Understanding Stimming, Hand Flapping, and Other Repetitive Behaviors

Stimming

Stimming is the common term used for self-stimulating behaviors. Stimming encompasses a number of repetitive actions and sounds such as hand flapping, spinning, and echolalia (repetition of words).

Stimming is generally a harmless way for people to self-regulate.

What does it mean when someone is stimming?

Everyone stims to some degree. However, It is often more pronounced in neurodiverse children.

People might stim for several reasons including:

●      To self-regulate. People engage in stimming behaviors to regulate their bodies or emotions. They might stim as a result of excitement, fear, frustration, or any other heightened emotion.

●      To seek pleasing sensory stimulation. Stimming often occurs simply because the action feels good.

●      To eliminate pain or discomfort. Stimming may occur for medical reasons. For example,  teeth grinding may occur to eliminate tooth pain.

●      To escape an aversive stimulus. Some people stim when they are in the presence of uncomfortable stimuli. For example, a child who has sound sensitivities may stim during times when the sounds in their environment are higher than their comfort level.

●      Boredom. Some people stim as a way of passing the time when they are unsure what else to do. This may be observed in children with limited leisure skills.

Should I pay attention to the reason my child is stimming?

It can help to identify the reason, or function, of a child’s stimming. Don’t feel that you have to take on this feat by yourself though. This is best approached with a medical and behavioral healthcare team.

If you suspect your child’s stimming may have a medical basis, it is best to rule this out. For example, a child with repetitive head banging may engage in this behavior due to headaches or other physical pains or discomforts that they cannot express. This harmful stim may help them to eliminate or refocus the pain. This is not true of all self-injurious behaviors. However, it is always a good idea to eliminate this as a possibility.

It is also beneficial to identify when a child is stimming to escape aversive situations. When children engage in stimming to escape or avoid particular stimuli or situations, honing in on what situations they are seeking to escape can help determine what alternative strategies and environmental modifications can be made.

Should I stop my child from stimming?

Generally, no. The reasons people stim vary. Oftentimes they don’t even realize that they are stimming, though it is serving a purpose for the individual.

Typically, stimming is considered harmless and does not require intervention. In the case of aggressive or self-injurious stimming, intervention may be needed. If stimming is interfering with your child’s ability to function and learn, or is otherwise interfering with their quality of life, then redirection may be recommended. Speak with your child’s behavioral health team to discuss their particular needs and develop individualized plans.

What is hand flapping?

Hand flapping is a stim commonly exhibited by children with autism. This looks like fast-paced waving in an up-and-down motion. Some children will hand flap once or twice. Others engage in sustained periods of hand flapping. Sometimes hand flapping occurs in isolation while the child is not engaged in other activities. Other times it occurs during other preferred or non-preferred activities. For example, a child whose favorite activity is watching cars drive past their house may flap their arms while excitedly watching the cars.

What age does stimming start in autistic children?

Stimming behavior such as hand flapping starts in infancy and early toddlerhood, during the age when other signs of autism become noticeable. Toddlers tend to be natural sensory-seekers however, so it is important to keep in mind that self-stimulatory behaviors do not automatically indicate an autism spectrum disorder. If you are concerned, it’s always best to bring your concerns to your child’s medical professionals.

Can hand flapping be “normal”?

Hand flapping is common in toddlers as a way of expressing excitement and moving about in their environment. Typically, neurotypical children will grow out of this behavior by around three years of age. Stimming, including hand flapping, does not always indicate that a child will have an autism spectrum diagnosis.

When should I be concerned about hand flapping or other repetitive behavior?

If your child is not diagnosed with ASD and you notice hand flapping or other self-stimulatory behaviors, there is not necessarily a cause for alarm. If you observe your child stimming frequently in conjunction with other early signs of autism, then it is recommended to seek a screening and/or diagnostic evaluation.

What are other signs of autism?

Signs and symptoms of autism involve delays in social communication and the demonstration of restrictive, repetitive patterns of behavior and activities.

