ARE THEY BAD? "RESTRICTED, REPETITIVE BEHAVIORS."


"Restricted, repetitive patterns of behavior" is one of the criteria for the diagnosis of autism. Clinicians and other professionals who work with autistic individuals often consider these behaviors as undesirable and even problematic. Often, there is a focus on reducing those behaviors through behavioral approaches. What behaviors are these, specifically? Some examples are:

  • repetitive play

  • lining up/piling up toys

  • stimming (self-stimulatory behaviors)

  • echolalia

  • need for sameness

  • adherence to routines

  • "special" interests

I would like to share a different perspective on these behaviors that I have developed in my practice. Some of my observations are also complemented by information gleaned from writings by autistic adults.

Repetitive play and Lining up/Piling up toys

Autistic children usually play in repetitive and rigid ways when they do not have the skills to play more freely. To play, a child needs to be able to regulate their emotions, to tell a story, to understand the emotions and behaviors of others, to make planned movements, and to coordinate and solve problems with others if playing together. Many of those are challenging for an autistic child. Always playing in the same way allows a child to be sure of success. It is also a familiar, comfortable activity that allows a sense of control and reduces the anxiety that usually comes with a lack of skills.


Lining up or piling up toys is one example of repetitive play that is very common. By arranging objects, a child can self-regulate and organize their world in a way that makes sense to them. If adults on the spectrum have collections or favorite objects, they can be sensitive to others touching, moving, or re-arranging them because it violates their need for the order that is comforting and is based on their own rules.

Stimming

Self-stimulatory behaviors, often referred to as "stims," can involve movements, vocalizations, as well as mental processes. "Stims" can serve the following many functions:


•Self-Regulation:

•Overstimulation: Stimming can help block out unpleasant or overwhelming sensory input

•Under-stimulation: Stimming helps provide extra sensory input when needed

•Self-soothing and comforting, stress release

•Pain reduction:

•Repetitive impacts can reduce the overall sensation of pain

•Possibly, 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

•Joy or excitement -- jumping or hand-flapping

•Frustration or anger – stim can become destructive

•Habit

Echolalia:

Echolalia is defined as the "meaningless repetition of another person's spoken words." Echolalia can be immediate or delayed.


Consider the following exchange:

Parent: Do you want some juice?

Child: Juice.


This is an example of immediate echolalia. You might want to say, let's get rid of it, the child is not answering the question, they are just repeating the last word they heard. But if you leave the content out, you can see that the child understands that question requires an answer. The child understands that a conversation involves back and forth. The child is using echolalia to follow the form of the question-and-answer type exchange. You can build on that strength to move a child forward to being able to answer questions. It will likely take learning core vocabulary and a lot of practice. It can be done using behavioral strategies of shaping and positive reinforcement of approximations to the correct answer, or it can be taught via modeling. If you get rid of the echolalia, you will lose an opportunity to use it as a bridge to more functional communication.


Often, echolalia is a strategy that helps a person understand what has been said. By repeating a part of it out loud and hearing it again, there is an additional processing opportunity and extra time that can help comprehension.


"Scripting" is an example of delayed echolalia. For a person who has trouble coming up with their own language, "scripting" can be a way to communicate more quickly while relying on "ready-made" phrases. Sometimes these are connected emotionally or situationally to what a person is trying to say. It can take some knowledge of the individual and their life to understand what scripted communication means.

"Scripting" can also be a way to stim and have no communicative purpose. In this case, the purpose is to self-regulate.