Self-stimulatory behavior, also known as "stimming" [1] and self-stimulation, [2] is the repetition of physical movements, sounds, words, moving objects, or other behaviors. Such behaviors (also scientifically known as "stereotypies") are found to some degree in all people, especially those with developmental disabilities such as ADHD, as well as autistic people. [2] People diagnosed with sensory processing disorder are also known to potentially exhibit stimming behaviors. [3]
Stimming has been interpreted as a protective response to overstimulation, in which people calm themselves by blocking less predictable environmental stimuli, to which they have a heightened sensitivity. [2] [3] A further explanation views stimming as a way to relieve anxiety and other negative or heightened emotions. [4]
Although some stimming behaviors have been shown to be healthy and beneficial—as they help regulate intense feelings— [5] [6] stimming is often socially stigmatized and looked down upon. People who are neurodivergent often feel that they need to hide or decrease their self-stimulatory behavior, as it appears to not be socially acceptable, and often elicits an undesirable response from those who do not understand the compulsion behind them. There are also potential mental health and well-being risks in suppressing and masking autistic stimming behaviors that are harmless or adaptive. [7] [6] [5] [8] [9]
Stimming behaviors can consist of tactile, visual, auditory, vocal, proprioceptive (which pertains to limb sensing), olfactory, and vestibular stimming (which pertains to balance). Some common examples of stimming (sometimes called stims [10] ) include hand flapping, clapping, rocking, blinking, pacing, head banging, repeating noises or words, snapping fingers, and spinning objects. [11] [12] In some cases, stimming may be dangerous and physically harmful to the person doing it; for example, individuals may risk injuring themselves by forcefully banging their body parts against walls. [13]
Stimming behavior is almost always present in autistic people but does not, on its own, necessarily indicate the diagnosis. [5] [14] The biggest difference between autistic and non-autistic stimming is the type of stim and the quantity of stimming. [14] In the Diagnostic and Statistical Manual of Mental Disorders , published by the American Psychiatric Association, stimming behavior is described as "stereotyped or repetitive motor mannerisms" and listed as one of the five key diagnostic criteria of autism spectrum disorder. [15]
Different perspectives suggest that stimming involves both sensory and motor functions. Underdevelopment of these sensorimotor functions can result in stimming behaviors produced by the person as a controllable response. One study which interviewed thirty-two autistic adults found that unpredictable and overwhelming environments caused stimming. [16]
Stimming can sometimes be self-injurious, such as when it involves head-banging, hand-biting, excessive self-rubbing, and scratching the skin. [17]
As it serves the purpose of self-regulation and is mostly done subconsciously, it is difficult for others to suppress stimming. [18] Managing the sensory and emotional environment while increasing the amount of daily exercise can increase comfort levels for the person, which may reduce the amount of the need for stimming. [19] Consciously or subconsciously suppressing stimming with the aim to present as neurotypical is one type of autistic masking. [20] [21] It typically requires an exceptional effort and can negatively impact mental health and well-being. [20] [21] [22]
Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD due to relatively unimpaired spoken language and intelligence.
Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).
Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language, social engagement, bowel and bladder, play and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarities to autism and is sometimes considered a low-functioning form of it. In May 2013, CDD, along with other sub-types of PDD, was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.
Neurodiversity is a framework for understanding human brain function and mental illness. It argues that diversity in human cognition is normal and that some conditions classified as mental disorders are differences and disabilities that are not necessarily pathological.
Ole Ivar Løvaas was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well known for his research on what is now called applied behavior analysis (ABA) to teach autistic children through prompts, modeling, and positive reinforcement. The therapy is also noted for its use of aversives (punishment) to reduce undesired behavior, however these are now used less commonly than in the past.
A stereotypy is a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place. They are found especially in people with autism spectrum disorders, visually impaired children, and are also found in intellectual disabilities, tardive dyskinesia and stereotypic movement disorder, yet may also be encountered in neurotypical individuals as well. Studies have shown stereotypies to be associated with some types of schizophrenia. Frontotemporal dementia is also a common neurological cause of repetitive behaviors and stereotypies. A number of causes have been hypothesized for stereotypy, and several treatment options are available.
