In this 3-part blog series, we will explore the repetitive behaviors typically seen with many children with autism. This Part 1 blog post will discuss what stereotypy is, how it differs from other similar behaviors, and how it can present a problem for the child engaging in this behavior. Recently in the Westchase Patch Emily Braff posted an excellent overview on stereotypy that can be read here. That post is a great introduction and this series will go more in depth on this important topic.
What is Stereotypy?
Stereotypy is defined as repetitive body movement invariance that serves no social function (Rapp, Vollmer, St. Peter, Dozier & Cotnoir, 2004). Stereotypy is a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place. Often children with autism engage in these repetitive, restricted, and stereotyped patterns of behavior. Stereotypic behaviors can take many unusual forms.
For example, the behavior can take the form of mouthing objects, hand flapping, body rocking, repetitive finger movements, and or nonfunctional/noncontextual repeated vocalizations.
The stereotypic behaviors exhibited may be verbal or nonverbal, fine or gross motor-oriented, as well as simple or complex. It may occur with or without objects, and some forms involve repetitive motor gestures or the use of language (Cunningham & Schriebman, 2007).
Other examples of stereotypy include toe walking, spinning objects, requiring order and predictability in routines, immediate or delayed echolalia (repeating things that others have said), running objects across one’s visual field, or dropping items and watching them fall.
These patterns and movements of behavior are one of the key diagnostic features of autism (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 2000) and often are the target of behavioral interventions. Typical individuals, people with mental retardation, and people with sensory disabilities also engage in stereotypic behaviors (e.g. Schwartz, Gallagher, & Berkson, 1986; Smith & Van Houten, 1996; Woods & Miltenberger, 1996). For example, many typical individuals are often observed engaging in leg shaking, body rocking, hair twirling, or finger tapping behaviors that all fit the definition of stereotypy.
Distinction from Tics
Like tics, stereotypies are patterned and periodic, and are made worse by fatigue, stress, and anxiety. Unlike tics, stereotypies usually begin before the age of three, involve more of the body, are more rhythmic and less random, and are associated more with engrossment in another activity rather than predictive urges.
Examples of early tics are things like blinking and throat clearing, while arm flapping is a more common stereotypy.
Stereotypies do not have the ever-changing, waxing and waning nature of tics, and can remain constant for years. Tics are usually suppressible for brief periods; in contrast, children rarely consciously attempt to control a stereotypy, although they can be distracted from one.
Stereotypy and Learning
Children with autism engage in stereotypic behaviors that can often interfere with attempts to teach academic skills (e.g. spinning objects, hand mouthing, body-rocking). This behavior poses a problem to the teacher, the child, and other children. “When engaged in stereotypical behaviors these students are socially unavailable and it presents teaching challenges for professionals,” (Hanley, Heik, & Luiselli, 2010), and this can be seen either in the classroom or while working one-on-one. This social unavailability makes it hard for the child to engage in skills such as joint attention or social referencing while in the classroom.
Joint attention is the process by which one person alerts another to a stimulus via non-verbal means, as with an eye gaze or pointing (Bruinsma, Koegle, & Koegle, 2004). Joint attention skills are an important skill for being in a mainstream classroom since these behaviors can be used to prompt correct responding and to gain group attention.
Another important skill that is normally not displayed by children with autism is social referencing. Social referencing is known as the seeking and use of information from another individual to help evaluate a situation (Bruinsma et al., 2004). The reason this may be difficult for individuals with autism is that they may prefer not interact with others and may not find this behavior reinforcing, and would rather engage in self-stimulatory type behaviors instead. Lacking these skills in the classroom can present teaching challenges to the teacher during whole class instruction, choral responding and teaching in the natural environment.
There are several possible explanations for stereotypy, and different stereotyped behaviors may have different explanations. A popular explanation is “stimming,” which hypothesizes that a particular stereotyped behavior has a function related to sensory input. Other explanations include hypotheses that stereotypy discharges tension or expresses frustration, that it communicates a need for attention or reinforcement or sensory stimulation, that it is learned or neuropathological or some combination of the two, or that it is normal behavior with no particular explanation needed.
Stay tuned for Part 2, which will discuss how to assess the functions of stereotypy, and Part 3, which will address different treatment options based on the function.