Understanding Stereotypies and When to Intervene

Stereotypies are repetitive behaviors that often occur across conditions (i.e. settings, people, demands, etc.) and may serve as their own reinforcer. They often function independent of external influence. A child engages in the behavior because it feels good. As a professional working with children with autism, it’s important to gain an understanding of stereotypies to know when to intervene.

Although stereotypies are often automatically reinforced, it’s important to consider that, for your client, the behavior may serve a different function. Many children with autism use stereotypies for self-soothing and regulation. They should not be targeted for reduction unless they interfere with other activities. If you do decide to intervene, identify replacement behaviors and use reinforcement to help change the behavior.

Let’s look at this in more detail.

Repetitive Behaviors

All children with autism engage in some form of repetitive behaviors. According to the DSM 5, the current diagnostic criteria for autism requires 2 distinct traits:

  1. Impaired social skills
  2. Restricted or repetitive interests or movements

Learn more about the DSM 5 diagnostic criteria in the post Autism Spectrum Disorder: DSM 5 Criteria on Accessible ABA.

For some, those behaviors present as restricted interests or a need for sameness. For others, repetitive behaviors might present as stereotypies.

When to Target Stereotypies for Reduction

The early years of Applied Behavior Analysis (ABA) focused a lot of interventions on making individuals with autism appear “normal.” Clinicians attempted to mask the symptoms of autism. Children were ostracized by their peers because their stereotypes made them look “weird.” Professionals aimed to help these children be more accepted by their peers by changing these behaviors. (For more on this read our post Understanding the Debate About ABA)

As we come to understand autism better, ABA professionals shift to targeting other needs of children with autism. The goal of making children with autism appear “normal” no longer exists. Rather, the focus directs professionals toward improving the quality of life for individuals with autism and teaching them in a way that works for them.

Before You Develop a Plan

Before deciding to intervene on a child’s stereotypies, it’s important to consider the impact they have on the child’s ability to engage in other activities. Avoid targeting stereotypies for reduction just to make him more acceptable to peers. Instead, teach other children about autism. Discuss stereotypies openly and present examples of stereotypic behavior that they also engage in (i.e. hair twirling, bouncing legs, tapping a pencil, etc.). We all engage in behaviors because they feel good. These are stereotypies. Most people are able to regulate their stereotypes so they don’t interfere with their participation in other activities.

Children with autism often engage in higher rates of stereotypies than other children for a variety of reasons. These children may engage in these behaviors in an effort to self-sooth in exciting or stressful situations. Adults with autism sometimes report that these behaviors help them regulate themselves. Keep this in mind as you decide whether or not to intervene.

Some children engage in stereotypies at such a high rate that it becomes nearly impossible for them to attend to academic, recreational, or social tasks. Some rates of vocal stereotypies prohibit vocal communication or create an environment where other children struggle to learn. Other children engage in stereotypies that pose a safety hazard such as jumping or spinning regardless of location. When these conditions occur, proceed with intervention to reduce the stereotypy or to alter it to something safer or at a more reasonable level.

Recognizing Stereotypies

Stereotypies come in many different forms, some vocal and some motor. These behaviors vary in frequency and intensity and occur at various times throughout the day. They are often unpredictable. Stereotypies fall into two categories:

  1. Vocal
  2. Motor

Vocal stereotypies may sound like babbling, humming, or a sing song sound. Any type of repetitive vocal behavior may be considered a vocal stereotypy.

People commonly think of hand flapping or repetitive jumping when referring to stereotypies in children with autism. While these behaviors are common, motor stereotypies are not limited to just these forms. Some children engage in pacing, wiggling fingers, or holding their fingers up to their eyes. Motor stereotypies may involve objects or simply be movements of the child’s own body.

Children may engage in only vocal or motor stereotypies, or both.

Defining Stereotypies

Often when defining stereotypies, using a functional definition provides more accurate and useful data than a topographical definition, unless there is one specific topography of stereotypy that is particularly disruptive or dangerous. Many children don’t engage in just one topography of stereotypy. They likely engage in several forms and if one form is unavailable, they will choose a different form.

If you want to understand exactly how often the child engages in stereotypic behavior, and you have determined that the function is likely automatic reinforcement, your definition should focus on automatically reinforced repetitive behaviors. Be sure to include many different examples and non examples, especially if you won’t be the one collecting the data.

For more help with writing a definition, read these posts: Clearly Define the Behavior and Examples of Operational Definitions.

