Stimming is a term commonly used to describe the “stereotypy” or “self-stimulatory behaviors” linked to autism. These behaviors can include repetitive activities, or stims, involving body movements, sounds, or the manipulation of objects. This is the point where the Hollywood renditions of stimming will most likely come to mind with the flapping, and screaming, and lining up toys, but there is so much more to it than that.
In looking at some of the physical attributes of stimming, it is important to note stimming is not the same as dyskinesia in that stimming serves a purpose while dyskinesia involves involuntary movements lacking in purpose. Tardive (slow onset) dyskinesia may be identified in some autistic patients who have experienced long-term use of various antipsychotic drugs.
While stimming is listed as a diagnostic cue for autism, the majority of the human population has probably indulged in a favorite stim on occasion, whether it was twirling their hair, drumming their fingers, popping their chewing gum, or sorting beads by size and color. It isn’t that uncommon, and it isn’t limited to those with an autism diagnosis.
It has been said that one of the biggest differences between autistic stimming and non-autistic stimming is that the latter is usually a little better at controlling their stims, or at least picking those that are more acceptable for “public use”.
It was only after reading multiple autism related articles that I recognized several of Lia’s (and a few of my own) repetitive behaviors for what they were. You can find a rather extensive list of behaviors that may be associated with stimming on The Stimming Checklist.
If you have ever stimmed, and you probably have, there’s a good chance you didn’t realize you were doing it until somebody pointed it out to you – because it annoyed them. You were probably trying, on a subconscious level, to block out some undesirable stimulus or to find focus. Perhaps you were seeking a distraction from your situation or environment, or maybe it just felt good to do whatever you were doing.
There are those who say they are actively aware of their stimming activities and choose to stim in order to refocus and realign their systems, or to shut out painful stimuli such as sounds that hurt their ears, or lights that feel like burning rods being jabbed into their eyeballs. Stimming fills a need for either adding to or detracting from the amount of stimulus that is presented for processing. It has even been described as a way of communicating emotions that can only be described with a stim.
While it appears most stims are fairly benign, for some, stimming can become an uncontrollable compulsion that may result in harm to self or others, warranting intervention to maintain safety.This is an area of great debate among the various members of the autism community. There are those who feel stimming is a form of self-expression and should not be restricted, while others are of the opinion that there is a time and a place for stimming, and some stimming behaviors are simply unacceptable. Most agree that safety is a governing factor that should always be considered in the stimming or not stimming debate. As healthcare professionals we are governed by a patient’s right to self-determination. While Lia isn’t technically able to make these decisions for herself, I try to allow her to have choices whenever possible, as long as it doesn’t cause harm.
If Lia wants to sit and swing her pom-pom, I don’t interfere. It has a calming effect on her, almost like someone who is trying to clear her head or think through something that’s troubling her. If she squats and starts to gently scratch her ankles, as if soothing an itch, I have not interfered so far, but I monitor her from a distance. This stim is usually pretty brief and she hasn’t broken her skin. If she decides to include others in her scratching stim – that’s a problem and it isn’t allowed.
Many of Lia’s stim-fests are times when she needs her space and solitude. But, on other occasions I have actually engaged in co-stimming with Lia. It all started with a little echolalia, and over time it has morphed into a special “game” shared by the two of us. In fact, it is one of my go-to distractions whenever I sense she’s hovering on the verge of a wilt or a meltdown. Engaging her in this game is the lifeline that pulls her back and helps her settle.
Echolalia is an automatic, almost parrot-like repetition of the vocalizations made by another person. I’ll address echolalia in a future post, but this particular instance involved one of my rather uniquely euphonic sneezes. I sneezed and she echoed it perfectly. The look of open-mouthed astonishment on my face sent her into a fit of laughter. A short while later, she “sneezed” again. I knew I could never duplicate that initial response for her, so this time I said, “Bless you!” and echoed her sneeze. After a brief consideration she decided that would suffice and fell backwards in another burst of laughter. We now have a list of sounds that we go through either in clusters, over and over for a time, or periodically throughout the course of my shift. I’m sure the two of us make for a curious little ensemble, but it makes her happy and that makes me happy.
Another co-stimming activity she enjoys is one where she slowly tears the pages from a coloring book (she likes this more than actually coloring them, so I don’t stop her). In this stim I am more of a quirky assistant. She tears the pages from the book and passes them to me where I am obliged, because of the aforementioned quirkiness, to stack them neatly in a pile. When she completes round one, she turns to me and says, “More please.” I pass her my neat little pile of pages and she slowly tears them into two pieces which she then passes to me. I stack them neatly in a pile. We keep the pages for her to tear the next time she wants to “color”. Thank goodness she isn’t a counter, because once the pieces are too-tiny-to-tear or to stack neatly, they vanish.
So, in the personal opinion of this professional caregiver, some stimming is not necessarily a bad thing, and can in fact be therapeutic. But, as with anything else in life, too much of a good thing can become detrimental. Fortunately for us, Lia has not exhibited any extreme compulsions for any one stim. When her stims are inappropriate, and there are a few, they are blocked immediately and without question. Our mantra: Keep Calm and Carry On
** This article by Temple Grandin, PhD was also used as a resource for this post.