestions of what to do about it?

Answer

Almost all kids with any form of autism tend to repeat behaviors, an action referred to as stereotypic behaviors or perseveration. Your youngster may stare at objects or repeat behaviors that seem to have no purpose for hours at a time. This can be seen in the “flapping” of your child’s hands or other circumscribed, repeated movements, even those that are self-injurious or destructive to others or property.

In kids with Aspergers (high-functioning autism), these stereotypic behaviors may diminish and give way to obsessive interests, usually topical in nature, as the youngster gets older. This is exemplified by obsessive fascination with a particular narrow field such as sharks, weather, train schedules, airport architecture, maps, and so on. The pursuit of a very limited area of knowledge may encompass a huge amount of detail on the subject. Such persons seem to display an exquisite ability to memorize the smallest facts.

In discussion on their favorite topic, they can “nitpick” over the smallest details. Grandpa may think he remembers World War II, but his grandson with Aspergers has memorized the details of the war with far greater accuracy. Clearly, the student can display perfectionism in building such a base of information. For this reason, Aspergers has been compared in such respects to obsessive compulsive disorder. Autistic kids who are later found not to be categorized as having Aspergers may tend to display stereotypical behaviors longer and at levels that are difficult to extinguish. In many cases, physical perseverations decrease significantly over time, and in some cases, only obsessive thinking is perseverative.

Stereotypic behaviors such as hand flapping, ritualistic pacing, spinning, lining up objects, or visual inspection of objects are thought to be “automatically” and intrinsically rewarding for many kids with Autism Spectrum Disorders (ASD). These activities may give a youngster a new sensory experience that is rewarding.

One way to think about this is that many kids with ASD often do not have age-level play and social skills. Some pass time by engaging in repetitive motor behaviors. It is also possible that, though stereotypic behaviors are initially reinforced intrinsically, they may also become reinforced by social attention when parents try to stop or discourage the behaviors. These behaviors can interfere with learning if they occur a lot in the school setting. They can also “stigmatize” the youngster (i.e., make him appear odd).

There are at least 3 possible behavioral interventions that may be used to reduce such repetitive behaviors. These interventions are usually employed separately, but they may also be done simultaneously. If moms and dads wish to reduce such behavior, they should seek the help of a behavior therapist.

First, some therapists may decide to stop the behavior. Simply ignoring the behavior, if it is intrinsically rewarding, usually will not work. One usually attempts to stop the behavior with as little social attention as possible. Talking with or looking at the youngster is usually discouraged when preventing the behavior from continuing. The minimal amount of physical guidance to stop the behavior is recommended. Then parents and others around the child are coached to pay attention to the youngster again when the repetitive behavior has stopped.

A second approach involves teaching the youngster how to play appropriately with toys. This approach works even better the child is exposed to toys that achieve the same or similar sensory experience provided by the repetitive behavior.

If the repetitive behavior involves objects or household equipment, such as rewinding a part of a video cassette, a third approach is sometimes used. One can minimize the behavior by limiting access to those objects or equipment. Regardless of the approach used, any behavioral intervention for stereotypic behaviors needs to be highly individualized. We strongly recommend that moms and dads obtain expert consultation with a qualified clinical psychologist.

Some medicines may also help to reduce repetitive or compulsive behaviors. Sometimes the serotonin selective reuptake inhibitors (Prozac-like medicines) are helpful. Examples are citalopram, sertraline, and paroxetine. The newer types of antipsychotic medicine are sometimes helpful for reducing stereotypic behaviors. Examples of these medicines are risperidone, aripiprazole, and ziprasidone.

Ordinarily, the antipsychotics would not be used solely to reduce repetitive behaviors, however, unless such behaviors were linked to other, more serious, behaviors. This is not frequent, but sometimes Ritalin-like medicines may actually make stereotypic behaviors increase in some kids with autism-spectrum disorders. The parent and doctor should be watchful for this if a youngster with an autism-spectrum disorder is starting a new medicine for ADHD or if the dose of the medicine is increased.

The stereotypical behaviors that you mention can certainly be associated with pervasive developmental disorders. It is important that you get your youngster to a clinic familiar with autism and related issues, and with psychopharmacological management. Only then can a plan be best formulated.

The Aspergers Comprehensive Handbook

16 comments:

Anonymous said...

‎: / don't think ur child is embarasing u or ur family ... Ur son is who he is... And don't worry about what others are thinking...because u and ur family have been given a special angel to take care of and nourish into this world .... Just focus on what makes ur son happy ......

Anonymous said...

My 8yo does the same sorts of things. I realize I can't change her, and really deep down I don't want to. If people want to look, let them. They don't know the sorts of things we go through on a daily basis. I remember not too long ago when I couldn't take her ANYWHERE with out a complete meltdown. We've come a long way and I love to see her happy and excited about anything. Just to see her smile melts my heart. If she flaps, jumps or sways cos she's happy - I say - sway away sweetie!! Lol!!

Anonymous said...

People will look and stare at anything really. Also, just cos they're looking - you don't know what they're thinking??? Who's to say they too don't have an ASD affected child in their family?

Anonymous said...

I just worry about my daughter's self esteem and other kids making fun of her. Kids are cruel. Mine likes to rock herself and has had kids say stuff to her on the bus. While we encourage her there is nothing wrong with what she is doing-we also encourage her to try to do this around the house and around people that love you..

Anonymous said...

my little man makes heaps of animal noises and acts out animal type plays ... And when I think he is going to over board ... I just try to put his mind onto something else instead ... it could be anything from asking him to help mum hang out the washing ... Or sweeping and doing the dishes... ... More or less just trying to slowly change there thinking to doing something else ... And giving heaps of encouragement on anything he does that is good ; ) I hope all goes well for yous xxx
52 minutes ago · Like · 1

Anonymous said...

