What is stemming in Autism Spectrum Disorder (ASD)?

Understanding Stimming in Autism Spectrum Disorder

Stimming refers to repetitive actions or posturing of the body, arms, hands, or fingers (including hand flapping, finger flicking, and atypical arm and foot movements) that serve as self-regulatory mechanisms for individuals with Autism Spectrum Disorder. 1

Definition and Characteristics

• Stimming is short for "self-stimulatory behavior" and includes repetitive body movements or repetitive movement of objects 2
• These behaviors are classified as "stereotyped or repetitive motor movements" in diagnostic criteria and are considered core features of ASD 2
• Common forms include hand flapping, finger flicking, rocking, spinning, and atypical arm and foot movements during walking 1
• Stimming behaviors may emerge early or late during the second year of life, depending on the individual and study design 1

Functions of Stimming

• Self-regulation mechanism: Stimming helps individuals with ASD regulate their emotional and sensory experiences 2, 3
• Emotional regulation: These behaviors help soothe or communicate intense emotions or thoughts 2
• Sensory regulation: Stimming can help manage sensory sensitivities, which are highly correlated with repetitive behaviors in both autistic and non-autistic individuals 3
• Cognitive enhancement: Movement can enhance thinking and focus for autistic individuals 4
• Energy release: Stimming provides an outlet for releasing energy 4
• Body awareness: These movements can increase proprioception and body awareness 4
• Self-identity: For many autistic adults, stimming has become part of their identity and self-expression 4

Clinical Significance

• Repetitive behaviors with objects and body are significantly higher in children with ASD compared to typically developing children 1
• The severity of repetitive and stereotyped behaviors (RSB) correlates with the overall severity of ASD symptoms 1
• Atypical body movements may serve as early markers for ASD, though this evidence is less well-established than other diagnostic markers 1
• Stimming behaviors should be distinguished from tics, which are seen in Tourette syndrome and can co-occur with ASD 1

Impact on Quality of Life

• When autistic individuals are able to stim, their self-efficacy (ability to cope with difficulties) is comparable to non-autistic individuals 3
• When prevented from stimming, autistic people report significantly lower self-efficacy than non-autistic people 3
• Many autistic adults view stimming as an adaptive coping mechanism rather than a behavior that needs to be eliminated 2
• Stimming can serve as a well-being resource to reduce distraction, overwhelm, confusion, and distress 4

Social Acceptance and Perception

• Stimming behaviors often attract negative judgment from others, similar to other atypical movements like mis-coordination during sports or dancing in unusual places 4
• Autistic adults report that stimming lacks social acceptance but can become accepted through understanding 2
• The neurodiversity movement has reclaimed the term "stimming" as a positive or neutral aspect of autistic identity rather than a pathological behavior 2

Treatment Considerations

• Traditional approaches often aimed to eliminate stimming behaviors, but current understanding suggests these behaviors serve important functions 2, 3
• Medications like risperidone may reduce irritability and aggression in ASD but are not specifically indicated for stimming behaviors 5
• Rather than eliminating stimming, therapeutic approaches might focus on understanding its function and supporting healthier forms of self-regulation 4
• Autistic adults generally object to treatments aimed at eliminating stimming behaviors 2

Clinical Pitfalls to Avoid

• Misinterpreting stimming as purely pathological rather than potentially adaptive 2, 3
• Focusing on eliminating stimming without understanding its function for the individual 2
• Failing to distinguish between harmful stims (self-injury) and beneficial stims (self-regulation) 4
• Overlooking the potential negative impact on self-efficacy when preventing stimming behaviors 3
• Not recognizing that stimming serves similar functions to socially accepted behaviors like dancing or exercising 4

Understanding stimming as a potentially adaptive behavior rather than simply a symptom to eliminate represents an important shift in how we approach autism spectrum disorder, with significant implications for quality of life and well-being of autistic individuals.