“Stimming” is a term used to describe a type of repetitive behavior, and it is often pronounced in children and adolescents with autism. The word “stimming” itself stands for self-stimulatory behavior (SSB). However, it’s not confined to those with an autism diagnosis —everyone has a stim. What does self-stimulatory behavior mean? Classically, stimming involves repetitive body movements or vocalizations.
There are “common” stims and what are classified as “other” stims. While everyone has a stim as you’ll find out below, SSBs may be much more pronounced in those with autism. Common textbook stims include hand flapping and rocking back and forth, but there are many others. Behaviorally, you may want to eliminate or decrease your child’s stimming as an unwanted occurrence, but is decreasing the stim harmful or helpful to your child’s well-being? Stimming is a common behavior that is addressed in applied behavior analysis (ABA). Through collaboration with your child and family, your ABA therapists can assist in supporting your child in engaging with their environment without eliminating behaviors that are reassuring, comforting, or preferred by them.
What Is ABA Therapy?
For those unfamiliar with applied behavior analysis, it is a dedicated study of the science of learning and behavior. ABA clinicians work in the home, in the clinic, and in the community to meet the specific needs of each child. An ABA clinician, commonly a board-certified behavior analyst (BCBA), will draw up an individualized plan to help decrease unwanted behaviors and behaviors that disrupt learning and growth.
A goal of ABA therapy is to increase behaviors that are helpful and promote learning. One of the main strategies used in ABA therapy is positive reinforcement. For example, an ABA clinician will introduce a new skill, and the child will be rewarded for repeating the more positive skill. Over time, ABA has shown to be a very effective therapy for reducing unwanted behaviors and replacing them with new skill sets. However, where does stimming fall under the umbrella of unwanted behaviors, and how should it be addressed? First, a more comprehensive look at stimming itself.
More About Stimming: Types of Stims
Self-stimulatory behaviors are repetitive body movements, with or without objects, that occur as a form of stimulation to the body. Everyone stims, even though you may or may not notice it. Think about people who tap their fingers on a surface while thinking or play with their hair when they’re anxious in a situation. Some more examples of “common” stims include:
- Tapping a pencil
- Cracking your knuckles
- Tapping your foot
- Biting your nails
Why do we engage in these behaviors? Because they are soothing in certain situations. You may hum or whistle when you’re in a good mood, you may tap your foot when you’re impatient during a work meeting, or you may bite your nails when preparing for a job interview. “Other” stimming occurs in those with autism, so while the stims may appear different, the underlying reasons are often the same—to express happiness, to soothe when anxious, etc.
Other stims can be more pronounced and more noticeable; however, it is important to keep in mind that a common stim does not necessarily mean a child has autism. Many children self-soothe with SSBs, especially when younger. Some atypical stims can include:
- Walking on tiptoes
- Hand flapping
- Rocking back and forth
- Repeated jumping
- Covering your ears in a noisy place
- Atypical vocalizations (e.g., Eee-EEee-Eeee)
- “Smelling” a stranger
- Spinning or twirling
- Chewing on non-edible things
In a child with autism, an ABA clinician will determine the function of the behavior (stimming). In ABA, stimming is most often maintained by automatic reinforcement. In essence, this means the behavior feels good or alleviates an internal feeling in the person demonstrating the behavior.
There are also different types of atypical stims. Some examples are:
- Auditory – consistently repeating a phrase or favorite line from a TV show
- Olfactory (smell) – smelling other people
- Vestibular – spinning and twirling
- Taste – licking objects or putting non-edible items in one’s mouth
- Tactile – repeatedly touching a certain surface or item
- Visual – looking out of the corners of the eyes
Stims occur for many different reasons and across a variety of situations and environments. Your ABA therapists will assist in identifying times, situations, and environments in which your child’s stimming may be impacting their ability to engage in daily activities.
Why Does Stimming Occur?
Stims most often occur for sensory stimulation: adding to or relieving an internal sensation. Sensory stims happen because the stim provides a type of sensory stimulation. For example, walking on the tip toes provides a certain sensation in the legs, while the sensation of rocking back and forth may simply feel good.
There are also “medical” reasons. If a child with autism is sensitive to noise, they may hum or cover their ears in certain situations that are overwhelming. Children that chew on inanimate objects may be trying to relieve a toothache. This is why it’s always important to find the reason for the behavior of the stim.
Stims can also occur to help a child to escape or avoid the current environment or self-soothe within an aversive environment. If there’s something they want to block out in the moment, repeating words or phrases may help to block out other conversations or interactions. Looking out of the corners of the eyes can be self-soothing if something stressful is happening.
Stimming also helps communicate emotions. If a child is happy, they may be communicating their happiness with a stim. This could look like hand flapping if a favorite TV show is coming on, but it could also appear like unusual vocalizations. Unusual vocalizations may also be used if a child is feeling upset or overwhelmed. Putting the hands over the ears can also communicate this.
In a 2016 article published in The Mighty by Melissa McGlensey, adolescents and adults relate and share their experiences about stimming. One person wrote, “Sometimes the sensory input gets too much, and I feel like I might explode. Stimming releases the tension.” However, autism manifests differently in every individual, and others describe stimming differently. Another person said, “Stimming is like turning down the radio when you think you smell something burning. It’s a way of turning off the other senses so you can make sure nothing’s burning.” Yet another person speaks about the comfort of stimming: “It’s a comforting thing to do. Neurotypical people probably understand and do similar things, but the difference is that autism stims feel more necessary, and trying to stop them causes unpleasantness for us. It makes me feel uncomfortable when [it] cannot be done.”
Should Stimming Be Controlled?
