“Omg, he’s so weird!” Becky said to her friend Lane. They were watching Tommy across the school playground. He was walking on his tiptoes, and flapping his arms as he crossed the hard court to his group.
One of the teachers, Mr Gordon, gave them a sharp look. “Girls”, he said sternly, “Be nice”. It broke his heart to hear the other kids talk about Tommy.
He knew the struggle he carried, and even though he seemed like he was in his own little world sometimes, Gordon knew these comments penetrated more often than anyone cared to admit. Tommy was autistic, and stereotypy and autism go hand and hand, he wished people would take the time to understand.
Many parents know this struggle well. We see our children engaging with the world on their own terms. We see the world’s reaction to them and sometimes it hurts.
Today I want to talk about stereotypy. You may be asking yourself, “what the heck is stereotypy?” Let’s find out together.
What is stereotypy in autism?
According to Webster’s Dictionary, the definition of stereotypy is: frequent repetition of the same, typically purposeless movement, gesture, posture, or vocal sounds or utterances
Stereotypy is directly linked to autism spectrum disorders and is included in the third criteria of the diagnostic and statistical manual (DSM-5) for autism diagnosis. The word is often mistaken for the word stereotype, especially since stereotypic behaviors are often considered a stereotype of autism spectrum disorder. However, as the definition above reveals, they are two different words with two different meanings.
People with autism are not the only ones who may engage in stereotypic behaviors. People who are neurotypical, people with mental disorders, and people with other conditions may also use them.
In a study, Allison B. Cunningham and Laura Schreibman stated that: “Stereotypic behaviors are not isolated to autism. They are common to individuals with other sensory, intellectual, or developmental disabilities. For example, research indicates that a large majority of individuals with mental retardation exhibit stereotypies.
“However, in comparison to individuals with mental retardation, those with autism tend to display more varied topographies, along with increased severity and overall occurrence (Bodfish, Symons, Parker, & Lewis, 2000). Stereotypies also occur in typical individuals from infancy through adulthood.
“Some examples of stereotypic behavior in typical adults include tapping feet, nail biting, smoking, organizing, playing sports, and watching TV. Alternatively, stereotypies in typical infants and toddlers often resemble behaviors seen in individuals with autism across the lifespan.” (Smith & Van Houten, 1996)
The wording in the definition “purposeless movement” is a bit misleading. Studies have shown that, while it may not serve an outwardly functioning purpose such as washing dishes, stereotypic behaviors do serve an internal purpose: self-stimulation, and regulation.
Are there different kinds of stereotypy?
There are different kinds of stereotypy: motor and vocal.
- motor stereotypies – Motor stereotypies are repetitive, rhythmic, often bilateral movements with a fixed pattern (e.g. hand flapping, waving, or rotating) and regular frequency that can usually be stopped by distraction (e.g., calling one’s name) (Harris et al., 2008)
- vocal stereotypies –Vocal stereotypy was defined as any instance of non contextual or nonfunctional speech and included singing, babbling, repetitive grunts, squeals, and phrases unrelated to the present situation. Examples include “ee, ee, ee, ee” outside the context of a vocal imitation task and laughter in the absence of a humorous event. (William H Ahearn, Kathy M Clark, and Rebecca P.F MacDonald)
What are some examples of stereotypic behaviors?
In the same study we learn that “some forms involve stereotyped and repetitive motor mannerisms or use of language”.
What do stereotyped movements look like in people with autism?
Many children with autism spectrum disorders display repetitive behaviors. “Common examples of stereotypy are hand flapping, body rocking, toe walking, spinning objects, sniffing, immediate and delayed echolalia, and running objects across one’s peripheral vision” (Schreibman, Heyser, & Stahmer, 1999).
Others can be:
- rearranging objects
- pulling hair
- scratching themselves
- blinking repetitively
- staring at rotating objects
- focussing on lights
- licking or rubbing certain objects
These, and others, can be off putting to the people around them if done in an inappropriate way, place, or time.
Is stereotyping the same as stimming?
The relationship between stereotyping and stimming is that stimming is a form of stereotyped behavior. A child engaging in repetitive behaviors such as hand flapping, spinning in circles, body rocking, and walking on tiptoes, is typically referred to as stimming.
Other examples of stereotyping that are not considered stimming can include arranging objects in a line, insistence on sameness, repeating phrases, and other behavior.
The difference between stereotypy and tics?
Though tics are repetitive behaviors, their causes and function are different from stereotypy. Tics are motions of particular muscles, often in the face. They are often done unconsciously, until the person is able to control them.
What are some social consequences of stereotypic behavior?
“Stereotypies in autism are distinguished by their lack of developmental and social appropriateness.” (Allison B. Cunningham and Laura Schreibman). This means that in autism, stereotypic behavior is done at times and/or places that are socially unacceptable, frowned upon, or seen as “abnormal”. This can have an impact on the way a person with autism is treated, or accepted within society.
