I am writing this blog in response to the father of a kiddo with autism who is disrupting the home and causing great stress by engaging in a constant verbal stim, but these techniques can be applied to all stimming. I have written this in a flash so please excuse any typos.
What is stimming? Stimming is a term heard often in the autism world and it refers to any behaviour that is self-stimulating for the person. Common ones are flapping, bouncing, swaying, wringing hands, eye tracking (running their eyes along lines in the room such as the windowsill), humming, grunting, squealing. People with autism sometimes engage in stimming because it feels amazing. Their sensory system may be oversensitive or under-sensitive; they may feel things more intensely than the average person and stims are quite simply intoxicating! Try to tell someone who is drunk or high to stop swaying around and they will tell you “bugger off, I feel great!” The stim may also be “filling in the gaps” for the person with a high sensory threshold, meaning they need a lot of input into their sensory organs in order to feel stimulated. So they create this themselves by moving or making noise to “feed” the sensory system. Alternatively, if there is too much input coming into the system, they may stim in order to “drown out” this overwhelming amount of sensory information. Stims may also be coping mechanisms for anxiety. If you don’t expect yourself to stop biting your nails or eating a whole block of chocolate when you feel crap, then don’t expect them to stop stimming!
To Stim or Not to Stim? That is the Question! Stimming should not be banned. This is the worst possible thing you can do. It will only increase the anxiety that the child with autism feels. Temple Grandin says that she was allowed to stim for one hour in the afternoon after her therapy sessions but no other time during the day and this worked great for her.
You can reduce the time they engage in it and place boundaries VERY SLOWLY. If they are doing this for hours, only reduce a couple of minutes at a time. Put boundaries on when and where and then use replacement behaviours for when the anxiety or excitement comes and they are not in the place you have set boundaries around. This requires a decision about the BEST INTERESTS OF THE CHILD. Note the shouty capitals because this idea is vital, it cannot be shaped by your own feelings of embarrassment. If you realise it is your own embarrassment that is creeping in, please watch this vid and learn some techniques to cope with those thoughts, and allow your kiddo to be who they are!
However, for anxiety responses we do want to reduce the stim by controlling their environment better. When do they tend to stim more? Who is around? What are the setting conditions? (No sleep that night, high allergies, no good food that day, etc). Map when, who, where to figure out why and how to control their environment better.
Back to the best interests of the child. This may include the social repercussions of their stimming behaviours. If your child is very conscious of wanting friends we may want to put social boundaries around the stim. We can go two ways here, educate his or her peers – this is often the best choice! But you cannot do this for every person that comes into contact with your child over their life (I am thinking really long-term here – work mates and such!) Another empowering tool for your child would be to teach them to use this stimming behaviour as a release and a reward for coping with a big day at school, after coming home from the supermarket, after therapy time, etc. They can look forward to it in the same way we look forward to our after work routines (imagine if your work mates saw you get home after work, blast the music up and prance around your lounge room while your hubby kicks his shoes off and farts loudly as he walks through the door – these are behaviours you may have held in through the day and have looked forward to once it was appropriate – I’m not judging you ;)). It is a great lesson to teach your kiddo appropriate behaviours in appropriate places based on how those behaviours impact others. So in the case of the verbal stims, these often impact others in a big way. It is not harmful for your kiddo to learn this responsibility for other people’s feelings, it is a good thing!
If your kiddo has a visual schedule you can put the flash card for stimming next to all of the activities they are allowed to stim during. This will teach them when and where they can do it. It might be next to a few different activities and you can point to the activity you are doing and say “oops” if they are stimming when you don’t want them to, then you can place a red cross over the stim flash card and place it next to the activity you are currently doing. That was long-winded! Let me know if you want more instruction with any of this…
You must first give them a replacement behaviour and reinforce the use of this. NEVER TAKE A STIM AWAY BEFORE THE PERSON HAS OTHER COPING SKILLS TO FALL BACK ON AND THE TRIGGERS IN THEIR ENVIRONMENT HAVE BEEN CONTROLLED. The replacement behaviour needs to serve the same function as the stim .e.g. if it is for anxiety you may need to use a breathing technique or a muscle relaxation technique, if it is a verbal stim for sensory input you will need to make use of face and throat muscles, if it is an excitement response you may need to find something else pleasurable. If it is a verbal stim I would get help from an Occupational Therapist to design some face exercises to replace the verbal stim. Usually the excitement responses can be explained to others and don’t need to be replaced. You can eventually teach them to control the urge to engage in the stim by teaching them to engage in small amounts of time doing the replacement behaviour. I would set it up using an ABA program easily implemented at home:
- Teach the replacement behaviour when the child is calm and NOT stimming
- Role model the behaviour first e.g. show them how to put their hand on their belly and take a breath in so their belly fills up, show them that they can take a breath in through their nose and out through their mouth and that they can make a quiet noise to do this
- Prompt them to do the behaviour when they have watched you enough to understand. Say “do this”, show them the behaviour and expect them to copy
- If they copy the behaviour, reinforce using something very highly desirable such as a small natural lolly or a toy they can play with. Repeat the instruction a number of times!
