Question:

My 9 year old son has a variety of stereotypical behaviors – he flaps his arms, he hops, he makes some odd writhing movements. They get worse when he is excited or overstimulated. He may have some Asperger`s, no one really knows what he has. At age 9 these behaviors are really sticking out and can be quite annoying and embarassing to the rest of the family when we are out with him, in particular his teenage brother. Do you have any suggestions of what to do about this?

Answer:

Stereotypic behaviors such as hand flapping, ritualistic pacing, spinning, lining up objects, or visual inspection of objects are thought to be “automatically” and intrinsically rewarding for many children with autism spectrum disorders.These activities may give a child a new sensory experience that is rewarding. One way to think about this is that many children with autism often do not have age-level play and social skills. Some pass time by engaging in repetitive motor behaviors. It is also possible that, though stereotypic behaviors are initially reinforced intrinsically, they may also become reinforced (i.e., strengthened) by social attention when caregivers try to stop or discourage the behaviors. These behaviors can interfere with learning if they occur a lot in the school setting. They can also “stigmatize” the child (i.e., make him or her appear odd).

There are at least 3 possible behavioral interventions (forms of behavior modification) that may be used to reduce such repetitive behaviors. These interventions are usually employed separately, but they may also be done simultaneously. If parents wish to reduce such behavior, they should seek the help of a behavior therapist.

• First, some therapists may decide to stop the behavior. Simply ignoring the behavior, if it is intrinsically rewarding, usually will not work. One usually attempts to stop the behavior with as little social attention as possible. Talking with or looking at the child is usually discouraged when preventing the behavior from continuing. The minimal amount of physical guidance to stop the behavior is recommended. Then caregivers and others around the child are coached to pay attention to the child again when the repetitive behavior has stopped.
• A second approach involves teaching the child how to play appropriately with toys. This approach works even better the child is exposed to toys that achieve the same or similar sensory experience provided by the repetitive behavior.
• If the repetitive behavior involves objects or household equipment, such as rewinding a part of a video cassette, a third approach is sometimes used. One can minimize the behavior by limiting access to those objects or equipment. Regardless of the approach used, any behavioral intervention for stereotypic behaviors needs to be highly individualized. We strongly recommend that parents obtain expert consultation with a qualified clinical psychologist.

  Some medicines may also help to reduce repetitive or compulsive behaviors. Sometimes the serotonin selective reuptake inhibitors (SSRIs; the Prozac-like medicines) are helpful. Examples are citalopram, sertraline, and paroxetine. The newer types of antipsychotic medicine (called “atypical” or “novel” antipsychotics) are sometimes helpful for reducing stereotypic behaviors. Examples of these medicines are risperidone, aripiprazole, and ziprasidone. Ordinarily, the antipsychotics would not be used solely to reduce repetitive behaviors, however, unless such behaviors were linked to other, more serious, behaviors. This is not frequent, but sometimes Ritalin-like medicines (methylphenidate, amphetamine) may actually make stereotypic behaviors increase in some children with autism-spectrum disorders. Parents and doctors should be watchful for this if a child with an autism-spectrum disorder is starting a new medicine for ADHD or if the dose of the medicine is increased.

The stereotypical behaviors that you mention can certainly be associated with pervasive developmental disorders (the global term that includes autism and Asperger syndrome). It is important that you get your child to a clinic familiar with autism and related issues, and with psychopharmacological management. Only then can a plan be best formulated.

For more information:

Go to the Autism health topic.