Viewpoint Expert opinions on trends and controversies in autism research.
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Opinion / Viewpoint

Stimming, therapeutic for autistic people, deserves acceptance

by  /  25 June 2019
The Expert:
Expert

Steven Kapp

Research fellow, University of Exeter

Rhythmic, repetitive behaviors are a hallmark of autism. Hand-flapping, spinning in circles, body rocking, vocalizations such as grunting and muttering, and other habits can be disquieting to people unfamiliar with them. Scientists and clinicians have long puzzled over what these behaviors mean — and how to respond to them.

For many years, experts thought repetitive movements resulted from deprivation or even trauma, and that they hindered learning. Psychologist Ole Ivar Lovaas, an early autism specialist, reportedly referred to them as “garbage behavior.”1 He made suppressing these habits a priority. Lovaas and his followers electrically shocked, screamed at, shook and slapped autistic children2. Others prescribed antipsychotics and other stupefying drugs. Even in today’s sometimes gentler treatment paradigms, therapists often train children to have ‘quiet hands’ as opposed to freely flapping ones3.

But growing evidence suggests that repetitive behaviors have been misunderstood — and that they may in fact be incredibly useful. My colleagues and I have found that the behaviors give autistic people a sense of control, helping them cope with overwhelming external stimuli, and a way to calm and communicate their moods. On the other hand, many autistic people say that engaging in repetitive behaviors makes them feel like social outcasts.

Autistic adults have defended their right to these behaviors. Reclaiming the technical term ‘self-stimulatory behaviors’ as ‘stimming,’ they have self-published blogs, vlogs (video logs) and books that reveal how it helps them cope4. Society needs to take their lead and accept these behaviors by understanding their benefits.

Uncontainable emotion:

Theoretical debates swirl about why autistic people stim, with many experts believing the behaviors are purposeless. In a study published earlier this year, my colleagues and I interviewed 31 autistic adults about their stimming behaviors5. Ours was the first peer-reviewed article I’m aware of to gather in-depth data about stimming directly from autistic people.

One of our most noteworthy findings is that although many participants said their stims are automatic and uncontrollable, none consistently dislike them. Most people described the behaviors as calming, and no one contradicted this account for stims that do not cause injury.

Another key finding is that stims are a response to either sensory overload (such as a noisy room) or overpowering thoughts (such as anxiety about work). Whether the source is the outside world or a person’s mind, the result is a state we called ‘uncontainable emotion.’ Autistic people can be overwhelmed by sensations, new information and their own thoughts. Study participants told us that stimming soothes these intense feelings, helping them regain a sense of control.

“It sort of metronomes everything in your body to sort of go at that speed,” a male participant said, “so it just sort of helps quell everything.”

Stimming also sometimes serves as a way for people to communicate their moods. Participants said they sometimes stim out of joy or excitement and other times out of anxiety or boredom, but that the emotion colors the behavior. For example, hand-flapping that reflects a positive emotional state often involves holding the arms out and making a waving motion, whereas in hand-flapping due to distress, autistic people tend to keep their hands and arms near the torso.

Participants reported that some insightful family members and close friends knew how to “read” their emotions by observing the nuances of their stim behaviors. It is evident that such understanding holds the key to social acceptance of stimming.

Breaking the rules:

Finally, most participants described encountering social judgment and rejection because of their stimming. Many regularly felt like social outcasts and thought they were perceived as weird or immature.

In response to rejection, participants concealed their stims (for instance, under a desk), transmuted them (for example, replacing hand-flapping with activities such as tennis and chess that engage the hands and arms) and suppressed them (stimming only when alone or around accepting people).

One of our study participants recalled that as a child she loved to spin and swing but later realized that these behaviors are unacceptable. “It actually still feels glorious if there’s nobody around and I can skip, or I can spin, and it’s like I’m breaking the rules,” she says.

Suppressing stims is far from beneficial, our study showed. The effort takes a lot of energy and makes people feel, in the words of another female participant, “more on edge.” Educators have often considered stims a distraction, but many autistic people say the opposite is true. Stims are the equivalent of doodling, they say, freeing the mind to concentrate on other things.

Nevertheless, therapeutic attempts to eliminate stimming remain common. The approach is misguided because it strips people of a key means of coping. One caveat: Some forms of stimming, such as head-banging, are harmful and do warrant sensitive, consensual treatment. No participant wanted to engage in self-injurious stims, which were involuntary.

Loud hands:

I hope that greater awareness of autistic people’s experiences with stimming makes repetitive behaviors such as finger-flicking or squealing more accepted — not just in classrooms but in supermarkets, movie theaters and all public places.

The neurodiversity movement, which celebrates autism both as a way of being and a disability to accept and support, has embraced stimming. “Loud hands” is the defiant rallying cry4. Stimming resources include Stimtastic, which sells stim toys and chewable jewelry, and Stim Your Heart Out, a dance project that encourages stimming in mainstream society.

The way to help autistic people is not to discourage stimming but to address certain reasons they stim: sensory overload or distress. Our participants mentioned several environmental modifications, including earplugs and rimmed hats to reduce sensory input, settings that meet autistic people’s needs or schedules that include breaks. Anecdotal evidence suggests that when stimming is not enough to relieve stress, autistic people might welcome calming medications or training in emotional self-regulation.

Preliminary research I’ve done suggests that there are commonalities between stimming and the ‘fidgeting’ that neurotypical people do. The bottom line may be that everyone stims, in one form or another. Recognizing that fact might aid acceptance.

Steven Kapp is research fellow in autism and neurodiversity at the University of Exeter in the United Kingdom.


References:
  1. Silberman S. (2015) Neurotribes: The legacy of autism and the future of neurodiversity. New York, NY: Penguin
  2. Grant A. (1965) Screams, slaps, and love. Life (pp. 87–97) Full text
  3. Richter Z.A. (2017) Melting down the family unit: A neuroqueer critique of table-readiness. In M. Rembis (Ed.), Disabling domesticity (pp. 335-348) New York, NY: Palgrave Macmillan
  4. Bascom J. (2012) Loud hands: Autistic people, speaking. Washington, D.C.: Autistic Self Advocacy Network
  5. Kapp S.K. et al. Autism Epub ahead of print (2019) PubMed