Autism and Stimming

Everyone has a stim.

I play with my hair while chatting with a friend.

Maybe you bite your nails when you’re nervous or bored.

You may tap your fingers or pencil on a desk while you’re thinking.

I once knew someone who chewed on sticks of cinnamon bark, and I’ve noticed some who move their eyes in an unusual way.

I can recognize certain people from far away just by their distinctive movements. We all know someone who has an annoying stim like cracking their knuckles every 5 minutes or repeating a phrase over and over; or a socially unacceptable stim such as nose-picking or biting oneself.

The word stim is short for self-stimulation. It is most commonly associated with autism. My son’s neurologist calls it “autistic stereopathy.” It is also sometimes called “stereotypy.”

The DSM-5 includes stimming as part of the diagnostic criteria for Autism Spectrum Disorder: “Stereotyped or repetitive motor movements, use of objects, or speech.” It also says, “Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.” That is the difference between autistic stimming and typical stimming: When the stimming interferes with everyday activities and prevents learning, it is often a symptom of autism.

“How do I stop the stim?” That’s usually the first question parents ask when a young child discovers stimming. But it’s the wrong question.

First of all, no one can stop self-stimulatory behavior completely, because everyone does it anyway! Secondly, even if one stim can be removed, it will be replaced by another — and the next stim may be less preferable that the current one.

The most important reason not to eradicate stimming is that you may cause your loved one to withdraw more and more, and lose your opportunity to encourage healthy interactions.

“Why does my child engage in this behavior?” Seeking to understand the motivation for a behavior is always a great place to start. There are several hypotheses and known causes for stimming:

• Overstimulation: Stimming can help block out excess sensory input.
• Understimulation: Stimming helps provide extra sensory input when needed.
• Pain reduction: Repeated banging of the head or body actually reduces the overall sensation of pain. One hypothesis is that stimming causes the release of beta-endorphins in the body, which then causes a feeling of anesthesia or pleasure.
• Management of emotions: Both positive and negative emotions may trigger a burst of stimming. We’ve all seen physical reactions to joy or excitement, such as jumping or hand-flapping. Frustration or anger may intensify a stim to the point that it becomes destructive.
• Self-regulation: Some stims serve the purpose of soothing or comforting. Many infants learn to suck their thumbs to relax themselves.

I recently read a blog in which a parent asked why her son covered his ears in his sleep. He had learned to cover his ears when his environment was too noisy, and that was soothing to him. So he started covering his ears whenever he needed to comfort himself, especially when falling asleep.

Self-stimulation can interfere with learning, interpersonal relationships and social situations. Some types of self-stimulation are self-harming and may lead to infections or require surgical repair.

Self-stimulation may also be a symptom of an ongoing medical problem such as migraines which a person with a disability may be unable to verbalize.

Here are some ideas for increasing relationship skills while reducing time spent stimming:

• Get a medical exam to eliminate the possibility of physical causes for stims, such as ear infections, chronic pain, migraines and retinal detachment.
• Manage the sensory environment and emotional environment to maximize personal comfort.
• Vigorous exercise reduces the need to stim, probably because exercise is associated with beta-endorphins just like stimming.
• Continue interacting while stimming occurs. In his book Communicating Partners, author James MacDonald suggests that individuals with autism tend to perceive the world through sensation and action, while most neurotypicals perceive through thought and language. Once this difference is understood, self-stimulatory behaviors make sense. MacDonald recommends turn-taking activities to engage a child without trying to stop stimming during the activity; the activity will gradually become increasingly comfortable and attractive, naturally reducing the stim.
• Create a positive association between stimming and relationship-building. One way to use stimming as a productive part of the learning process is to allow stimming as a reinforcer or reward after a period of playful interaction or work. Julia Moor writes in her book Playing, Laughing and Learning With Children On The Autism Spectrum that making time for stimming will allow the child the comfort of being himself, encourage more interactions and actually reduce the total number of hours per day spent stimming.
• Join the stim! Some treatment programs, including Son-Rise and Floortime, propose joining in the self-stimulatory behaviors as a way to initiate interaction. If a person is spinning plates, then start spinning plates. If a person is rocking back and forth, then rock back and forth right next to the person. My son’s preferred stim is to hold up his hand and talk to it, as if looking in a mirror. He thinks it’s hilarious when I do that with him!

Stanley Greenspan, author of Engaging Autism and developer of the Floortime method, explains: “Some children become intrigued—they now have a partner in crime, so to speak—and we get some shared attention and relating.”

He adds that if you begin to use the gestures so the child, in order to get what she wants, has to gesture purposefully back to you, the can become part of an interaction. “The overall principle is to offer the child experiences that produce the same sort of sensations as the self-stimulatory activity but lead up the developmental ladder of regulation, engagement, and interaction.”

In other words, to reduce the stimming, offer a replacement that is more alluring than the stim!

This article was originally published on friendshipcircle.org, the web site of a community organization in Michigan that offers assistance and support for families with special needs. A special needs blog on the site features many articles with tips and ideas for parents of children with special needs.