What is stereotypy?
Stereotypy is defined in the research literature as “contextually inappropriate and repetitive operant motor movements maintained by automatic reinforcement”. In lay terms we are talking about behaviors that the person is able to control, that are repetitive, and that serve no functional purpose. Another important feature is that the person does stereotypy because he or she enjoys the sensation or stimulation they get when they do the stereotypy. This is why many people call stereotypy “stimming”. In fact, the terms stimming and stereotypy are almost interchangeable in the autism community.
What does stereotypy look like?
Stereotypy comes in many forms. The most common forms are hand flapping, shaking objects and repeating vocal sounds. However there are many more forms of stereotypy and these include opening and closing the mouth, facial grimacing, head tilting, head shaking, shoulder shrugging, body tensing, stamping feet, twirling objects, spinning, ear covering, staring at objects, side looking and vocal scripting.
Why do people with autism do stereotypy?
A very simple answer to that question is that people with autism do stereotypy just because they like doing it. But that answer always leaves people wondering why people with autism like doing stereotypy. Unfortunately, there is no simple explanation for why people with autism like doing stereotypy. My experience is that the people with autism who do a lot of stereotypy tend to lack appropriate leisure skills. In other words they do stereotypy because they are not able to entertain themselves in any other way. Additionally, stereotypy tends to interfere with learning. So there is this kind of cycle where stereotypy happens because the person does not have leisure skills, and the stereotypy prevents the person from learning new skills, which further contributes to the person not having leisure skills.
Should we treat stereotypy?
Absolutely! It is very important to make stereotypy go away, especially in younger people with autism. There are several reasons to eliminate stereotypy in people with autism. First, stereotypy interferes with skill acquisition. This means people who do a lot of stereotypy tend to make slower progress at school. People who engage in stereotypy often experience difficulties in the community and it is more challenging for them to interact with their peers. Another big reason to target stereotypy is that people who engage in a lot of stereotypy are at a much greater risk of developing other, more severe behaviors like self-injury and aggression. Stereotypy is also associated with higher levels of parenting stress and parents often rate stereotypy among the most difficult aspects of autism to deal with.
What are some ways to treat stereotypy?
There are several viable treatment procedures for stereotypy that have the support of scientific research. All of these interventions come from the field of Applied Behavior Analysis (ABA), and are considered evidence-based practices because their effects have been proven and reported in scientific studies. Generally speaking parents and clinicians should use only evidence-based practices when attempting to treat stereotypy and other maladaptive behaviors associated with autism. Additionally, these procedures are very technical in nature and require assessment and supervision from a skilled clinician, ideally a Board Certified Behavior Analyst (BCBA), in order to be properly carried out. These procedures are unlikely to work without the support of a skilled clinician.
Here is a list of procedures along with a brief description of each:
Differential Reinforcement of Other behavior (DRO): With DRO the person receives a preferred item or activity (i.e., a reinforcer) for intervals of not engaging in stereotypy. Initially the interval is very short so the person can easily receive the reinforcer, but the duration of the interval is systematically expanded based on the person’s progress.
Sensory Extinction: With sensory extinction the person is prevented from receiving the sensory reinforcer that is maintaining the stereotypy. This may involve blocking the behavior from occurring.
Environmental Enrichment: This is a procedure that involves providing the person with some other form of stimulation so that they no longer need the stimulation they receive from doing the stereotypy.
Leisure Skills Training: Leisure skills training is a long-term solution for stereotypy. The idea is to teach the person to do some appropriate behaviors instead of doing the stereotypy. Remember stereotypy is usually happening because the person has no other way of entertaining himself or herself. So by teaching leisure skills the person learns a new way of entertaining himself or herself. Puzzles, peg boards, building blocks, coloring, lacing cards, mosaic designs, picture activity schedules and even computer and video games are great skills to start with.
Article by Geoff DeBery, M.A., BCBA, Eden II Behavior Analyst