Here are some social consequences that can take place as a result of stereotypic behavior:
- teasing
- bullying
- lack of self esteem
- withdrawing from others
- avoidance of social events
- staying in their “own world”
- self injurious behavior
- anxiety
- depression
These are just a few, and because of the reasons why someone with autism spectrum disorder engages in stereotyped behaviors, it can be a vicious circle. So, how can we help our children with autism spectrum disorders and stereotyped patterns engage with people and places more comfortably?
How do you handle stereotypic behaviors?
The functional analysis of stereotypic behaviors has led to a better understanding of stereotypy. Knowing what is behind each behavior clues us in to how to help kids manage it.
Finding the root cause and effect
In an article titled Assessing and Treating Vocal Stereotypy in Children with Autism we learn that: “One approach to developing treatment for automatically reinforced behavior has been to attempt to isolate the specific source of stimulation that maintains such responding. It has long been thought that identifying a specific source of stimulation that maintains a behavior can be translated into establishing other means of accessing similar sensory stimulation that can then be used to reduce undesirable behavior.”
The above studies have shown that when there is a decrease in sensory input, there is a decrease in stereotypic behavior. These behaviors are directly tied to sensory stimulation and task demands. In other words, when children with autism engage in certain activities, their response to stimuli is increased.
Sensory consequences
The sensory input component of stereotypy can be a tough one. Controlling the circumstances for our kid, especially outside the home, is difficult. However, whenever possible, we can curate their experiences.
Sensory diets, modified activities for holidays, choosing more conducive times for visiting public places, the use of noise canceling headphones, providing a predetermined getaway, and giving more choices can all be ways to help our kids.
Applied behavior analysis
Historically, applied behavior analysis (ABA therapy) was employed to help children fit into society better through behavioral interventions designed to reduce their stereotypic behavior. Behavioral interventions that seek to use automatically reinforced behavior use repetitive behaviors as a reward for control at other times. Differential reinforcing properties seek to praise the child for using more appropriate behavior in order to teach new coping techniques.
This helps the individual gain more control over their repetitive behaviors, thus increasing their use at more appropriate times. However, new methods include addressing stereotypy in society, normalizing it, and helping children with autism be more understood and accepted regardless.
The study Stereotypy in Autism: The Importance of Function concluded: “Although traditionally considered to operate under sensory and automatic reinforcement contingencies, research has clarified that repetitive and stereotyped behaviors may also be maintained by social or non-social positive and negative reinforcement. It is important that interventions be applied in line with this evidence.”
Applied behavior analysis therapy is one therapy that may help children with autism spectrum disorder manage their symptoms. Though it has a controversial history, new and updated methods increase the likelihood of receiving appropriate help.
Mental health considerations
Children with autism may also benefit from the services of a mental health professional if they are struggling with the social consequences unleashed on them by others. If their mental health is compromised by other socially impacted issues such as:
- their sexuality
- comorbid conditions,
- differences in sense of humor
- medical complications
- anger
- depression
- Anxiety
- Rejection sensitive dysphoria
Each one of these can be addressed in therapy. Compounding factors increase the possibility of adverse effects on their health. It is important for them to know that they are accepted and loved and that they are able to learn healthy ways to express themselves and connect with others.
Summary
More research is needed to better understand, treat, and accept stereotypy. The more we understand the more we can help.
As parents, we need to be able to tackle the main issues, as well as the compounding issues in our kids’ lives. This can be overwhelming, but there is hope and help available.
Letting your child know that they are loved, accepted, and valued is key. You know your child best. If you feel that they could be helped in any way, reach out to their pediatrician, they can refer you to therapists and other resources as needed.
Lastly, please know that you are not alone. You don’t have to hide your child away. For each child diagnosed with autism there are caregivers representing that child who know and understand the rewards and challenges that come with it. You’ve got this!
References
Péter, Z., Oliphant, M. E., & Fernandez, T. V. (2017). Motor Stereotypies: A Pathophysiological Review. Frontiers in neuroscience, 11, 171. https://doi.org/10.3389/fnins.2017.00171
Cunningham, A. B., & Schreibman, L. (2008). Stereotypy in Autism: The Importance of Function. Research in autism spectrum disorders, 2(3), 469–479. https://doi.org/10.1016/j.rasd.2007.09.006
Hung D. W. (1978). Using self-stimulation as reinforcement for autistic children. Journal of autism and childhood schizophrenia, 8(3), 355–366. https://doi.org/10.1007/BF01539637
Ahearn, W. H., Clark, K. M., MacDonald, R. P., & Chung, B. I. (2007). Assessing and treating vocal stereotypy in children with autism. Journal of applied behavior analysis, 40(2), 263–275. https://doi.org/10.1901/jaba.2007.30-06