- If they don’t do the behaviour say “oops” and repeat the instruction. You MUST FOLLOW THEIR RESPONSE WITH SOME KIND OF CONSEQUENCE IMMEDIATELTY EVERY TIME (a no response is a wrong response and must be followed with an oops). Don’t repeat the instruction without giving either an “oops” or a reward, for instance you don’t want to say “do this”…no response… “do this”… you want to say “do this”…no response…”oops, do this.”
- Again say “do this” and reinforce immediately, repeat until you feel they are confident in using the behaviour. Check by asking someone else to prompt the behaviour and see if they also use the behaviour with others and can generalise it to other places
- Remember to utilise visual support, when you say “do this” and model the behaviour, also point to a flash card with a picture representing the replacement behaviour (this is usually best if it is a photo of them doing the behaviour themselves!)
- Eventually you will be able to fade your role modelling and simply point to the flash card for them to try the behaviour
- Keep reinforcing
10. Once they perform the behaviour with confidence slowly start to replace the stim when appropriate
11. When they are in a safe environment and are engaging in the stim, prompt the new behaviour by using a FIRST-THEN card. Place the flash card of their replacement behavious on the FIRST side and next to it the stim photo on the THEN side. Point to each as you say “first breathe, then hum” (you could use a visual support here like a timer so they know how long they have until they can stim again.) At the beginning, reinforce the tiniest attempts at doing the replacement behaviour and then allow them to go straight back to the stimming, Gradually increase the amount of time they do the replacement behaviour between the stim until you are redirecting the child away from the stimming and no longer using the FIRST-THEN cards. So take the THEN part off the visual support. Only show the replacement behaviour flash card and then redirect them to another activity after they do the replacement behaviour. Start very small with only a few seconds of replacement behaviour then back to the stim, then a few seconds more the next time, and so on
12. THIS WILL NOT SUCCEED UNLESS THE REPLACEMENT BEHAVIOUR HAS BEEN SO WELL REINFORCED THAT WHEN THEY SEE THE FLASH CARD THEY ARE HIGHLY MOTIVATED TO PERFORM THE BEHAVIOUR. If they know that every time they do the replacement behaviour they get their favourite lolly they will be more likely to do it even when they are stimming. Eventually you can fade the reward out. If you have paired verbal praise with the reward, eventually they will respond just to the verbal praise and an irregular reward every few responses
As well as an ABA method of teaching I would enlist Positive Behaviour Strategies and reduce the need for the stim. If they are stimming due to sensory overload for instance, take the time to remove the environmental triggers. You may need to figure out what is it about the environment that they stim in.
I would do a Social Story™ to explain the boundaries. You can use the following example as a template.
I love to hum! (ADD IN WHAT NOISE THEY MAKE…scream, sing, grunt, etc)
Humming makes me feel great!
Humming feels awesome in my throat.
When I hum I feel calm.
My parents are proud of me when I feel calm.
Sometimes when I hum, my family feels annoyed.
When I hum, my family can’t concentrate and this makes them frustrated.
They can’t talk to each other if I am too loud. My family love to talk to each other!
They can’t watch TV if I am too loud.
(ADD IN SPECIFIC ISSUES HERE…)
My family loves when I hum but not all the time.
(NOW SET UP THE BOUNDARIES FOR HUMMING…)
I can hum when I am in my room by myself.
I can hum when we are driving in the car. Humming in the car makes me feel calm.
When I get home from school I get one hour when I can hum loudly. Dad will show me a timer and he will warn me when I have 5 minutes left, and when I have 1 minute left to hum.
Instead of humming I can (ADD IN WHAT BEHAVIOURS YOU WOULD LIKE TO SEE INSTEAD…squeeze my face up tight and relax it. I can do this again and again and again. I can stretch my mouth up wide, as wide as it can go, then I can squeeze it shut really tight. I can do this again and again and again. I can tap my tongue on my teeth very quietly 100 times. I can squeeze up my fists so my whole arms are tight and then I can let them go floppy. I can do belly breaths, I breathe in through my nose and out through my mouth and I can do this with a quiet noise if I want.)
I can hum when the orange star is on my visual schedule
I grunt and squeal when I feel angry.
This makes everyone feel angry.
I can grunt and squeal in my bedroom by myself.
If I feel angry I can….
Use this document (including reward chart and Social Story™) Inside Voice and Verbal Stimming Control to create some visual supports that suit your situation. To use this document you would need to do the verbal stim yourself while you point at the colour that it represents on the visual guide until they know what colour/picture means what noise.
My last piece of advice is to engage in the stimming behaviour with your child! Yes you read that right. They are constantly being told that their behaviour isn’t right and they need to change. Show them you can engage with them on their level and you love them just the way they are by sharing in this special behaviour. When I worked as an ABA therapist with a beautiful non-verbal 4 year old, part of the program was to eradicate his stimming. This was tough going and never really worked. In fact it made him more distressed. Instead, I decided to put boundaries around the behaviour. In some ABA programs you will have a cycle of a few minutes of “work” followed by a few minutes of play. I taught my little buddy that when we were “working” we weren’t stimming but when we were playing if he felt like stimming I would join in with him. This was liberating for us both. His stim was a bouncing, spinning, flapping, head shaking combination of epically enjoyable movement. I didn’t mind getting involved in the behaviour one bit! But it wasn’t “right” socially. It’s a tough choice. Either way, your kiddo will benefit from your care no matter which way you choose to go.
Stay insanely sane,