"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:
lining up/piling up toys
stimming (self-stimulatory behaviors)
need for sameness
adherence to routines
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.
Self-stimulatory behaviors, often referred to as "stims," can involve movements, vocalizations, as well as mental processes. "Stims" can serve the following many functions:
•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
•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
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?
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.
Need for Sameness and Adherence to Routines
Repeating the same experiences and following the same routines are functionally close to organizing and controlling the world through piling up toys and playing repetitively. If your experiences are the same every time, you are never faced with not having skills to manage a new, unexpected problem. If you always eat the same food for breakfast, cooked in precisely the same way, you are sure to enjoy your meal. You are not going to need to deal with unpleasant tastes, textures, or smells. Familiarity can be soothing. It also reduces the demand load for using skills that might not be automatic, and in this way it conserves energy. Creating predictability is a way to stay regulated and in control.
These are very deep, focused, intense, and specific interests that autistic individuals often pursue. They can change over time or remain the same. I like the way Barry Prizant calls them "enthusiams." Special interests serve a dizzying variety of useful functions:
- Self-regulation strategy
- A coping strategy, for example, for anxiety
- Deeply satisfying and enjoyable, a source of positive emotions
- Source of a positive self-image, expertise, self-confidence, control
- Finding social connections via common interests, finding "your people"
- Can be a gateway to a vocational choice
- Can be a way to accomplish goals
- Increased sense of well-being
- Increased life satisfaction in the areas of connectedness and leisure
- Interest and knowledge
- Engagement and flow
- Prestige (status in one’s one social circle) and achievement
To sum up, "restricted, repetitive behaviors" in autism serve a function. The same behavior can serve different functions depending on the circumstances. The main point is, these behaviors are not useless. They cannot be evaluated based on neurotypical norms. Even if some of them are "annoying" or "distracting" to neurotypical individuals, it is important to recognize that they are meeting a valid need. That the behavior is not "typical" does not mean that it has no right to exist. If you take it away, the autistic person's well-being will suffer.
We need to shift our perspective from reducing these behaviors to making the environment more friendly for autistic individuals and increasing the options autistic individuals have to get their needs met. For example, if an autistic individual stims to self-regulate due to the environment being overwhelmingly noisy, we can reduce the noise. We can also teach the person to recognize the problem and communicate, "It's too loud here, I need to leave."
Repetitive and restricted behaviors do not need to be pathologized. They have many useful functions. They can also communicate the challenges the individual is experiencing and give clues as to the skills the person could use. We need to understand and respect these behaviors in the context of what they represent for autistic individuals.
Credit: Section on stimming is partially based on this article by Karen Wang