Restricted interests and repetitive behavior are characteristics of autism. Stereotypic behavior, like hand flapping, body rocking, repetitive tapping of objects, and non functional vocalizations (e.g., repetitive grunts, laughter, echolalic vocalizations), is a common form of repetitive behavior. Many persons have noted that such behavior is socially stigmatizing and can interfere with learning. Let me start by saying that the socially stigmatizing aspects stereotypy will not go away with educating the public about autism. Acceptance of persons with ASDs in society IS very important but there will always be a natural reaction on the part of others when such behavior occurs. Again, I agree that acceptance via educating the public about ASDs is a worthy pursuit but it will not resolve this matter.
All young children (and probably most adults, at least there are some studies that suggests it occurs in the behavioral repertoire of college students) exhibit some form of stereotypy but it occurs pretty infrequently and seems very sensitive social feedback in typically developing children. In a previous post (http://www.psychologytoday.com/blog/radical-behaviorist/201002/did-thomas-jefferson-flapping-his-hands), I discussed a study by a colleague of mine (MacDonald et al., 2007). She provided young children an opportunity to play and the level of stereotypy was recorded. Children with an ASD that participated were just entering early intensive behavioral intervention. One of the interesting observations was that two year olds with an ASD engaged in about as much stereotypy as their typically developing peers. However, three and four year olds with an ASD had much higher levels of stereotypy. This implies that differences in how much stereotypic behavior occurs may partly be a function of age. It might also be the case that as the child with autism ages, they learn to engage in additional forms of stereotypy and, perhaps, the motivation to engage in stereotypy increases.
I wanted to jump off this point to talk about what to do about stereotypy and repetitive behavior. However, I'd like to first touch on restricted interests. Some restricted interests can be interferring but in other situations they can be very productive. Many individuals with ASDs (and society at large) have benefitted greatly from restricted interests in that these drive behavior and produce expertise in a manner that could only be obtained with acute focus. There are likely many sources of reinforcement behind restricted interests. Besides the self-reinforcement that comes from engaging in a preferred activity, there are many tangible benefits that may also follow. Such as a high paying job and recognition of expertise that leads to accessing more tools to further pursue those interests. If a restricted interest is not harmful, there should be support provided to pursue those interests.
What about stereotypy and repetitive behavior? Should we foster that behavior? That depends. There was a paper written by a behavior analyst many years ago suggesting that people with developmental disabilities should be allowed to eat donuts and take a nap. I couldn't agree more (even though I really don't like donuts). Everyone should be allowed to eat donuts and take naps but not to the exclusion of everything else. Because, if all you do is eat donuts and take naps you are likely not going to have as rich of a life as you would if there were other activities in your life. It might actually be much shorter than it could be as well. So, when determining what to do about stereotypy there are a number of relevant variables. One is, how frequently does it occur? Another is, how much does it interfere with the occurence/development of appropriate behavior?
Take as an example a young child that repetitively taps blocks together and emits a high pitched squeal during times in which they could be playing with other children. If this child never interacts with their peers then a decision to promote more social behavior is probably necessary. There are many studies that discuss effective interventions strategies. One study showed that merely providing prompts and praise to children with ASDs increased the social initiations on the part of the children (Odom & Strain, 1986). The amount of interaction was greater when the typically developing peers were encouraged to play with the children with ASDs. Moreover, the fact that merely suggesting that the child should play with others and praising that behavior resulted in improvements in social behavior is notable.
Such strategies aren't effective for everyone. A number of other interventions suggest that video modeling, role playing, written instructions (in the form of "role playing"), and overtly reinforcing play behavior during play can improve social behavior. But these strategies don't always work. When they don't redirecting behavior from stereotypy to appropriate behavior can have a significant impact. One study I mentioned in the previous post linked to above suggests that interrupting and redirecting stereotypic behavior can have a quick effect that produces much lower levels stereotypy by simply asking the child to do something that they already do, like answering social questions (e.g., "what's your name?" "where do you live?" "What's your brother's name?"). However, more importantly, this type of procedure can produce a significant change in appropriate behavior.
In Ahearn et al. (2007), 3 of our 4 children displayed more appropriate communication when we interrupted stereotypic vocalizations by asking them social questions. We've used similar strategies with many other children and promoting more appropriate behavior that can be fostered and serve as an important foundation for building skills is very desirable. One video that I often show when conducting workshops on working with children with ASDs shows what happened when we redirected a child's stereotypic manipulation of objects. Prior to the treatment, he would rarely approach his teacher or engage in cooperative play. However, when we redirected his stereotypy, he started to look towards his teacher. He engaged in a variety of new responses with the toys he had access to, and within a short period of time, he brought the toys to his teacher, sat on her lap, and played with her. Sometimes it is better to interrupt preferred behavior to establish other important skills. That said, given that stereotypy is typically harmless, there should be a time and place for it because everyone should be able to eat donuts and take a nap.
