Repetitive Behaviors: When and How to Intervene
Repetitive behaviors are very common among many neurodiverse individuals, and they often vary in the way they appear from person to person. These behaviors may include restricted interests, self-injurious behavior (SIB), strict routines, and stereotypical behaviors. Stereotypical behaviors include motor movements such as flapping hands, finger/hand movements (with or without an object) jumping up and down rocking, or repetitive vocalizations (McLaughlin & Fleury, 2020). In fact, neurodiverse individuals have such a high level of repetitive or stereotypic behaviors that it has become one of the signs that a professional might look for when diagnosing someone with a neurodiverse condition. As such, it is important to understand what causes these behaviors, how they can fit into an individual’s life, and if we need to intervene at all.
Behaviors Have Functions
Professionals and caregivers alike have attempted to reduce repetitive stereotypic behaviors for years. There has been a good amount of success by using scientifically proven behavior analysis. But what exactly is the cause of these behaviors? It is important to note that when we talk about this topic, as a behavior analyst/parent, we should start looking for the purpose that the individual is getting out of the behavior. For the most part, stereotypic or repetitive behaviors appear to be maintained by a nonsocial or self-stimulating component (Wang and colleagues, 2020). It is common for individuals with ASD to selfstimulate in order to help with the sensory processing of their environment. Understanding that these behaviors serve a purpose, how should caretakers and therapists approach this nuanced topic?
Positive behavior supports, a set of researched-based techniques for managing behaviors, teaches us to use applied behavior analytic techniques called antecedent strategies. Antecedent strategies are simply modifying an environment to reduce unwanted behaviors. When going to a restaurant with a young child, often waiters will give you a menu and hand you crayons and a coloring book. The restaurant is changing the environment, so while the child waits for the food or if they finish first, they have something to do (e.g., instead of throwing a tantrum or crying). That was an antecedent because it is something you do in advance to reduce a behavior that you know is likely to happen in the current environment. Baby proofing a house lowers the likelihood of a child opening the toilet and falling in or even drinking the toilet water. Antecedent strategies are everywhere, and we do them all the time. They take thought and preparation, but they pay off.
In the professional field of behavior analysis, the best practice is to identify and work to improve behaviors that are of social importance and will improve the quality of life of the individual and their families. An example would be self-injurious behaviors (SIB) such as a repetitive movement of the chin touching the clavicle, which can break the skin and become infected and very painful. We suggest that such SIB repetitive behaviors must be addressed. If you are a caregiver and are noticing SIB, seek professional support for reduction or replacement of those behaviors as soon as you can.
Stereotypic behaviors: Should we “Treat” Them or Not?
There are some other repetitive stereotypic behaviors such as making loud noises and fast flapping that can be socially stigmatizing, interfere with learning, or disrupt attention to other social cues that are important for daily living skills or routine activities. On the other hand, such behaviors may have some benefits to the individual and are part of who they are intrinsically. Many neurodiverse individuals that are able to more easily state their thoughts on the matter are communicating that these behaviors bring a level of soothing comfort in a world that, for them, is overwhelming. So, does “treating” those behaviors interfere with their coping skills?
Some groups largely composed of neurodiverse individuals are advocating that we should not target repetitive stereotypic behavior based solely on social components. These groups mention that many people cannot advocate for themselves. They state that targeting stereotypic behavior diminishes the rights of neurodiverse individuals. From their perspective, why would anyone choose to change something that is not hurting the individual or anyone else, when in fact it is society that needs to change? By targeting loud noises, for example, we may be allowing our world to continue to look at neurodiversity as unacceptable. One of the goals of their movement is to encourage the world to grow into acceptance and approval of our ever-growing diverse population.
It could be said that most repetitive stereotypic behaviors fall outside of the norm of today’s standard of “appropriate” when it comes to social behaviors. In a perfect world, we all would not only accept the individual but would embrace the beauty in their diverse behaviors and accept everyone for who they are. Our world is not that socially advanced. When deciding whether or not to target certain behaviors, we also must consider the social ramifications that come with not fitting the status quo. For example, could the individual be targeted for bullying or exploitation? And how can we target the bullying or exploitation instead?
Looking at both arguments will help us all, caregivers and professionals included, to be more aware and respectful when making decisions on what interventions and behaviors to target in therapy or in the home. We need to really consider the purposes of our actions and to make responsible decisions, making sure to ask the “why” behind choosing to treat such behaviors, and incorporating the input of our children as much as possible.
Perhaps you are on the fence about what to do. One solution is to teach when and where it is appropriate to use repetitive behaviors. The classroom might not be the right place to make loud, repetitive noises, but we can teach that before class or in recess they can feel free to scream. The public bus might not be the right place to play aloud the same verse of a song over and over, but we can teach the habit of wearing headphones*. This would allow an individual to experience a comforting ride on a public bus without getting scolded by strangers for listening to a favorite song.
If you find yourself stuck deciding one way or the other, remember that you know your child/dependent best. Only you truly know your circumstances, and as long as you are honoring their individuality and helping them become happier and more independent, then you are on the right path. Give yourself grace because you’re doing your best. Allow some time to enjoy your child for who they are; not every moment has to be a teaching moment or a socially appropriate moment. Together we will continue to nurture them, and hopefully one day not so far in the future, others can see the same beauty we do in their transparent, gentle souls.
*Note to parents: if your child/dependent has trouble wearing headphones, there are tolerance techniques that can be applied to aid your child in adjusting to this new experience.
About Author Holly Downs
Holly is the Director of Ethical Compliance at [PBS Corp] (https://www.teampbs.com/). and an instructor at Capella University. She is a certified behavior analyst with over a decade of experience in various populations
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This post originally appeared on our May/June 2023 Magazine