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.


More resources for parents of children and teens with Asperger's and High-Functioning Autism:

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