Is it better to let a child with autism flap his hands or should you stop it?– Jane
This a good question an one I’ve been asked many times about as an occupational therapist because many people consider it to be “self-stimming” and “sensory” in nature. This is possible, but as with any behavior, I use hand-flapping as a cue to help me understand the internal state of the child, which is important information to consider when determining if or how the behavior can be stopped or when deciding if it should be stopped.
The medical term for hand-flapping that occurs with any regular frequency is “motor stereotypie” and is defined by the Johns Hopkins Medicine website as : “Primary motor stereotypies (also called stereotypic movement disorders), are rhythmic, repetitive, fixed, predictable, purposeful, but purposeless movements that occur in children who are otherwise developing normally. Examples of primary motor stereotypies are flapping and waving of the arms, hand-flapping, head nodding and rocking back and forth.” In typically developing children a motor stereotypie is considered primary (physiological), and when there is a known neurological disorder such as autism, it is called a secondary motor stereotypie.
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Additional information about motor stereotypies such as hand-flapping can be found here.
It is important to recognize that an underlying cause of hand-flapping in both typically developing children and in children with autism can be a heightened emotional state. When emotions run high, it impacts a child’s nervous system, and it may be escalating in positive and/or negative ways. A heightened state of arousal can indicate emotions of excitement, happiness, anticipation, and joy but it can also indicate anxiety, frustration, and overwhelm.
Playing detective to determine whether the child’s state is positive or negative at the time of hand-flapping may help you decide about whether you want to intervene to stop it or not. Be aware, however, that even if you or others want to stop the hand-flapping behavior, research shows varying levels of success with either behavioral or habit changing interventions or with medicine. Another common hypothesis is that hand-flapping is a way for children to regulate their visual sensory input. Children may do this to avoid other types of input, to keep themselves feeling calm and/or paying attention. Always keep in mind, hand-flapping should never be defined as “bad behavior.”
Some things to observe when the hand-flapping occurs that may help you determine the cause of it are:
- Who is around the child?
- What is the child doing?
- Where is the child/what is the environment?
- Is the child exposed to or experiencing known sensory triggers (sights, sounds, smells, movement, all of the above)?
- What are the demands being placed on the child at the time (transitions, homework, eating, social/play skills, language)?
- Is this a new scenario or a familiar one for the child?
By noticing the above factors, you may begin to notice patterns for when the hand-flapping occurs and thus be able to come up with ways to preemptively decrease how often it occurs without even addressing the behavior with the child. You may also gain information to share with those who seem bothered by the behavior. For example, “He’s flapping his hands because he seems happy to see you.” or “When he flaps his hands, he is frustrated so it may be time to give him a break.”
Some behaviors while not harmful as is often the case with hand-flapping might make others feel uncomfortable, others don’t know what to think or do when the behavior occurs, or others fear the child may be ostracized because they don’t “look normal.” These examples may or may not offer insight as to how you respond to those who want the behavior changed. It may be more about them than it is about the child, or they want to be helpful but don’t know if help is needed or how to help.
Once you see patterns and can determine if the hand-flapping is indicative of positive or negative emotion, you can determine if the hand-flapping serves a purpose of self-calming or not. Trying to eliminate a self-calming behavior without other effective means of self-calming, is unlikely to provide a positive lasting change in the hand-flapping. Building positive emotional states, building overall self-regulation skills, and avoiding negative triggers for escalation, are more likely to prove helpful.
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If the hand-flapping is indicative of positive emotion and you still feel it’s impacting the child socially, consider the developmental skills and age of the child and based on these factors, decide whether you think they have the capacity to make a change or desire a change for themselves. You may then use that motivation to assist you in teaching the child long term to self-monitor the hand-flapping behavior. Occupational therapists, speech therapists, and applied behavior analysts and behavior technicians can be helpful professionals in working with you to address hand-flapping.
The last thing I always want people to remember is that if you choose to address it or attempt to change it, be realistic with your expectations and be clear on your reason for wanting to change the behavior. As with any behavior, the more attention you give to the hand-flapping, the more likely you are to reinforce it. Additionally, research shows that hand-flapping is likely a result of how the nervous system is functioning, thus expecting it to change simply by pointing it out to the child or addressing the behavior directly in the moment is not likely to result in a decrease or lasting change.
This article was featured in Issue 87 – Building ASD Awareness and Communication