Autistic ‘Stimming’ Behaviour

According to DSM-5 TR (APA 2022), one of the diagnostic criteria (B1) for Autism Spectrum Disorder is stereotyped or repetitive motor movements such as hand flapping and finger flicking and repetitive use of objects such as spinning coins or lining up objects. The clinical and academic term for such behaviour is Restricted and Repetitive Behaviours (RRB). However, the popular term can be ‘stims’ or ‘stimming’, a shortened form of self-stimulatory behaviour.

The term stimming was first used in the United States in the late 1960s to describe behaviours that were due to an autistic person who had very limited speech living on a ward in a government institution with spartan furniture, almost no recreational facilities and staff who were not trained in supporting autistic patients. The response of a non-speaking autistic person to under-stimulation was to provide stimulation by engaging in actions such as hand flapping, jumping, rocking, toe walking, pacing, spinning, and tapping objects. The rationale was that ‘stimming’ provided stimulation to the mind and body in a deprived environment. An alternative rationale was that stimming was a protective response to overstimulation in an unpredictable environment and a means of blocking experiences and achieving sameness.

In the past stimming was often seen as an aberrant behaviour that needed to be eliminated by autism treatments such as Applied Behaviour Analysis (ABA).Autistic individuals who camouflage their autism may deliberately suppress stimming so as not to appear different to others. However, stimming or RRB may have adaptive qualities that need to be recognised.

It is also important to understand that stimming is not limited to non-speaking autistic individuals and occurs across the autism spectrum. It serves multiple functions, including communication for those with limited speech, blocking sensory and social experiences, providing extreme pleasure, reducing stress and anxiety, and creating a mind and body-connection.

Communicating thoughts and feelings

Non-speaking autistic children and adults can communicate their thoughts and feelings using body language. Autistic mannerisms have a message. There are signature movements that parents and experienced professionals translate, for example, a happy hand flap, which means ‘I am enjoying the experience’, and an agitated hand flap, which means ‘I don’t know what to do’. The difference is in terms of ‘tone’ or ‘energy’. When very excited and exuberant, there can be an autistic ‘dance’, a sequence of movements that express pure pleasure.

Specific movements can also mean' leave me alone' or' please help me'. We ask parents to create a ‘foreign phrase’ dictionary explaining the meaning of the mannerism and make a video recording of the mannerism so that others will know what they mean and respond appropriately. A speech pathologist may identify and encourage a conventional gesture, such as a hand ‘brushing away,’ as an alternative action that means leave me alone that is more easily understood.

Blocking social and sensory experiences

When overwhelmed by sensory and social experiences, a non-speaking autistic child or adult may use repetitive actions to ‘block’ such events. Temple Grandin did not speak until she was three and a half years old. In her autobiography, she explained her coping strategy for sensory and social experiences as a young child.

“Intensely preoccupied with the movement of the spinning coin or lid, I saw nothing or heard nothing. People around me were transparent, and no sound intruded on my fixation. It was as if I was deaf. Even a sudden loud noise didn’t startle me from my world. But when I was in the world of people, I was extremely sensitive to noise” Grandin and Scariano 1986.

The repetitive action of spinning a coin or lid is considered an expression of stimming. This behaviour reduced her auditory and visual sensitivity and the effects of social intrusion on her enjoyment of solitude.

The ‘stim’ or RRB prevents overload and a potential meltdown. When such actions occur, they are an indication of the need for environmental rather than behavioural modification.

A pleasurable experience

Some repetitive actions or ‘stims’ seem to be maintained by intrinsic sensory pleasure. Autism is associated with sensory sensitivity, and many sensory experiences are aversive. However, some sensory experiences are fascinating and totally engaging. This can include enjoying and being mesmerised by symmetry and regularity, such as the sleepers on a railway track or a picket fence. There may be many pleasurable sensory experiences, such as being on a swing, bouncing on a trampoline, enjoying the wind on the face from a fan, flickering light through moving fingers, twirling a blade of grass and seeing a favourite colour such as bright yellow.

There can be intense enjoyment in predictability, as described in the quote by Sean Barron:

"I loved repetition. Every time I turned on a light, I knew what would happen. When I flipped the switch, the light went on. It gave me a wonderful sense of security because it was exactly the same each time." Barron and Barron 2002.

Parents and professionals may be concerned about a lack of self-control over the behaviour and apprehension about whether it could become an addiction and whether to interrupt the behaviour.