Early signs of autism include:

●      Failure to make eye contact

●      By 9 months, does not respond to their name

●      By 12 months, cannot play basic interactive games such as peek-a-boo

●      Limited or no use of gestures such as waving

●      By 15 months, does not share interests with others

●      By 18 months, does not point

●      By 24 months, does not notice when others are hurt or upset

●      By 36 months, does not attend to other children or join others in play

●      By age 4, does not engage in pretend play

●      By age 5, does not sing or dance

Please note again, these signs do not immediately indicate that a child has an autism spectrum disorder. Each child progresses at their own pace and therefore will not meet all milestones by the expected age range. Early intervention is a factor in the best possible outcomes. Therefore, if you suspect something, it is recommended to play it safe by communicating your concerns with a medical professional.

Stimming examples

Most people engage in stimming in one way or another, even neurotypical people. Nail biting, hair twirling, and rocking in your chair are all common self-stimulatory behaviors. Take a moment to consider your own behavior and what stims you engage in. Perhaps you crack your knuckles or you tap your fingers while you’re thinking hard.

Stimming can be expressed through all of our senses-sight, touch, sound, smell, taste, vestibular, and proprioception.

Auditory stimming

Stimming that uses the sense of hearing is auditory stimming. Some people stim by humming, grunting, singing, or making other verbal noises. Other auditory stimming can include hand clapping, finger flicking or snapping, or the creation of other noises.

Tactile stimming

Stimming through the sense of touch is tactile stimming. Tactile stimming may manifest as touching or squeezing particular textures, rubbing one’s hands together, or any other sensory-seeking actions using the sense of touch.

Visual stimming

Repetitive behaviors involving the sense of sight are visual stims. Common visual stims include repetitive blinking, lining up toys or objects in a particular manner, staring at objects, and watching objects out of the corner of one’s eyes. Often times children with visual stims enjoy watching things fall, so these stims may be exhibited through throwing objects. 

Olfactory stimming

Some children stim through their sense of smell and/or taste. They may excessively sniff items or people or lick or mouth items that are not meant for eating. Many autistic children use chew tools and other products to support this sensory need.

Vestibular stimming

Rocking, spinning, and jumping are behaviors that involve our sense of balance and physical movement. These behaviors may be stims when demonstrated repetitively. Some children with autism repetitively rock back and forth or pace around their environment.

Proprioceptive stimming

Stimming may occur in ways that activate the proprioceptive system. Walking on one’s tiptoes, heavy lifting, pressure seeking such as hand or arm squeezing, and throwing objects are examples of proprioceptive stims.

Does stimming only occur in those with autism?

No! Everyone stims. Stimming is expressed in those with neurodiversity as well as neurotypical children and adults. We all stim in different ways and for different reasons. However, for those with autism and other neurodiversities, stimming may be more noticeable to others.

Why is stimming more evident in children with autism?

A key feature of autism spectrum disorder (ASD) includes challenges with social communication. Neurotypical children and adults tend to be more aware of social expectations and norms and therefore avoid behaviors that society deems as atypical. Children with autism are often less aware of those norms and simply engage in activities that feel good or help them regulate.

Bottom line

If your child stims, rest assured, we all do. While there are times when intervention is necessary to protect the child or others in their environment from harm, stimming is most often a harmless way of self-regulation. If you’re concerned, speak with your child’s pediatrician or another medical professional.

Resources

Diagnostic Criteria | Autism Spectrum Disorder (ASD) | NCBDDD | CDC. (2022, November 2). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

Everyone stims: When to redirect. (2016). Cigna.com. https://www.cigna.com/static/www-cigna-com/docs/individuals-families/bhs-autism-2016-july-handout.pdf

What You Need to Know About Stimming and Autism. (2021, April 22). WebMD. https://www.webmd.com/brain/autism/what-you-need-to-know-about-stimming-and-autism

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