Can Stimming Be Stopped?

In the past few weeks, I have been asked to give a therapeutic solution to problems that probably don't have a proven solution. It is very difficult to tell someone that the answer they are seeking may not exist. Unfortunately, certain conditions are very difficult to treat because they serve a purpose. Today I was asked to provide methods to stop a little girl from what therapists refer to as stimming, which is shorthand for self-stimulation. It is a stereotypic and repetitive behavior that is often seen in children with autism, but can be found in other disorders. Very often, low functioning children will self-stimulate.

As of now, there is no definitive explanation as to the etiology of stimming. It is believed to be a means of organizing and coping with whatever is going on in the environment. The behavior can be excitatory or inhibitory. Stimming can take many incarnations: blinking, staring, licking, clapping, flicking, rocking, hair twisting, jumping, grunting, lining objects up, sniffing people... the list goes on. Given that these behaviors are assumed to be helpful to the child, why is it viewed as a problem? Although these behaviors may be helpful to the child, they actually prevent the child from attaining better function. Most significantly, they interfere with the child's ability to focus and pay attention. They also stigmatize the child. And by their nature, they reinforce themselves and prevent the child from adopting alternative and more acceptable self calming techniques.

All of us display these tendencies at some time or another, but especially under stress. Who hasn't twirled their hair, or tapped their toes, or drummed their fingers? In the mainstream population, these habits are viewed as annoying outlets for nervous energy. When you think about it in these terms, it is more understandable. Everyone has a nervous habit or two which emerges in stressful or anxious situations. And unexplainably, it helps.

One goal that is important to all special needs children is that of social acceptance. Sadly, the more unusual the behavior exhibited by a child, the less likely this is to occur. That means that it is important to either suppress stimming, or to re-direct it to a more acceptable form. I personally prefer to try and suppress these behaviors. Although they provide some internal organization to the child which helps them cope, I like to work on improving social behaviors by using behavioral strategies. Applied behavioral analysis (ABA) has proved very effective in changing disruptive behaviors and eliciting more appropriate ones. Many practitioners who implement ABA therapy incorporate something called "discrete trial training" (DTT). This is very effective with children with Autism Spectrum Disorder and also PDD children. Stereotypical, repetitive movements are common in both these groups. DTT helps by rewarding and reinforcing discrete events. Reward reinforcement is great for helping to build positive behaviors. With DTT, the components of a behavior are broken down, and each component is worked on individually and rewarded when achieved correctly. The components, when put together, form a new behavior. DTT can also be used to eliminate an unwanted behavior. The therapist rewards the child when they are told to stop, and the child does stop. ABA treatment has been demonstrated to work very well in stopping inappropriate behaviors such as stimming.

Another treatment approach is to replace the undesired stimming with a more acceptable method of self-calming. Obviously, if a child's stimming is manifest in licking objects, they need to stop. Aside from the fact that it might cause them to be ridiculed by peers, it poses a health risk. At a minimum, it is unsanitary. A therapist might try to find acceptable food items, like sugarless lollipops, which will replace the habit. Remember Kojak? Telly Savalas always had a lollipop in his mouth. If a child is touching others, the therapist could try to give the child a doll or a stuffed animal to touch instead. These solutions tend to work better with a very young population. Once the child is older there aren't as many substitutes available.

We know stimming plays an important role in children with certain disorders. We also know that the benefit to the child probably doesn't outweigh the downside. That is, the stimming diverts attention which is needed in order to learn and take in important information, and it opens the child to being ridiculed and stigmatized. It is difficult to treat because the child needs the behavior as a means to cope. Working with the child to gain purposeful skills and possibly giving them alternative ways to cope can help to diminish, and possibly eliminate, stimming.