The Cause of Stimming: What’s your stim?

Stimming

Everyone has a stim

I play with my hair while chatting with a friend.

Maybe you bite your nails when you’re nervous or bored.

You may tap your fingers or pencil on a desk while you’re thinking.

I once knew someone who chewed on sticks of cinnamon bark, and I’ve noticed some who move their eyes in an unusual way.

I can recognize certain people from far away just by their distinctive movements.  We all know someone who has an annoying stim like cracking their knuckles every 5 minutes or repeating a phrase over and over; or a socially unacceptable stim such as nose-picking or biting oneself.

The Definition of Stim

The word stim is short for self-stimulation.  It is associated with several conditions such as deafblindness and intellectual disability, but most commonly with autism.  My son’s neurologist calls it “autistic stereopathy.”  It is also sometimes called “stereotypy.”

The DSM-5 includes stimming as part of the diagnostic criteria for Autism Spectrum Disorder: “Stereotyped or repetitive speech, motor movements, or use of objects…symptoms together limit and impair everyday functioning.”  That right there is the difference between autistic stimming and typical stimming: when the stimming interferes with everyday activities and prevents learning, it is often a symptom of autism.

The Wrong Question

The right question to ask for stimming“How do I stop the stim?”  That’s usually the first question parents ask when a young child discovers stimming.  But it’s the wrong question.

First of all, no one can stop self-stimulatory behavior completely, because everyone does it anyway!  Secondly, even if one stim can be removed, it will be replaced by another — and the next stim may be less preferable that the current one.

The most important reason not to eradicate stimming is that you may cause your loved one to withdraw more and more, and lose your opportunity to encourage healthy interactions.

The Right Question

“Why does my child engage in this behavior?”  Seeking to understand the motivation for a behavior is always a great place to start.  There are several hypotheses and known causes for stimming:

1. Overstimulation
stimming can help block out excess sensory input.

2. Understimulation
stimming helps provide extra sensory input when needed.

3. Pain reduction
repeated banging of the head or body actually reduces the overall sensation of pain.  One hypothesis is that stimming causes the release of beta-endorphins in the body, which then causes a feeling of anesthesia or pleasure.

4. Management of emotions
both positive and negative emotions may trigger a burst of stimming.  We’ve all seen physical reactions to joy or excitement, such as jumping or hand-flapping.  Frustration or anger may intensify a stim to the point that it becomes destructive.

5. Self-regulation
Some stims serve the purpose of soothing or comforting.  Many infants learn to suck their thumbs to relax themselves.

I recently read a blog in which a parent asked why her son covered his ears in his sleep.  He had learned to cover his ears when his environment was too noisy, and that was soothing to him.  So he started covering his ears whenever he needed to comfort himself, especially when falling asleep.

Reasons To Reduce Stimming

Self-stimulation can interfere with learning, interpersonal relationships and social situations.  Some types of self-stimulation are self-harming and may lead to infections or require surgical repair.

Self-stimulation may also be a symptom of an ongoing medical problem such as migraines which a person with a disability may be unable to verbalize.

How To Reduce Stimming

Here are some ideas for increasing relationship skills while reducing time spent stimming:

Sensory or Ear infection1.  Get a medical exam to eliminate the possibility of physical causes for stims, such as ear infections, chronic pain, migraines and retinal detachment.

2. Manage the sensory environment and emotional environment to maximize personal comfort.

3. Vigorous exercise reduces the need to stim, probably because exercise is associated with beta-endorphins just like stimming.

4. Continue interacting while stimming occurs.  In his book Communicating Partners, author James MacDonald suggests that individuals with autism tend to perceive the world through sensation and action, while most neurotypicals perceive through thought and language.

Once this difference is understood, self-stimulatory behaviors make sense. MacDonald recommends turn-taking activities to engage a child without trying to stop stimming during the activity; the activity will gradually become increasingly comfortable and attractive, naturally reducing the stim.

5. Create a positive association between stimming and relationship-building.  One way to use stimming as a productive part of the learning process is to allow stimming as a reinforcer or reward after a period of playful interaction or work.

Julia Moor writes in her book Playing, Laughing and Learning With Children On The Autism Spectrum that making time for stimming will allow the child the comfort of being himself, encourage more interactions and actually reduce the total number of hours per day spent stimming.

6. Join the stim!  Some treatment programs, including Son-Rise and Floortime, propose joining in the self-stimulatory behaviors as a way to initiate interaction.  If a person is spinning plates, then start spinning plates.  If a person is rocking back and forth, then rock back and forth right next to the person.