This is a perfect time to teach your older Daughter empathy and Family strength. She has a big Role in his life and he has a big role in her's. Be supportive of how different they both are and how wonderful those differences can be. There may be a day when all they have is each other for support.

Anonymous said...

We've been implementing a couple of strategies. One of the is using a worry stone. It's basically flat piece of lightly polished quartz with a thumb groove in it. When under stress, you rub the groove with your thumb. We told him that the quartz absorbs all the bad energy and feelings you rub into it, cleans it and then releases it so it can hold more. Kinda like an emotion filter.The added bonus is after using it for awhile it the oils from hand and the friction from the rubbing will give a highly polished look, which makes the idea more concrete. My kid has embraced this, but normally uses when he's outside of our house. The worry stone has really helped him cope in really difficult situations. He tells me he rubs his anger and frustration into the stone so he can keep using his manners with other kids.

He has developed the habit of cracking his neck and knuckles when he's really anxious, which is not very socially acceptable. The first thing we started doing was redirecting him to click his tongue just to help him become aware of his actions (because he really wasn't aware he was doing it at all). This way, he doesn't feel like we're nagging him or judging him about the cracking. The second part we're phasing in is the use of a stress ball to replace the cracking of knuckles of and neck. Finding the right stress ball has been difficult. I'm trying to find one that's textured that can hold up to his manipulation... We've also thought about getting him a variety of sensory stimulating objects, but I haven't had a chance to look yet.

We've talked to him about stims and habits rather extensively. I don't want to stop them entirely because they bring him a great deal of comfort. We just want to make them healthier and less socially off-putting. He's been really receptive to the process and there have been a lot of proud of himself moments for him (and moments where we are proud of him).
24 minutes ago · Like

Anonymous said...

I am an autistic parent who raised an autistic child and an NT child. I am so completely socially aloof that this whole "being embarrassed" thing or even seeing that other people were looking is completely foreign concept to me. My mind is blown that anyone would care about how others are looking at your autistic child as he is being autistic. I think that worrying about that is a complete waste of everyones energy.

My NT child learned to not care about that and is a brilliant, confident 29 year old today (two degrees and teaching in Dallas schools). My ASD kid is also a brilliant, confident person. Neither were affected by learning to not care what others thought of them and instead learning acceptance of all people for who they are. Call me different but I think this is a better way...
24 minutes ago · Like

Anonymous said...

I have an aspie son, but I also have am extremely low functioning autistic brother that I grew up with. I will honestly tell ypu this... it is easier being the parent. The best thing you can do for your daughter is agree with her that yeah, it really sucks sometimes. Hearing that makes you feel less "evil" for feeling that way. Don't force her into being a saint about it, and give her breathing room. As for your child, I bet they wish they didn't have to do those things either
3 minutes ago · Like

Anonymous said...

My son is 8 now and this is something that he has always done., he is high functioning, PDD-NOS. I've been watching both my kids when they get excited, my daughter does not have autism , she will hop, cheer/yell with her arms in the air, my son hops silently, sometimes on 1 foot and flap his hands. I guess we all cheer and get excited in different ways, if I tell him to quit cheering in his way, I may as well tell my daughter to quit cheering too.

Anonymous said...

My daughter does a lot of 'stimming' at home, usually while reading or watching TV - "relaxing" activities. By stimming, I mean hand flapping and leg twitching, almost to the point of it looking like a minor seizure. However, the autism specialist I spoke with said I should ignore it as she would only replace one behaviour for another if I tried to get her to stop because it 'serves a need' for her. As for other people witnessing the stimming or other quirky behaviours, it seems she does not do them as much when at school or with other family members (the stimming in particular), and those who spend time with her regularly know her issues anyway, so they would not be surprised or taken aback by these behaviours. And as for what strangers think of her behaviours, I really could not care less. ;)

Anonymous said...

I'll never be embarassed by my kids autism because thats basically what your saying,get over it and get on with the job at hand

Anonymous said...

My 12 yr old Aspie son did a lot of stimming when he was much younger but seems to have outgrown it.

Michelle Williams said...

I agree. Maybe you and your oldest daughter need counseling for a good lecture on getting over yourselves. Also, please walk away from that lecture, knowing that you as a parent needs to set the tone that all of your children are individuals, and that respect for individualism is of the highest priority for all involved. Not anyone's narcissistic feelings of embarrassment.

Thomas Black said...

As a parent and a professional special needs advocate, I see how the family is impacted and there is no doubt family members with autism spectrum disabilities cause turmoil for the entire family. The most sensitive or difficult behaviors don’t have to be so hurtful and there are solutions and strategies to minimize the damage. While I agree in general terms with the ‘at least 3 possible behavioral interventions’, there are strategies that stretch well beyond these that really work well and work well for the entire family. We've come a long way.

Thomas black
www.specialneedsadvocates.org

BU LLS said...

WOW. It is a little disheartening seeing so many negative comments. I just wanted to add that it is ok, and normal for your DD to feel that way sometimes. Good for you seeking help. I was looking for the same advise because there is nothing wrong with dealing with the truth. It is helpful to everyone if the children can learn to act more socially acceptable. I am sure you, as I love all of our children very much, and want them to have a normal life. That means not being stared at because your sibling is doing bird impressions, or being the one doing the impressions not having another way to release your tension. My children all love one another, and know that people are rude to stare. It isn't that we want approval of the rude people, either; It would just be nice to have a way to deal with the stimming issues and such. Thank you to to other positive posters! I see several things that may help! yay!

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