Stereotypy: What Is It and How Do You Address It?

Written by Emily Braff, M.A., BCaBA

Children with autism often exhibit repetitive actions or noises which serve no apparent purpose. These actions may include flapping hands, spinning in circles, waving hands or items in front of their eyes, rocking, and many more. Some children may also hum, yell, or repeat noises. These behaviors are generally called stereotypies (STER-ee-AW-tih-pees). Children engage in stereotypic behaviors in order to produce or decrease a certain sensory stimulation. For example, a child may move an object back and forth in front of his eyes because the visual stimulation is enjoyable. Alternatively, the child may rock with his eyes closed to block out some visual stimulus which is unpleasant or overwhelming.  Children and adults without autism may also exhibit these behaviors (twirling hair, tapping a pencil, humming a tune) but typically they do it with less frequency and intensity, so the behavior is not as noticeable or disruptive.

 Stereotypy can be very difficult to treat because the child usually cannot tell us why he or she is engaging in that specific behavior. A child may hum because he enjoys the feeling it produces in his lips and tongue or because he is trying to block out other noises. The key to treating stereotypies is to determine specifically why the child is engaging in the behavior and find an appropriate alternative behavior which either produces the same sensation or is more enjoyable than the target behavior. Some possible treatments for the previous example of humming include finding an item the child can wear on a necklace and place in or near his mouth which produces a similar sensation, chewing gum, and noise-cancelling headphones, depending on why he is engaging in the behavior.

Treating stereotypy generally entails making an educated guess as to why the child engages in the behavior and trying various replacement behaviors based on that hypothesis. All of our treatments should be based on measured behavior (for more information read The Importance of Measuring Behavior) so first you would take data on the number and/or duration of the occurrences of the behavior before any intervention is implemented. This way when treatment begins you can objectively determine if the behavior is decreasing significantly. After a week or two of this pre-intervention data collection, you would introduce the alternative behavior. When the child begins to engage in the stereotypy or is in a situation in which he typically engages in that behavior, instruct him to engage in the alternative behavior instead. Eventually, prompts to engage in the alternative behavior should be faded and the child should do so on his own. If there is no significant decrease in the stereotypy within a few weeks, a different alternative behavior should be introduced. This approach requires a great deal of trial and error as you must attempt to determine why the alternative behavior was ineffective and formulate a new plan accordingly.

One way to decrease the amount of guesswork involved in treating stereotypy is to conduct a small experiment with the behavior. Put the child in an environment in which he typically engages in the behavior but systematically change the situation to isolate which part of the behavior is producing the desired stimulation. For example, if the child usually spins in circles, try turning the lights on or off or even blindfolding him to see if he is responding to some visual stimulus. Also try observing him in various rooms to see if certain lighting, colors, or other visual stimuli impact the behavior. Then change various aspects of the child’s clothing, such as the tightness of the fit or the material, having shoes on or off, and even covering the child’s exposed skin such as face and hands. This may help determine if some aspect of the physical sensation of spinning such as the wind on skin or movement of clothing is enjoyable. If changing a certain aspect of the situation decreases the behavior, this will give you a better idea of which alternative behaviors might be most effective. It is important to note that if you just change the environment so the behavior no longer produces the desired stimulation (ex: requiring the child to wear gloves at all times to block tactile stimulation) then the child will likely find another behavior which produces the same effect. This behavior may be even less acceptable than the original so providing an appropriate alternative is generally advisable.

Finally, be aware of the other factors surrounding the behavior. If the child only engages in the behavior when asked to complete undesirable activities and does not have to complete the activity as a result (ex: child flaps hands in front of face so teacher cannot prompt him to hold pencil) then a behavior that looks like stereotypy may actually be maintained by access to escape or avoidance of non-preferred activities. This would be treated very differently (see previous blogs “Do You Know Your ABCs?” “Teaching Replacement Behaviors,” on problem behavior for more information on identifying functions and reducing inappropriate behavior). Also pay attention to factors such as time of day, sleep schedule, and signs of discomfort. A child may engage in stereotypic behaviors to reduce sensations associated with hunger or being tired or sick. If the behavior occurs consistently when one of these factors may be present, preventative steps may be taken or a medical issue may need to be addressed.

Stereotypies can be greatly disruptive to children and their families’ lives. These tips may help make life easier and more enjoyable for everybody.  If you have any helpful suggestions you'd like to add on how you've reduced your child's stereotypy, please share them in the comments below!