An OT’s Thoughts on Stereotyped Behaviors – Part 2

An OT’s Thoughts on Stereotyped Behaviors – Part 2

Welcome back! My last post talked about stereotyped behaviors, what they are and how you can help determine their purpose. This post will talk about reducing them.

Once you have some ideas of why the stereotyped behaviors exist, you can start working on reducing them. If you are working with a child who is verbal, especially if they are older, make sure they are part of this process. Talk to them about the effects the stereotyped behaviors are having on them. You should be straightforward to really emphasize the fact that changing is in their best interest, and not just something you want to happen. “Hopping up and down and yelling might feel good, but it makes the other kids less likely to want to or hang out with you.” By making a person invested in changing, you are going to be more successful. Again, if your child is non-verbal, you are more likely to have to work by trial and error.

If the stereotyped behavior is sensory based, you want to try to substitute something that is more socially appropriate and less harmful. This should never be a power struggle. Give a person gum or chewy jewelry to stop them from biting themselves, their clothes or other things. Provide a trampoline to jump on before and after a situation where a child who jumps or stomps is asked to sit still. Offer something to the person and encourage them to try it. If they respond well, give them verbal praise and further encouragement. If they seem unsure, provide reassurance and praise and the choice to stop. Some strategies will not work right away. Keep trying! Keep offering a strategy for a week or two. Sometimes it just takes some time for a kid to accept something new. There are exceptions. If offering a new strategy makes a person angry or upset reassure them that they don’t HAVE to do this, and set it aside for the time being. Sometimes strategies will not work at all. Don’t feel bad, just try something else. Another thing to remember, is stereotyped behaviors can be reduced, but rarely extinguished. Why? Because it’s a habit, it feels good, and, sometimes, it’s fun. But it can get better!

For the last year I have been working with a boy with autism who stomps his feet frequently. His parents are concerned because the stomping is very hard and hurts his feet. He often had cuts on his toes and heels. They were also concerned because this stomping is very loud, causing people around them to complain while they are in the community. This young man is non-verbal, so I had to observe his behaviors and try to determine what he was getting from foot stomping.

Based on his behaviors, I theorized that this boy stomps his feet because he is looking for heavy input. By stomping his feet he is getting intense input to his feet, legs and hips, which helps him to calm and focus as well as giving him a better sense where his body was in space. So, I began to spend a significant portion of his sessions trying to give him input to his feet and legs. This starts with therapeutic brushing and a foot massage. Since he is looking for heavy input, I provide as much pressure as he will tolerate while massaging the soles of his feet with lotion. I will also use a handheld massager, but at times he does not want this. After this, we will go to a treadmill to run or a small trampoline to jump for several minutes to give him further input to his feet as well as to his legs and hips. I also provide an inflated balance disc for him to stomp on when seated to provide something for him to stomp on that will not harm his feet. Throughout the time I have worked with him, I have communicated with his family and demonstrated these activities. His parents are using some of the techniques I have recommended including the foot massages and giving him an inflated disc at home.

Over time this boy has reduced the amount of time he spends stomping his feet and how hard he stomps. It is often hard for me to see, because I see him frequently and progress with stereotyped behaviors is slow. But other people often tell me how much less he is stomping. Another indication is that he no longer has cuts and scrapes on his feet. I am very proud of this young man. He is better able to concentrate during his sessions after all that heavy work has been provided. He is also better able to indicate when he has had enough input to his feet. Sometimes he asks for more, and sometimes he tells me he is all done. As I said, he still stomps his feet. I cannot provide him with input that is as intense and immediate as he gets from stomping. But it doesn’t happen as often, and he is more likely to redirect to something else, like jumping on a trampoline or stomping on his cushion.

Stereotyped behaviors are a tough thing to work with. But with some dedication, brainstorming, and a good sense of humor, it’s possible to make it better. I hope these ideas are of help to you. If you have further comments, suggestions or success stories, share them in the comments below. If you have any questions or concerns, you can always call our Pediatric Center at 425-481-1933.

Join me again soon for our next topic, encouraging fine motor skills!