This is a summary of a presentation by Tony Attwood, Ph.D., from Brisbane, Australia. Dr. Attwood described the developmental sequence followed by typical children. Children with autism spectrum disorder follow the same developmental sequence, but in an exaggerated fashion. For example, children with autism spectrum disorder may collect the same type of objects as other children, but to a point of excess. Another example is the intense need for symmetry, or for information on a certain subject. These exaggerated behaviors are identified as a restricted repertoire of activities and interests.
Many individuals with autism spectrum disorder engage in simple, repetitive actions such as rocking or spinning objects. What to do about repetitive actions depends on the reason the individual is performing the activity or the function of the behavior. The following are possible reasons for repetitive actions and programming ideas specific to these reasons.
Reason: Exploration for sensation.
Programming: Try to find a more acceptable alternative, and provide a variety of sensory activities which fulfill the same sensory needs. Divert the person's attention to some other activity.
Reason: The desire to screen out excessive stimulation. The individual may be hypersensitive or have a disturbance in perception of sound, vision, touch, taste, or smell.
Programming: Use ear plugs, blue tack in the ears, sunglasses, or a visor to help the individual filter stimuli. Change the environment. Desensitize the person to the sensation. Screen out the distressing sensation, perhaps by listening to music on a walkman. Teach the individual to relax and calm down when the input level is high.
Reason: Enjoyment of a sensation, such as rocking.
Programming: Try to find a more acceptable alternative, and provide a variety of sensory activities which appeal to the same sense. Divert the person's attention to some other activity. Negotiate with the person when and where such actions are acceptable.
Reason: The need for life to be predictable and secure. These individuals need to create order out of chaos.
Programming: Make a portable visual schedule for the person. Changing environments may allow you to stop an elaborate routine that is interfering with programming. Try to stop the sequence of behaviors from beginning. Encourage tolerance for change early in the person's life.
Reason: Communication of thoughts or feelings, such as happiness, anger, or "I need help."
Programming: Teach a more appropriate way of communicating "I need help" or "I am frustrated." Accept that emotions can be communicated by body language. Teach when and where to show various emotions.
Reason: Compulsive behaviors. For example, an act starts as pleasurable but the need to continue is irresistible or the person is unable to switch to another activity on his/her own. The thought occurs and the individual cannot prevent him/ herself from carrying out the action.
Programming: This behavior may be related to an obsessive- compulsive disorder and to high levels of anxiety. Avoid the initial stimuli that may set the stage for this behavior. Ask if the person wants to be finished with the repetitive activity or would like to switch to another activity, and help him/her do so. Reduce the person's level of stress. Use distractions, such as music.
Reason: The inability to start or change actions or emotions. This may be related to transitions between activities or environments. The person who has a movement disorder such as akinesia or bradykinesia sometimes uses a short repetitive action to get his/her body into gear with the brain.
Programming: Develop a picture schedule to help the individual move from one setting to another.
Repetitive behaviors cannot and should not be eliminated completely from a person's behavioral repertoire. You may wish to reduce the time spent performing the repetitive behavior or to identify a more acceptable alternative with similar sensory input. Consider the following:
- Teach the person an alternative behavior.
- Provide a variety of sensory experiences during a person's day.
- When the behavior is happening, try to divert the person's attention to another activity.
- Negotiate with the individual when and where repetitive actions are acceptable. Controlled access to the behavior will reduce the person's level of desperation to do the behavior. This controlled access should not be contingent on good behavior. The person's visual schedule should note the appropriate time to engage in the repetitive behavior.
- Gradually reduce the amount of time allotted for the repetitive behavior. Increase the amount of time between scheduled access to repetitive behaviors.
- Use freedom to indulge in repetitive behaviors as a reward if the person has few motivators.
- Use the level of repetitive behavior to assess the person's level of stress. Institute other stress reduction measures when repetitive behavior rates increase.
- Promote success in other areas. The behavior will reduce itself when the person achieves success in other areas and has a low level of distracting sensory stimuli.
- Allow the person to engage in the repetitive behavior in an emergency situation to calm him/herself.
Repetitive behaviors are very resistant to reward or discouragement programs, so if you can live with them, leave them alone. Remember, repetitive behaviors will come and go. However, if one behavior is suppressed, another will replace it. The replacement behavior is always dictated by the individual and may be worse than the one it replaced.
Originally contributed by Susan Gray, 1994
Pratt, C. (1993). Restricted repertoires in autism and what we can do about it. Indiana Resource Center for Autism Newsletter, 7(1), 4-5.