Interventions for Stereotypies

Before developing an intervention plan to reduce stereotypic behavior, be very clear about your rationale and ensure that you provide the child with an alternative way to get her needs met. If the stereotypy is dangerous or prevents participation in other activities, what other ways can she self-soothe or meet her sensory needs? Can she learn to ask for time to engage in stereotypic behavior? Stereotypies should not be targeted for reduction simply because they make the child look different than other children.

Decreasing Vocal Stereotypies

Response Interruption and Redirection (RIRD) is an intervention commonly found to be effective in reducing vocal stereotypic behavior. This intervention involves several steps:

  1. Block access to the current activity
  2. Gain the child’s attention/prompt eye contact
  3. Elicit an appropriate vocalization (i.e. intraverbal, echoic, tact, etc.)
  4. Continue until the child engages in 3 consecutive correct responses without engaging in the vocal stereotypy
  5. After 3 consecutive appropriate vocalizations, provide praise and allow access to the initial activity

RIRD may have a punishing effect in that children engage in less vocal stereotypic behavior in order to avoid the procedure. Alternatively, some research suggests that the social consequence associated with appropriate vocalizations may counteract the automatic reinforcement of the stereotypy. Whatever the cause, there seems to be a correlational effect of RIRD and an increase in appropriate vocalizations.

Dickman, S. E., Bright, C. N., Montgomery, D. H., & Miguel, C. F. (2012). The effects of response interruption and redirection (RIRD) and differential reinforcement on vocal stereotypy and appropriate vocalizationsBehavioral Interventions27(4), 185-192.

Ahearn, W. H., Clark, K. M., MacDonald, R. P., & Chung, B. I. (2007). Assessing and treating vocal stereotypy in children with autismJournal of applied behavior analysis40(2), 263-275.

In Verbal Stereotypies – Description and Example ABA Treatment Vincent Carbone, BCBA-D of the Carbone Clinic demonstrates the ability to reduce stereotypies by using them as a reinforcer for on-task behavior. This is a great example of accepting the behavior and providing a more appropriate time for the child to engage in that behavior. Check out this video:

Decreasing motor stereotypies

There appears to be less consistent research on interventions to decrease motor stereotypies. This may be due, in part, to the many different forms of these behaviors or even the possibility that they are not necessarily automatically reinforced. Some research recommends implementing differential reinforcement (for more information on implementing differential reinforcement, read the post: Differential Reinforcement). Other studies have utilized exercise to reduce stereotypic behavior.

One study found that appropriately implemented Discrete Trial Training (DTT) resulted in a decrease in motor stereotypy. It’s possible that the fast pace and rich reinforcement available during DTT influences the presence of disruptive stereotypic behavior. Read the article to learn more:

Dib, N., & Sturmey, P. (2007). Reducing Student Stereotypy by Improving Teachers’ Implementation of Discrete-trial TeachingJournal of applied behavior analysis40(2), 339-343.

A systematic review of studies that reduced stereotypic behavior suggests the importance of identifying appropriate alternative behaviors when reducing stereotypic behavior. Inevitably, when interventions have effectively reduced stereotypic behavior, other behaviors take their place. These behaviors are not always desirable. Read the article to find out more:

Lanovaz, M. J., Robertson, K. M., Soerono, K., & Watkins, N. (2013). Effects of reducing stereotypy on other behaviors: A systematic reviewResearch in Autism Spectrum Disorders7(10), 1234-1243.

Learn More

Although many stereotypies are automatically reinforced, there may also be a social component, especially if someone consistently tells them to stop, provides a reprimand, or otherwise attends to the behavior. This article discusses the possibility of stereotypies being socially reinforced and cautions against presuming the behavior is automatically reinforced:

Chao, H. T., Chen, H., Samaco, R. C., Xue, M., Chahrour, M., Yoo, J., … & Ekker, M. (2010). Dysfunction in GABA signalling mediates autism-like stereotypies and Rett syndrome phenotypesNature468(7321), 263.

Many people refer to these behaviors as “stim,” “self-stim,” or “stimming.” This assumes that the behavior is automatically reinforced and serves a sensory function. In addition, these terms conjure images of a stereotype and doesn’t reflect the true nature of the behavior. As professionals, I encourage you to choose your words carefully. Consider using the correct terminology and set an example for everyone else.

Stereotypies should be addressed carefully. Consider the function of the behavior and the impact that changing the behavior will have on the child. Is intervention necessary? Think before you intervene.