Sunday, August 18, 2013


Stimming is harmless, right?  Maybe it is just me but it sure seems like many autism self-advocates think that stimming is something harmless or is only a problem because of other people's opinions.

Here's one recent example -
But people tell autistic kids not to stim in public all the time. Again and again I see conversations and articles insisting that stimming–or if they’re trying to be politically correct, certain types of stimming– isn’t appropriate public behavior.  
Really? And why is that? Who exactly does stimming embarrass? Not the autistic person who’s doing it. 
The idea here is that stims happen, can't be controlled, and that the only reason that parents try to stop stims is that they are embarrassed.

Here's another one that is so hyperbolic that it would be funny if it weren't so sad -
Let me be extremely fucking clear: if you grab my hands, if you grab the hands of a developmentally disabled person, if you teach quiet hands, if you work on eliminating “autistic symptoms” and “self-stimulatory behaviors,” if you take away our voice, if you... 
if you... 
if you...
The overriding theme of this last one is that stopping or redirecting stims to tantamount to child abuse.  Yes, the point is that the common phrase "quiet hands" is somehow taking away this person's voice.  And here I was under the impression that it is autism itself that causes problem with expressive communication.  Silly me.

I could go on to point out other examples of this meme but I think you get the point - stopping stims is bad.

As a parent whose children who have to struggle with autism, I couldn't disagree more.  Stims are not some harmless thing that can be ignored.  Stims can and regularly do stop a person with autism from being able to function or learn.  And, in some cases, stims can directly harm a person or put them in harms way.

Normally I would just let these things go and simply ignore what is being said.  The people who are making statements like these presumably have a diagnosis of autism and know how their personal stims affect their daily lives.  I might think that they take an extremely shallow view of stimming and what it is like for people who aren't quite so high functioning but I don't like to nitpick what people with a disability say about their disability.  Especially since a lack of understanding of what others are thinking or experiencing is a large part of the disorder that they are struggling with.

However, this time I ran across that first article because someone pointed it out on twitter and highlighted it as a "great post and discussion".  This person, in my opinion, really should know better and should understand the nuances and issues surrounding stimming in autism.

But apparently that isn't the case.  Apparently the idea that stims are harmless is gaining traction and acceptance even among people who should know better.  So lets talk about what is wrong about that idea starting with a definition of what a "stim" is.

A stim is any behavior whose purpose is self-stimulation.  The behavior is typically going to target or involve one of the following things -
  1. One or more of the five senses (sight, hearing, taste, touch, smell)
  2. The vestibular sense (balance, movement, acceleration)
  3. Pain or pleasure
  4. Anything else that can induce a feeling or sensation
In one sense, everybody has stims because everybody has behaviors that are designed to stimulate themselves.  But there are very clear differences between a "typical" person's stim and an autistic stim and these differences come down to a matter of choice and a matter of degree. A "typical" person can control their behaviors and can choose when and where to engage in them.  They control their behaviors, their behaviors don't control them.  

In autism, there is a definite lack of choice and a definite lack of ability to control the level or degree of the stimulation.  Stims happen for a variety of reasons, some internal, some external but the person with autism doesn't necessarily have the ability to rein in or stop the behaviors even if they wanted to.

So, the question is then why do parents try to get their children to stop stimming?  If it stimming is really a compulsion that people with autism are being forced to do or a way of dealing with some external factor, why do mean parents like myself try to squash it?

The short answer is that the cause, effect, and context of the stimming very much matters.  Stims happen for a variety of reasons, have variety of effects, and both the cause and effect can change depending on the context of what is going on when the stim happens.  You can't make blanket statements about a stim being good, bad, or harmless without considering the whole picture.

Another reason to address stimming is to give the child the ability to recognize what is causing the need to stim, giving them the skill set to deal with the stim, and teaching them to better regulate themselves and their environment so that they can function better.

Though the overriding reason, to me at least, is to give the person the ability and option of controlling their behaviors rather having their behaviors control them.

Let talk a little bit about the cause, effect, and context of stimming and why it matters starting with some common causes of stimming.  Here is a short list of some common causes -
  1. Sensory overload or underload. One of the things about sensory processing in autism that is often overlooked is that the sensory imbalances goes both way - there are sensory avoidance issues as well as sensory seeking issues. A stim can be caused by a need for more sensory input as easily as it can be caused by too much input.

  2. An external factor that increases the person's level of stress, anxiety, fear, or some other mental state.  This reason is really about a failure of self-regulation - something else happens and the the person has no way to cope with the situation and resorts to stimming to relieve the pressure.

  3. An internal failure of self-regulation.  This is an internal failure to self regulate some aspect of a life and this failure leads to stimming.  A couple of examples would be not sleeping at night, not eating when hungry, or not stopping to rest when tired.

