What is stimming in children with autism?

Stimming, also known as self-stimulatory behaviors, are repetitive motions or sounds typically made as a way to self-regulate. 

Some common self-stimulatory behaviors include nail-biting, hair twirling, and tapping your fingers. These behaviors are often done as a habit to self-soothe, or simply because they feel good in some way. Sometimes, you may not even realize you are engaging in these self-stimulatory behaviors while you are doing them. 

While this is similar to the way children with autism engage in stimming, there are differences as well. In this article you will learn more about why children with autism stim and how you as a parent, caregiver, or educator can help in regards to stimming. 

Why do some children with autism stim?

Children may stim for many reasons, like when they are excited or overstimulated, or while adapting to a new environment. Stimming may also occur when a child is upset or anxious. 

Some children may have predictable stims such as hand flapping when they get excited. Meanwhile, other stims may be less predictable, especially when trying to find the reasoning behind that specific behavior. 

Below are a few of the main reasons some children may engage in self-stimulatory behaviors:

Medical factors

Self-stimulatory behaviors may have a medical cause. For example, a child may grind their teeth or chew on objects due to oral pain. Or a child may engage in repetitive vocalizations or cover their ears if they have a headache.

Researchers have suggested that banging one’s head although harmful, may temporarily reduce the pain sensations due to the release of beta-endorphins into the body which can create an anesthetic feeling. 

If you suspect that your child’s stims may be due to pain or a medical need, it is important to discuss further with their medical care team. 

Escape or avoidance

If a child is seeking to escape from something unpleasant or is looking to avoid something, they may engage in self-stimulatory behaviors to do so. For example, a child may say things repetitively or pace back and forth in a social setting if they are nervous or uncomfortable in engaging with others.

Sensory stimulation

Sometimes self-stimulatory behaviors occur simply because they feel good or are soothing to the individual. 

For example, stimming can look like shaking your leg or foot when you are sitting. While there are usually no medical reasons for it, it is usually done mindlessly. In this case, the pleasant feeling that comes from shaking your leg or foot can help regulate your body.

Communication 

Some children with autism struggle with being able to communicate their needs and thoughts. It may be difficult for them to express that someone is talking too loud, and that it hurts their ears. Some children with autism also may not have the ability to vocalize. Instead, they may resort to stimming behaviors such as self-hitting, plugging their ears, pacing, or other potential behaviors to communicate their needs. 

Boredom

Other times, some children may engage in self-stimulatory behaviors to pass the time. They may be bored and not know what else to do or how to pass the time. If your child is still practicing their leisure/play skills, this may be a factor in their stimming behavior. 

Over or under stimulation

Some children with autism may be hyposensitive or hypersensitive to different sensory experiences. Those who feel overstimulated by the sensory world may engage in self-stimulation to block out sensory input. Similarly, those who feel under-stimulated by the sensory world may engage in self-stimulation to add extra sensory input. 

Different types of stimming

Stim variations are categorized by the sensory experience of the repetitive behavior, so there are many ways self-stimulatory behaviors may present themselves. 

Different types of stimming include:  

• Tactile Stimming - Involves stimulation through one’s sense of touch. Some examples include: rubbing particular textures, skin scratching or rubbing, finger tapping and repetitive hand movements.
• Visual Stimming - Involves stimulation through one’s sense of sight. Some examples include: moving/playing with fingers in front of one’s eyes, eye-tracking from the corner of one’s eyes, visually examining items up close, repetitive blinking, object placement (i.e. lining toys up in a specific way), staring at objects - often bright lights or spinning objects.
• Auditory Stimming - Involves the use of one’s sense of hearing. Some examples include: repetitive sounds, words, or statements, humming, grunting, singing, covering ears, and playing with sound makers close to one’s ears.
• Olfactory Stimming - Involves stimming through one’s sense of taste and/or smell. Some examples include: excessively smelling objects or people, excessive tasting of objects, licking or mouthing items.
• Proprioceptive Stimming - Involves activation of the proprioceptive system. The proprioceptive system is within our muscles and joints. It allows us a sense of body awareness and force or pressure. Some examples include: the application of pressure (i.e squeezing arms), walking on tippy toes, throwing objects, lifting or covering one’s self with weighted objects, throwing self onto the floor.
• Vestibular Stimming - Involves one’s sense of balance and physical movement. Some examples include: rocking back and forth, spinning, jumping, pacing.

Are there benefits to stimming?

Yes! There are benefits to stimming. Regardless of the outward presentation to others, the behavior serves a purpose to the individual engaging in the behavior. 

The main benefit of stimming is self-regulation. The behavior feels good to the child and helps them to regulate their body and/or emotions. Stimming may also help children release excess energy, focus on difficult tasks, or reduce pain. 

Are there concerns about stimming?