My son’s preferred stim is to hold up his hand and talk to it, as if looking in a mirror. He thinks it’s hilarious when I do that with him!

Dr. Stanley Greenspan

Dr. Stanley Greenspan

Stanley Greenspan, author of Engaging Autism and developer of the Floortime method, explains, “Some children become intrigued – they now have a partner in crime, so to speak – and we get some shared attention and relating.

..so join in the child’s activity to create a relationship, and then begin to use gestures so the child, in order to get what she wants, has to gesture purposefully back to you and maybe begin using some words…

the overall principle is to offer the child experiences that produce the same sort of sensations as the self-stimulatory activity but lead up the developmental ladder of regulation, engagement, and interaction.

To work on regulation, start off with basic sensory experiences.  In this first stage, begin with the sensation but try to vary it, to expand the child’s world of sensory input.”  In other words, to reduce the stimming, offer a replacement that is more alluring than the stim!

What’s your stim?  I know you have one.  Please share in the comments below, and explain how your stim helps you in everyday life.

Karen Wang

Written on 2012/03/22 by:

Karen Wang

Karen Wang is a Friendship Circle parent. You may have seen her sneaking into the volunteer lounge for ice cream or being pushed into the cheese pit by laughing children. She is a contributing author to the anthology "My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities"
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  • Lsooner2

    I have a 9yr old son with Down syndrome who stims with a lanyard, he twirls it very methodically and if you take it away he just replaces it with socks, gloves or dish towels. The school is concerned that this is interfering with school work. I liked the ideas you presented today in the blog and have share it with his teachers and therapists. Hopefully, we can use your suggestions to eventually replace this behavior with a more suitable one.

  • Cindy Brandon

    I loved your article I posted part of it on my blog with the link to complete article. Wildworldofautism.blogpot.com. I love your blog. Thank you!!

  • Inbal Levin

    Hi Karen. This article was really exciting to read because I work with a little girl who has autism using the Son Rise approach. I’ve been involved with it for about a year now and I am loving every second. My favorite part of the program is to join in with the stims. There are videos of me trying to stop the girls from stimming, and I am not getting a response. Then there is a great video of me joinign in with her and she immeidately stops the stim and gives me this adorable hug! I love the Son Rise program and definitely recommend their technique to deal with stims. 
    Thanks for posting Karen! 

  • Mary

    This is an EXCELLENT post! 

    Seeking to understand the motivation for a behavior IS always a great place to start! And asking the question “What’s your stim?” helps us grown-ups realize that we’ve all developed self-stimulation habits. Our family and friends might be able to name them more comprehensively than we can! 

    Once in a “teaching self regulation skills” training I was doing for teachers, a colleague pointed out all sorts of things I do without even realizing it. (I laughed – just as your son does, when my behaviors were modeled back to me). 

    Full disclosure, I push my bangs back repeatedly with an open palm, tap fingers on the table like I’m playing the piano, and touch my fingertips together. 

    Your final paragraph is it in a nutshell:
    ‘To work on regulation, start off with basic sensory experiences.  In this first stage, begin with the sensation but try to vary it, to expand the child’s world of sensory input.”  In other words, to reduce the stimming, offer a replacement that is more alluring than the stim!’

    This takes time, and patience. But you’ll be giving your child a precious gift. 
    Thanks for the GREAT post!

  • http://abamisleading.blogspot.com/ Neil Samuels

     “The DSM-5 includes
    stimming as part of the diagnostic criteria for Autism Spectrum
    Disorder: “Stereotyped or repetitive speech, motor movements, or use of
    objects…symptoms together limit and impair everyday functioning.”  That
    right there is the difference between autistic stimming and typical
    stimming: when the stimming
    interferes with everyday activities and
    prevents learning, it is often a symptom of autism.”

    I am a Developmental therapist in early intervention and private practice using a DIR floortime based approach . The last sentence is the above paragraph is only partially correct.  I have seen many children where perseverative (i.e., stimming behaviors) can appear and is often mistakenly part of a diagnosis of ASD while in fact it is mostly a part of the child’s (or older) sensory processing disorder, that is, affect-sensory processing challenges over responsive,under responsive or mixed responsivities in one or more areas (e.g.,  tactile, auditory, proprioceptive, vestibular, visual-spatial, olfactory). This has been under review by the  DSM-V committee as separate diagnostic category, which should be considered as separate from ASD. However, at this present time, it is my understanding that the committee is only considering one part of SPD, “over-responsivity” which is arguably, perhaps, the most common).  It would be much more accurate to consider  SPD as a whole  and as a separate self-contained disorder  category and not just as another criterion in ASD diagnosis.  Unfortunately, at this time it is not likely.