Stimming falls under the umbrella of “repetitive behaviors,” which is part of the DSM-V diagnostic criteria for diagnosing autism. While repetitive behaviors are not unique to autism (obsessive-compulsive disorder (OCD) is another example), they are one of the first early signs of autism in a developing toddler. Unlike neurotypical children who may occasionally stim in childhood, repetitive behaviors in those with autism can exist beyond adolescence and into adulthood. They are also much more pronounced and noticeable.
There are two types of repetitive behaviors: lower-order and higher-order. Stimming is a part of lower-order repetitive behaviors, such as hand flapping, rocking back and forth, and unusual or repetitive vocalizations. Higher-order repetitive behaviors in those with autism can look like an insistence on routine, ritualistic behavior, and intense interests.
As a parent, your first instinct may be to try to stop the stim, considering it an unwanted behavior. Sometimes stimming can be unsafe, such as chewing on an inanimate object or jumping on the bed. But before you react, there are a few things to consider regarding the stim. First, try to understand why it is happening. Is your child happy or upset? Are you in a crowded place that may be overwhelming? Is their favorite show coming on? It’s important to remember that stimming is a behavior, and there is a reason for every behavior.
Next, a key question to ask is, is the stimming interfering with their ability to learn and interact and is it safe or unsafe? Also, does your child have a skill set (such as those taught by an ABA clinician) that they can use in place of the stim?
Negatively reinforcing stimming or trying to “stop the stim” can result in a more undesired behavior or stim. Keep in mind that stimming is often involuntary, and your child will need an alternative means to fulfill their sensory needs. For example, trying to address jumping in the living room by trying to stop the behavior could result in jumping in an unsafe location. Stimming helps manage emotions by providing sensory input. Underneath the stim, your child may be trying to effectively deal with emotions such as anxiety, fear, and anger, but they also may be dealing with emotions such as excitement or joy.
Your BCBA and ABA care team can work with your child to help manage stimming. There are interventions that can help your child with issues such as anxiety, and help them to manage and communicate their emotions. In general, the goal is not to eliminate stimming unless the stimming is causing physical harm to your child such as eye poking or skin picking.
When Stimming Is Self-Injurious
Toe walking, twirling, and unusual vocalizations typically aren’t harmful. However, some children may exhibit self-injurious stims, which require more intensive management. Self-injurious stims may include:
- Hitting oneself
- Hand biting
- Excessive scratching (or rubbing) of self
- Excessive nail biting
Not only are these stims self-injurious, but they can be alarming to others. Depending on the situation, this could cause ostracization, which in turn can lead to more harmful stims. The goal with self-injurious stims, just as with other stims, is not to eliminate the stim, but to replace it with one that is not harmful to oneself or others.
Your ABA clinician may also want to concentrate on stims that are not self-injurious but are harmful in other ways. This can include stimming that is disruptive at school or in similar settings, stims that cause ostracization or social isolation, ones that interfere with learning, and stimming that interferes with other members of the family. All interventions are decided on as a team including you and your child; if the behavior isn’t a concern to your family, it wouldn’t be socially significant to treatment at that time.
Parents can help implement simple interventions when it comes to some stims. For example, if a situation is overly stimulating to your child, you may want to remove them from the situation. On the other hand, if your child is under-stimulated and is looking for more stimulation, you can do simple things, such as turning on background music, offering a wide variety of textures in toys and books, or adding outside playtime with equipment such as trampolines or swings.
Stimming can also stem from anxiety. If you know your child has trouble transitioning or adapting to new situations, you can adequately prepare them beforehand with tools such as social stories. Your ABA clinician can help you come up with interventions across a variety of stims your child may engage in.
For example, if your child is “scripting” (repeating lines from a TV show, movie, song, etc.), some alternatives may be talking about the child’s interest (what they’re scripting), scripting along with them, or engaging in a back-and-forth conversation about the interest. Other types of vocal stereotypy (stimming), such as high-pitched sounds or irregular pitch, may be relieved by singing or listening to music or movies.
There are many reasons that hand flapping might occur—in many cases, it may occur when your child is happiest. But, there are replacement options for hand flapping as well. Skill sets such as squeezing a stress ball, having a fidget toy, engaging in fine motor activities, or placing hands in pockets can be taught as replacements for hand flapping if deemed socially significant by you and your child.
A child who is spinning in circles may be looking for extra stimulation. In this case, your ABA clinician may suggest interventions such as swinging, playing Ring Around the Rosy, dancing and movement, or other exercises such as jumping on a trampoline or riding a bike.
Interventions may also include incompatible behaviors; this means that your child can’t possibly stim (spinning in circles) while they are on a swing. Exercising is also an intervention for tip-toe walking—it’s impossible to be on the tip toes while riding a bike, for example.
Incompatible behaviors can work with many types of stims. First, ask yourself why your child might be stimming, and focus on the part of the body they’re utilizing. Once identified, offer other activities which engage the same type of physical activity to determine if your child prefers the alternatives. Showing preference can be a way of identifying alternatives to socially significant stimming behavior.
There may be some occurrences where you can’t answer the “why” question. This is a good time to turn to your ABA care team for guidance and for interventions, but there are things you can do in the meantime if you can’t answer “why.”
Always respect the behavior. From here, you may want to engage in the behavior with your child, depending on what it is, introduce a similar behavior that may not be as disruptive, or redirect to an incompatible behavior. As you sit in on ABA sessions and participate in ABA parent training, you’ll see your BCBA and registered behavior technician (RBT) in action with different interventions and redirection methods. Remember to always ask questions so you can repeat the same methods when the care team is not there. ABA works best when it’s consistent, and it doesn’t end when your clinician leaves the sessions. This is part of why it’s so important for parents to become engaged in their child’s sessions for consistency across the board.
Always, always talk to your care team about any stimming that is self-injurious or could potentially be so.