Sunday, October 11, 2009

#21 How do you deal with stims?

For those who don't know, stimming (short for self-stimulation) is a repetitive behavior that absorbs a child's attention. These behaviors are extremely diverse, ranging from self-injurious head banging, to staring at fans, to reciting movie lines over and over, to playing with trains at eye level for hours on end. All sorts of odd behaviors crop up in children on the autism spectrum, some more alarming than others.

Stimming behaviors may rise from the person's need to distract him/herself from unpleasant things in the environment or sensory inputs he/she can't handle. Think of Dustin Hoffman's character in Rain Man: he would start reciting the "Who's on First" skit whenever things got stressful for him. Lots of children on the high-functioning end of the spectrum can learn to control their stims while at school, but when they come home, they need to decompress with some stimming. Stimming may also be an obsessive-compulsive behavior...something the brain simply demands the person do for no good reason.

Because so little is understood about WHY people with autism stim, so-called experts in the autism community disagree on what to do about stimming. Obviously, self-injurious stimming (running hands under scalding water, head banging, picking) must be extinguished for safety and health, but what about more benign stimming? Should all stim behaviors be extinguished? Should stimming be allowed as a reward for good work? How forcefully should stimming be extinguished? It's confusing and stressful for parents to have conflicting advice. But without knowing the "why" of stimming, how can experts confidently give good advice? I'm baffled.

Jack has recently been singing a lot at school when he doesn't want to work. His repertoire of songs has grown over the's not just Blue's Clues anymore. But it's not appropriate at all in a classroom environment or on the bus to break out in random songs. Kids are going to pick on him, plus he's distracting to others.

At home, the stimming has changed a bit. He sings randomly and blurts out movie lines at the dinner table, for instance. This morning, however, he was eating an apple fritter (a fall treat for our family), and said, "This is the life!" It's a movie line, but used totally appropriately and intentionally.

He also makes annoying repetitive noises while playing with his cars and trains. But the noises he makes are becoming more varied and unpredictable, more like normal little boy noises, and often, they are JUST LIKE regular little boy behavior, especially when he includes his brother in his play, which happens more and more. This reminds me the line between abnormal and perfectly normal behavior can be quite hard to draw.

It also gives me hope that Jack's overall stimming is heading in the right direction.

Jack's noises are hardly difficult to deal with. Annoying, yes. But not difficult. Jack's diagnosis, PDD-NOS, is a form of autism that generally shows less perseverative behaviors than full-blown autism, which can involve downright alarming stims. In our case, we chose not to deal harshly or absolutely with extinguishing stims. We allow Jack to have a "decompression" time when he gets off the bus because he needs it. Trying to engage him in conversation is difficult at the best of times, and downright impossible when he gets off the bus.

I have no idea if this is the right thing to do, but it feels right to us. For some reason, Jack needs these behaviors, and if we can work on extinguishing them in certain situations (I discourage inappropriate movie lines in public and at the dinner table, for instance), we can hopefully move him in the right direction without being cruel. We ALL do things to calm ourselves and deal with stress; we usually do them in private and appropriately, or we engage in public activities (yoga class, dining out with friends) that serve the same purpose.

Guiding Jack toward more appropriate stimming has been slow, but we're making progress. Perhaps if we'd used ABA training, he would have made progress faster. But is faster better with benign stims? I simply don't know.

What stims do you see in your child/patients/students and how do you deal with them?


Carrie Wehmeyer said...

I think you are on the right track. How many adults have you seen in classes or meetings engaging in some repetitive behavior in order to achieve praxis. I believe even gum chewing fits into this category. We let our kids enjoy their stims unless they are physically harmful or just too darn annoying. Spencer loves to groom stuffies and Penny likes to sing. Those are fine. We do not let Spencer indulge in peeling paint and eating it, nor do we allow Penny to bark like my parents' dog.

tinamarie said...

Tony is 13 and he still stims at times. At school he plays with and eraser or even his fingers. He can do this for a long time to. Trying to get him to stop and draw his sttention elsewhere is very difficult when he is stimming and ususally makes him go into a meltdown.
At home he will go in his room and play with a hotwheel car. He has had an attachment to hotwheel since he was very small. The other day I went into his room to ask him something and he had them all lined up again in a perfect chain and he would take 1 car out and then 'parkp it and take another one out. He has always done this with them. He does have a hotwheel on him whereever he goes in his pocket.
Whenhe is nervous or bothered he will pull it out and play with it no matter where we are.

Sharon (Stitches on Mars) said...

We were at a shopping centre one day and i was letting Liam run up and down the aisles (repeatedly). I remember saying to his older (by 19 years)brother Simon that I wouldn't have let him do that, but Liam needs to whereas you didn't. I think letting a this stim occur in a safe environment was important to Liam at the time....preventing him would have stressed him out and as long as i picked a safe place and kept an eye on it what harm was it causing. Liam still needs to run occasionally, but not as much. Occasionally he twirls or repeats certain "words". He also calms down a lot if he can have a little something to hold on (sometimes he keeps it in his pocket).
If things get too much for him he shuts down (sometimes sleeps) kinder its in the home corner for example. After which he is fine again.
Throwing things we've obviously had to stop, but there are still times when we allow it and he knows when we will let him (usually at home) and he also knows to throw down and not at someone. Also we restrict (as best we can what items he is allowed to even this is improving) and we have few problems. To stop him completely could be detrimental.
We all do some of these types of things...I fiddle with things and doodle...just because I don't have autism doesn't make it any better. Once I doodled on Mum's doona (she wasn't happy), but no-one thought it abnormal.
I think we just have to follow our instincts.

Canadian Kristin said...

Our son (PDD-NOS, anxiety, OCD) does some hand flapping "I'm FLYYYinnggg" when he's getting excited, but his usual stim is thumbsucking. This is a lovely quiet stim and preferable as far is some of the other stims that have come and gone with him. His other usual stim is to stare at his Lego magazine or Thomas catalogue (hooray for freebies!) until he feels regulated. I don't mind the stims so long as they aren't self-harming. I'm a nail biter and a leg shaker... he who is blameless of stimming, cast the first stone. Though I do worry about transitioning him away from thumbsucking as he is soon 5 and eventually 15.

FibreJunky said...

My husband does something with his hand and fingers that would probably be considered a stim - but it had never occurred to me to think of it in that manner before. Both of our sons have Asperger's Syndrome, but neither were diagnosed early. I wish they both had been.