    My point is, I have seen Many children over the years who appear “autistic” but in fact  have typical or above age  cognitive and social-emotional functioning as well as strongly intact receptive and expressive language language skills with some pragmatic based challenges.  The foregoing areas are adversely affected by SPD challenges, which unfortunately thereby, often results in either a mistaken diagnosis of ASD, or more egregious and common a mistaken severity of diagnosis, e.g., moderate to very moderate ASD while in fact the functional-emotional developmental challenges the child (or older) has is very mild but it is the affect sensory motor processing challenges that make it appear far worse than actually is!

    • Taz

      I have a daughter with DS who is turning 6, she stims not stop!! usually with socks and leaves and twirls them between her first 2 fingers constantly, she gets mesmorised and very angry and upset when I take it away, it has caused us great uspet as it interferes with her play and social interaction.  She doesn’t do this at school a lot, but at home all the time.  We try and interact and give her other thigns to do but it is exhausting as we cannot do it all the time.  I am going to try and do some of these recommendations.

      • http://www.linkedin.com/pub/neil-samuels/2b/14a/4ba Neil Samuels

        The focus should be not on attempting to redirect her “behaviors” but to allow you to participate in her activity, for example, with the socks and leaves. One suggestion, perhaps at moments initiate the activity. For example: Take socks and leaves of your own and twirl them similar to her depending upon her reaction (e.g., looking at you, smiling, bemused), ask her if she want it on her fingers, which  finger?  Which hand? This leaf or that leaf over there? (in her visible sight but stuck beneath the couch, so then you have to further deepen the back and forth dynamic interaction, help her reach, get it with her, etc.).

        The point is two way back and forth varied engagement within this single activity (“behavior”) will then (can) evolve and deepen into a multiple nuanced engagement with lots of rich facial and bodily gesturing and communication (e.g., back and forth conversation depending upon where she is developmentally). The perseverating with “leaves and socks”, etc. are merely incidental!. They are the tools that (can) form (once you are co-creating with her) a larger meaningful back and forth communication/engagement dynamic. On one level the current perseveration (repetitive behavior) is most probably serving to give her a certain tactile input and help self-soothe/calm her. However, once you are able to respect (“not redirect”) and participate with her.. then you can take the lead and begin to add more affective suggestive variations (by doing), which then, in turn, becomes part of a larger and more integrated “conversation.”

  • http://profile.yahoo.com/NIFLGA2DVO6KDJNYMY3DPHKBQE Dayna

    My 6 yr old son has Ds and SPD and his stim is to take 2 toys and move them back and forth while making a kind of humming noise. The challenge is when he does it for more than a short while he gets rowdy and loud. I’ve even noticed his pupils becoming dilated and his strabismus which is usually not noticeable becomes more pronounced.
    I think the reason he stims is understimulation. 
    When I see him start I try to distract him with a puzzle or game but sometimes it is very hard to redirect his focus and I’m not always able to stop (feeding the baby, driving, cooking dinner….) and play with him.
    This article has been helpful and I would love any further advice. 
    Thanks! Dayna   [email protected]

    • http://www.facebook.com/profile.php?id=1556774338 Karen Wang

      If his pupils are becoming dilated, you should discuss this with a pediatric neurologist.  Pupil dilation may be a precursor to seizures.  The neurologist will probably prescribe an EEG.

      If understimulation is a concern, consider giving him something like a boom box or a toy that he can take apart, teach him how to load his favorite CD into the boom box or how to build/take apart the toy.  A hand-held vibrating massager is also great for tactile sensory input in cases of understimulation – he can switch it on and off.

  • MicheleManhire

    My son, Aaron, is 7 1/2, and has Down syndrome.  His stims are ‘waggling’ any object he can get ahold of which meets his criteria to hold in his hand and waggle around; and bumping on the bed with his hips (‘humping’) at bedtime.  Once we realized he really needed this behavior to self-regulate, it helped.  Aaron is not allowed to waggle all day at school, where he is in a contained classroom with teachers, aides, and others to keep him engaged and distracted.  But by the time he hits the bus, and then gets home, he’s consumed with the need to have something in his hand to waggle.  Being the parents of two other younger children also, there’s not always the opportunity to ‘keep him otherwise engaged’, and he’s granted more time than we wish to continue this behavior.  We’ve been assured he doesn’t have ASD; so perhaps his serious cognitive delays are the contributing factor. 

    All I know is that this article has shed more light onto this issue for me than the last 4 years of asking consistently various professionals about it.  THANK YOU!!!