  4. Biological imbalances. People with autism can (and often do) have certain biological imbalances that can lead to the need for stimming. For example, pica or mouthing can be caused by iron deficiency.  

  5. A compulsion for the stimulation, i.e. a repetitive behavior.  Another way of looking at this is that the stim and resulting sensation is addictive - the person craves the sensation and doesn't feel right without it.
As you can see, there are many different and varying reasons for stimming.  The above list is far from complete but each of the causes on the list needs to be addressed differently.  You can't address a sensory issue the same way as you address anxiety nor can you address iron deficiency the same way as lack of sleep.

The point is to properly evaluate and address a stim you need to get some idea of why it is happening, what a person is avoiding, or what they are getting out of it.

Along those same lines, an increase in the number or types of stims can point to a some new problem or issue that needs to be addressed.  If you are dealing with a person who is either non- or minimally verbal then this change might be the only sign of the problem.  For example, my children are sensitive to noise so they have a "stim" where they hold their ears.  However, if they start holding their ears more than normal than it can be a sign that they have an ear infection.  Or it could be a sign that something else is stressing them out.

Lets move onto the effects of a stim.  Simply put, the effects of a stim are as varied as the forms of the stims themselves.  But, in general, you have to consider the following questions when evaluating whether a stim needs to be addressed -
  1. Does the behavior interfere with the person's ability to function or learn?
  2. Does the behavior interfere with another person's ability to function or learn?
  3. Does the behavior harm the person or does the behavior pose a safety risk?
  4. Does the behavior harm another person or does the behavior pose a safety risk?
The overall goal of addressing stims is to stop or redirect behaviors that stop a person from being able to function or learn.  For example, if you have a child at school who can't sit in a chair and has to constantly move about the room and scream, then they are not going to be able to function and learn at school.  If you put them in a mainstream classroom then their behaviors might stop the other children from learning as well.

The goal is also very much about stopping the child from endangering themselves or others.  Contrary to popular myth, flapping, spinning, and humming aren't the most common stims.  There are quite a few others and many of them can be downright problematic.

To give you an example, two of my daughters have a stim where they hit or push on their chins with the palm of their hands when they are either stressed or tired.  If they are "just" pushing on their chin it isn't the end of the world but it certainly isn't good for them.  However, it is a short step from just pushing to slamming their palm into their chin and that could cause some real damage.  As a result, we do not tolerate that particular stim and stop them every time we see them start it.

The last part of the equation is that the context of the stim can influence or change both the cause, effect, and acceptability of a particular stim.  Some stims are going to be perfectly fine in one situation but very problematic in others.  Take for example the common stim of flapping.  Flapping comes in many forms, from a simple hand movement all the way up to moving the entire arm rapidly.

Flapping is harmless, right?  Well, yes and no - it all depends on where you are and how you do it.

If the person is at home and relaxing them flapping is probably going to be harmless and shouldn't be stopped.  But what if they are standing close to someone and their flapping involves their entire arms?  What happens if the person is standing in a crowd of people and starts hitting people around them with their flapping arms?

Taking it one step further, when a person is flapping they usually are paying less attention to their surroundings.  So what happens if a person starts flapping while they are crossing a street or walking through a parking lot and stops paying attention to the cars going past?

Neither one of these is a contrived example - we have had both happen several times to the point where we have had to work on getting the kids' flapping under control - and flapping is a relatively harmless stim.  There are stims that are far worse and more impairing than flapping.

The final part of the puzzle is what you do about problematic stims and this is the major bit that self-advocates don't seem to get or understand.  Children with autism do not learn like typical children.  You can't necessarily just talk to them about what part of a stim is a problem or when it is or isn't appropriate like you could a "typical" child.

At best the child with autism might have trouble applying what you saying when faced with the urge to stim, at worst they won't have the functional communication to understand what you are trying to explain.  This is why many parents use one of the forms of behaviorism to help them teach their children.

Two of the core ideas with behaviorism is that you have to be consistent and that you start with small, manageable bits of behavior and work your way up.  You don't start with a problematic stim in the most stimulating and stressful environment, you instead start teaching them to control the stim in a more relaxed, less stress environment and work up to the harder environment.  And, if the child doesn't have the ability to understand that different locations have different rules, you have to consistently stop or redirect the stim every time that it appears.  Alternatively you establish one place were the stim is allowed and stop it everywhere else.

I've really just scratched the surface of the issues involved with stimming in autism but I hope the point is clear.  Stimming is not a one dimensional "the parents are just embarrassed" sort of issue and any discussion that just focuses on that is not a "great discussion" of this complex issue.