What Are Repetitive Behaviors in Autism?

Repetitive Behaviors Are Part of Autism, But They're Not Always a Problem

Autistic Behaviors
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When most people think of autism, they envision a child lining up toys, spinning objects, or obsessively opening and closing drawers or doors. Almost as common is the vision of a person with autism who must repeat the same behaviors, phrases, or actions over and over again in a manner reminiscent of obsessive compulsion. These behaviors really are a part of autism -- though they can manifest very differently in different people.

"Stereotyped" (Repetitive) Behaviors Are Part of Autism

Autism's repetitive, sometimes apparently purposeless behavior is officially called "stereotypy" or "perseveration," and it's actually described in the diagnostic criteria for autism. Here's how these behaviors are described in the DSM-5 (the official diagnostic manual):

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
  1. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

What Do Stereotyped Behaviors Look Like?

Repetitive behaviors in autism can vary radically from person to person, and can range from passionate and inflexible interest in a particular subject to violent self-destructive behaviors, such as head banging.

Some people on the autism spectrum engage in repetitive behaviors constantly, while others only occasionally perseverate when they're stressed, anxious or upset.

Here are a few examples of repetitive behaviors you may see:

  • Rocking back and forth or pacing when excited or anxious
  • Compulsive touching or lining up of of specific objects in a particular manner or patternĀ 
  • Repetition of ideas, phrases, sounds, or words, often using exactly the same language and intonation
  • Repetitive actions such as hand flapping, finger flicking, door slamming, toilet flushing, etc.

Sometimes perseverative or stereotyped behaviors are obvious because they are so marked or unusual. Often, however, particularly with high functioning autism, perseveration may not be obvious to the casual observer. A person with autism may, for example, ask "Do you like Marvel movies?" Upon hearing that the answer is "yes," the autistic person may then run through the same speech about Iron Man that he has run through ten times before -- in exactly the same words, with exactly the same tone and gestures.

Are Repetitive Behaviors a Problem?

Of course, perseverative behaviors are not unique to people with autism. Most people engage in some such behaviors -- nail biting, pacing, pencil or toe tapping, compulsive cleaning, or even a "need" to watch the same TV shows or sporting events without fail are all forms of perseveration.

For some people with autism, the problem of perseveration is really no problem at all, since it only arises at the same times as it would for other people (usually under stress) and the behaviors are fairly unobtrusive. Perseveration can even be a plus for people with autism, since it may relate to a passionate interest that can lead to friendships or even careers. An individual who is perseverative in his interest in computer games, for example, can join gaming clubs -- and even create games of his own.

For many people with autism, though, perseveration or repetitive behavior is not only disturbing to others, but it's also a major roadblock to communication with others and engagement in the world. A person who compulsively flicks his hands to the exclusion of anything else is clearly unable to attend to the world around him or take part in real-world activities.

Causes of and Treatments for Repetitive Behaviors in Autism

No one really knows what causes perseveration in people with autism, though there are a variety of theories. Depending on the theory you espouse, you are likely to select a particular treatment. Some treatments have been more fully researched than others, but all have had some success with some individuals and less success with others. For example:

  • If you believe perseveration is a behavioral issue, you are likely to use behavioral techniques (rewards and, in some cases, consequences) to "extinguish" the behavior.
  • If you believe repetitive behaviors are a self-calming technique used to block out too much sensory input, you are likely to use sensory integration techniques to help the individual self-calm and regain a sense of control.
  • If you believe perseveration is a manifestation of real interests on the part of the person with autism, you are likely to use therapeutic techniques such as Floortime or SonRise to connect with the autistic individual and help him turn perseverative actions into meaningful activities. For example, a person who lines up toy engines can often turn his repetitive actions into symbolic play, and can even build on his perseverative interest to develop social skills.
  • If you believe perseverative behavior is caused by anxiety or a chemical or neurological issue, you are likely to attempt to control the behaviors through the use of pharmacotherapy.

Learn More About Autism Symptoms, Types of Autism and Autism Diagnosis

Sources:

BA Boyd et al. Sensory features and repetitive behaviors in children with autism and developmental delays. Autism Res. Apr;3(2):78-87. (2010)

LN Britton et al. The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy. Behavioral Interventions. 17, 93-103.(2002)

Mark Lewis et al. Repetitive behavior disorders in autism. Mental Retardation and Developmental Disabilities Research Reviews. 4:80-89 (1998)

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