Parents and caregivers of children with autism often wonder whether they should be concerned about their child’s stimming, or embrace it. 

Let’s consider what some of the common concerns with stimming are: 

• Social Impact - While everyone engages in some form of self-stimulatory behavior, oftentimes neurotypical children learn at a young age to mask these behaviors or they learn alternative skills that help them to meet the needs that their stimming may be seeking. Because of this, stimming may be socially stigmatizing for children with autism.  
• Harmful Behaviors - Stimming may become physically harmful when it is presented as self-injurious behaviors such as self-hitting, head banging, biting one’s self, etc. It may also be harmful if it involves destructive behaviors such as throwing objects that are not meant for throwing. Make sure to work with your child’s care team to address any behaviors that may be hurting your child. 

Should stimming be stopped?

A common question parents and loved ones of children with autism ask is whether they should intervene in their child’s self-stimulatory behaviors. As we have discussed, stimming serves a purpose for the individual who is exhibiting the behavior. Attempting to block or otherwise stop them from engaging in their stims may cause distress and reduce their ability to self-regulate. Additionally, aiming to stop one’s self-stimulatory behaviors without an adequate replacement behavior, may cause a more harmful or socially stigmatizing behavior to arise. 

Before intervening in self-stimulatory behaviors, consider the following:

• Is it harmful? If the stimming is self-injurious or in any way harmful to the individual or others in the environment, that is a sign that redirection may be necessary. 
• Is there a potential medical cause for the behavior? If there is any question about the behavior having a medical element, seeking an evaluation from a trusted medical provider is key. 
• Does the person engaging in the behavior want to stop? If your child communicates a desire to stop engaging in the behavior or learn new ways of self-regulating, this would be a reason to consider help from your child’s care team to modify the behavior. 
• Is it interfering with their ability to learn or complete everyday tasks? If a self-stimulatory behavior is so pronounced that it is interfering with a child’s ability to complete daily tasks, or is a barrier to their ability to learn, then redirection may be needed. 

Strategies for stimming 

If an intervention for stimming is needed, there are many potential ways to approach intervention and redirection for the safety and support of your child.  

1. Medical intervention - If a medical cause is identified, then the intervention will be to alleviate the medical condition. This may include addressing cavities or other oral issues, medication for infections, etc. Work closely with your child’s medical care team in determining the best course of action. 
2. Redirect to an incompatible behavior - This involves redirecting the child to engage in another behavior when the stimming occurs. Consider a child engaging in repetitive hand flapping. An incompatible behavior may be clapping their hands. An incompatible behavior means that they cannot engage in both behaviors at the same time. Make sure to partner with your child’s care team and therapist before making these redirections.
3. Teach a replacement behavior - It can be difficult to reduce a self-stimulatory behavior without providing access to a functionally equivalent replacement. Once the reason for the stim has been identified, teaching and reinforcing an adequate replacement is one way to reduce the behavior. For a child who bangs their head for sensory input, one replacement can be teaching other ways of gaining that sensory experience such as hand squeezes. (Note: Intervention for self-injurious behaviors such as head banging should be addressed by a professional and monitored closely.)
4. Remove and/or avoid triggers - When you are able to identify specific triggers to stimming, you can work to reduce or avoid them. Some potential triggers could be large crowds, bright lights, loud noises, or specific locations. If big crowds are a setting event that is stressful for your child and results in increased stimming as a coping mechanism, it could be helpful to avoid locations with big crowds. If loud noises are a trigger, a potential intervention could be avoiding places where loud sounds are likely and/or providing your child with noise-canceling headphones in noisy places.  
5. Teach communication skills - If stimming is occurring due to an unmet need, teaching the child to communicate how they are feeling and advocate for accommodations could go a long way in reducing the behaviors. For example, if your child stims when they are frustrated or overwhelmed, teaching them to request a break from a difficult task or to request a quiet space could be beneficial in meeting their needs and eliminating the need to engage in the stimming. 
6. Increase stimulation - If your child’s stimming occurs as a result of boredom, increasing stimulation may be key. Teaching alternative leisure activities and/or interactive activities could help. It is important however to ensure that the individual is motivated to learn and engage in other activities. 
7. ABA therapy - All of the intervention strategies discussed are based on behavioral principles of Applied Behavior Analysis (ABA). If your child is currently in ABA therapy, discuss intervention methods with your BCBA. Considering other therapies such as occupational therapy and speech therapy may be of benefit as well. 

Stimming can be an excellent coping or self-regulating method for people with autism (and neurotypical individuals as well). Stimming is not inherently dangerous nor is intervention always necessary. 

If your child engages in self-stimulatory behaviors that are interfering with their daily lives, have a medical cause, or are harmful to the individual or others, intervention may be needed. It is suggested to work with your child’s care team in determining the best course of action to ensure the cause of the behavior is being identified and a sound intervention is implemented. 

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