Carol sucked her thumb until age eleven. She also liked to suck on candy, licorice roots, and rock salt. This desire continued into adulthood. As a child, she had an odd habit of watching TV upside down. She also had a favorite blanket with satin edges that she would rub between her fingers, enjoying the cool soft feel while falling asleep.
As Carol entered young adulthood, she began zoning out, or staring off into space, especially in noisy areas like the mall and large family gatherings. She also rubbed the back of her hand or arm while talking to someone or watching TV. She seems to constantly move, whether it’s rolling her propped up feet in circles, swinging her crossed leg back and forth, or scratching at her head or arms.
To the casual observer, Carol’s habits don’t necessarily signal a problem; she just appears fidgety. She never thought about them until a counselor friend noticed and mentioned they were signs of self-stimulatory behavior, or “stimming.” She explained to Carol that these kinds of repetitive behaviors are common in people with autism, and she suspected that Carol might, in fact, be on the spectrum.
Now in her late forties, Carol was diagnosed with high-functioning autism spectrum disorder (ASD).
Common Ways People with ASD Engage in Self-Stimulatory Behavior
Stimming was the most outwardly obvious sign of ASD in Carol’s case, and was the very thing that prompted her to get a diagnosis, and the treatment she needed.
Stimming is a hallmark sign of ASD. Actions such as head banging, sitting on the ground and twirling over and over, or hand-flapping are classic forms of stimming, but there are many expressions like Carol’s, that are a bit more subtle.
- Staring at objects — especially anything with lights or movement
- Gazing off into space
- Blinking repeatedly
- Looking out of the corner of your eyes
- Flipping lights on and off repeatedly
- Random humming, shrieking, or making other noises
- Finger snapping, tapping or putting your hands over your ears.
- Tapping on ears or objects
- Covering and uncovering ears
- Repeating words or phrases including lines from a TV show, songs, or any other kind of repetitive verbalization
- Scratching or rubbing your skin in a repetitive manner.
- Any kind repetitive movement: spinning, pacing, twirling
- Tasting or licking — including thumb sucking, finger sucking, or tasting something one wouldn’t normally taste
- Unusual or inappropriate smelling or sniffing
Why Do People with ASD Resort to Stimming? … To Self-Sooth and to Communicate
There are many reasons for Stimming. When a person with ASD feels anxious or overwhelmed or uncomfortable in a social situation, it can be their way of calming their mind. For example, when Carol finds herself at a social gathering that starts to get loud, she quickly feels over-stimulated. Her body becomes tense and her mind races. She realized that zoning out distracted her from the noise and calmed her. It became her coping mechanism.
While stress can bring on stimming as a response, ironically the opposite is true as well. For instance, when a person is bored it becomes a way to deal with thoughts and feelings that have no place to go. An unoccupied mind and idle body isn’t necessarily in a state of calm; in ASD it can create a sense of tension or panic.
Stimming is also a way to keep the mind on track. The repetitive motions can allow those with autism to keep focused, and clear their head of distractions. Carol discovered this to be the case when she read a book. She often sucked on a piece of candy while reading. It helped her to concentrate. As one person with ASD described it, “…stimming improves my concentration. It’s a release, like sneezing or scratching an itch.”
Stimming may be about self-regulation for the person with autism, but it can also be a way to express their needs and feelings. For instance, if your child often twirls a pencil, and you see their actions increase in speed, they may be unconsciously communicating something – often distress or discomfort.
When routine stimming behavior becomes more intense or exaggerated, it often indicates that something in the environment is bringing about feelings of anxiety. If you see this in your child, you’ll likely be able to connect it to something going on around them – maybe it’s getting too loud, maybe there are too many people talking at once or too much busyness and movement, whatever it is, something is likely causing the child to feel stressed and agitated. This could mean it’s time to leave the environment. Pay attention and you could very well find your child communicating these feelings through their self-stimulatory behavior. This can be particularly helpful if your child is nonverbal.
When is Stimming Normal? … And When is it a Sign of ASD?
“I am always hesitant to give answers as blanket responses about behaviors. These behaviors come from a child and each child is different from the next child. What I might say about one child might very well not be appropriate for the next child … Self-stimulating behaviors are not only developmentally appropriate but also required if the child is to mature toward independence.”
– Dr. Ed Hammer, Professor, Department of Pediatrics Texas Tech Health Sciences Center in Amarillo said
Some forms of stimming are actually common and necessary to a child’s development. Many children suck their thumb, or rub their fingers on a favorite blanket as Carol did. All of these repetitive actions can be considered a form of stimming. They may be ways a child learns to self-sooth or keep their mind occupied. During play, a child may run around in circles until they get dizzy and fall down or they may sing the same song over and over. These actions don’t automatically mean a child has ASD.
The actions that are particularly connected to ASD are: fixated interests, preoccupations, and attachments. Many of the other behaviors may just be a sign of neurotypical development. They can also indicate OCD or Tourette’s syndrome.
The DSM-5 clarifies the nature of stimming as it relates to how it impacts a person’s life : “Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.” Are the behaviors compulsive and extreme; are they unusual, distracting or disturbing to others?
It’s these signs that help to determine if your child’s stimming is connected to ASD or not.
Is it Important to Address Stimming as a Problem?
In some instances it’s not. In fact, there may be times that your child will function better if they are allowed to stim. Carol realized that her reading comprehension was better when she sucked on a piece of candy. While this can lead to tooth decay or weight gain, it’s not exactly an alarming habit.
Other forms of stimming can be harmful or interfere with a person’s daily living, however. For example, head banging, picking at skin until it bleeds, pinching, or hitting oneself are the kinds of behaviors that require immediate intervention.
Other stims such as zoning out may become an habitual escape and interfere with a child’s ability to interact with others over their life span even if they don’t present an immediate danger.
There are different interventions to help mitigate the effects of stimming and address the overall effects of ASD. Some of the more recent and promising techniques include Play Therapy, Developmental Relationship-Based Treatment, and Supportive Therapies.
If your child watches TV upside down, twirls around in circles and jumps up and down while making frog noises during dinner, don’t panic. They may just be a neuortypical kid who’s bored or finds these actions entertaining.
Stimming doesn’t always indicate autism. Understanding all the signs of autism will help you determine if your child needs professional help, or just a time out to help them remember their table manners.