We recommend that there are times in the day when the autistic child can engage in and enjoy repetitive actions without interruption—a form of ‘free play’. The actions may not be acceptable in certain situations, such as at a meal table, but they are allowed in others, such as in the bedroom or garden, or when they have completed a task and are free to engage in a pleasurable experience. Temple Grandin explained that as a young child, one of her ways of coping with autism was that, at times, she was free to be autistic without correction. These are happy childhood memories for her.

Reducing stress and anxiety

Due to many factors, autistic individuals of all ability levels experience considerable stress and anxiety in their daily lives. Repetitive actions can be soothing and release stress. Non-speaking autistic children and adults may engage in whole-body movements, such as standing and swaying to the left and right or bending forward and backwards. It is as if their body was a huge metronome. We have noticed that the rhythm can be around 60 beats per minute and could be a way of synchronising and reducing heart rate when stressed or anxious. Some repetitive behaviours include being on a swing, bouncing on a trampoline or rocking on a rocking horse, again at a rhythm of around 60 beats per minute.

A recent study explored the function of repetitive behaviours in 12 verbally fluent autistic adults (Collis et al., 2022). Several themes were identified, including providing a distraction from anxious and depressive thoughts, maintaining attention, staving off boredom and regulating the build-up of emotional pressure and pent-up energy. We have found that repetitive action can be used as a ‘barometer’ to measure stress pressure.

The research participants reported being reprimanded or bullied in childhood for repetitive behaviour or ‘stims’ and having to develop their own methods of self-policing. They also found that resisting the behaviour increased stress levels and was difficult to achieve.

A study by Charlton et al. (2021) was based on an analysis of the results of an online survey of autistic adults. The study confirmed that ‘stims’ support self-regulation for emotional and cognitive functioning. They can be a means of emotional release, as in the quotes of the research participants:

• Stuck energy can flow out of me instead of stay in me and cause pain.
• To relieve a build-up of feelings before I get overwhelmed.
• I find it comforting and relaxing.

Being told not to stim at home or work meant changing, substituting, or suppressing stims for social acceptance. This was effortful and led to frustration with having coping mechanisms that you cannot use. There were comments such as Feeling caged, restrained, and trapped.

A participant in the Collins et al. (2022) study explained how he was reprimanded by his manager for repetitively taking apart a pen and said:

I didn’t really stop, but I didn’t take it apart. I just had it in my hands.

We recognise the value of RRB in reducing stress and anxiety and suggest that the autistic person explains why the behaviour is such a valuable coping mechanism to encourage acceptance or moderate the behaviour as a compromise.

Creating a mind/body connection

Some non-speaking autistic individuals have considerable difficulty initiating specific actions. There seems to be a mind and body disconnection. There is intent to make the movement, but the autistic person is ‘frozen’ due to a movement disturbance rather than the ‘freezing’ that can occur due to extreme anxiety. A mannerism or stim can be used to gain mental control of movement, a behavioural bridging action that functions as a mind/body connection. This can be observed in situations such as wanting to use a round door handle and moving the arm towards the handle but not being able to form the hand shape to use the handle. Quick motor mannerisms, such as flapping the hand, may facilitate initiating and completing the movement to open the door.

Conclusion

Stimming is associated with autism and can be misunderstood in our community. In the past, such actions were perceived as aberrant behaviour. We now know that stimming is a constructive coping mechanism, and we need to encourage acceptance, not correction and further explore the positive effects of RRB or ‘stims’ on mental health and everyday functioning.

Where to from here?

We recommend our online course Understanding and Supporting Non-speaking Autism. The course will equip participants with an understanding of life as experienced by a non-speaking autistic person, the reasons for specific behavioural and emotional reactions and the creation of an individualised plan to enhance the quality of life and well-being.

Participants in the course will learn practical strategies to encourage speech, the value of alternative and augmentative communication systems, how to acquire new abilities and coping mechanisms for accommodating changes in routines and expectations, sensory sensitivity, and social engagement, and how to express and regulate intense emotions constructively.

References

A.P.A. (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR (Fifth edition, text revision). American Psychiatric Association Publishing.

Barron and Barron (2002) There’s a Boy in Here: Emerging from the Bonds of Autism Arlington, Texas. Future Horizons.

Charlton et al. (2021) Research in ASD, 89, 101864

Collis et al. (2022) Research in ASD, 90, 101895

Grandin, T. and Scariano, M. (1986). Emergence: Labelled Autistic. Novato, California: Arena Press.