High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.
The Autism Diagnostic Observation Schedule (ADOS) is a standardized diagnostic test for assessing autism spectrum disorder. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and the person under assessment. The examiner observes and identifies aspects of the subject's behavior, assigns these to predetermined categories, and combines these categorized observations to produce quantitative scores for analysis. Research-determined cut-offs identify the potential diagnosis of autism spectrum disorder, allowing a standardized assessment of autistic symptoms.
Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that was pioneered by Robert Koegel and Lynn Kern Koegel. PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. In 2005, Richard Simpson of the University of Kansas identified pivotal response treatment as one of the four scientifically based treatments for autism.
Autistic art is artwork created by autistic artists that captures or conveys a variety of autistic experiences. According to a 2021 article in Cognitive Processing, autistic artists with improved linguistic and communication skills often show a greater degree of originality and attention to detail than their neurotypical counterparts, with a positive correlation between artistic talent and high linguistic functioning. Autistic art is often considered outsider art. Art by autistic artists has long been shown in separate venues from artists without disabilities. The works of some autistic artists have featured in art publications and documentaries and been exhibited in mainstream galleries. Although autistic artists seldom received formal art education in the past, recent inclusivity initiatives have made it easier for autistic artists to get a formal college education. The Aspergers/Autism Network's AANE Artist Collaborative is an example of an art organization for autistic adults.
Pathological demand avoidance (PDA) or extreme demand avoidance (EDA) is a proposed disorder, and sub-type of autism spectrum disorder, defined by characteristics such as a demand avoidance—which is a greater-than-typical refusal to comply with requests or expectations—and extreme efforts to avoid social demands. Any expectation, even routine activities or highly desired activities, such as getting ready to leave home to visit a playground, can trigger avoidant behavior. If the demand cannot be avoided, a panic attack or a meltdown may ensue. Depending on an individual's trigger, the intensity of their reactions may differ. Looking at a PDA profile can help determine explanations for the demand avoidance, whether it is internalized or externalized.
Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by deficits in reciprocal social communication and the presence of restricted and repetitive patterns of behavior. Other common signs include difficulties with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.
Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
Discrimination against autistic people is the discrimination, persecution, and oppression that autistic people have been subjected to. Discrimination against autistic people is a form of ableism.
Autism is characterized by the early onset of impairments in reciprocal social interaction and communication and restricted repetitive behaviors or interests. One of the many hypotheses explaining the psychopathology of autism, the deficit in joint attention hypothesis is prominent in explaining the disorder's social and communicative deficits. Nonverbal autism is a subset of autism spectrum where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5, are still nonverbal 10 years later.
The Ritvo Autism & Asperger Diagnostic Scale (RAADS) is a psychological self-rating scale developed by Dr. Riva Ariella Ritvo. An abridged and translated 14 question version was then developed at the Department of Clinical Neuroscience at the Karolinska Institute, to aid in the identification of patients who may have undiagnosed ASD.
Autistic masking, also referred to as camouflaging or neurodivergent masking, is the conscious or subconscious suppression of autistic behaviors and compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical. Masking is a learned coping strategy that can be successful from the perspective of autistic people, but can also lead to adverse mental health outcomes.
Current research indicates that autistic people have higher rates of LGBT identities and feelings than the general population. A variety of explanations for this have been proposed, such as prenatal hormonal exposure, which has been linked with both sexual orientation, gender dysphoria and autism. Alternatively, autistic people may be less reliant on social norms and thus are more open about their orientation or gender identity. A narrative review published in 2016 stated that while various hypotheses have been proposed for an association between autism and gender dysphoria, they lack strong evidence.
For some, stimming can include higher-risk behaviors such as banging their hands, head, legs, and objects, which may be potentially physically harmful.
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