Unit III: Thought and Behaviour in ASD
1. Motor and Verbal Stereotypes
2. Unusual Sensory Behaviours
3. Routines and Rituals
4. Play behaviours
1. Motor and Verbal Stereotypes
Repetitive and stereotyped behaviors (RSB) are an early diagnostic feature of autism spectrum disorders (ASD).
Motor stereotypies are common, repetitive, rhythmic movements with typical onset in early childhood. While most often described in children with autism spectrum disorder (ASD) and intellectual disability (ID), stereotypies can also present without developmental delay and persist into adulthood. Stereotypies are often disruptive and harmful, both physically and socially, and effective evidence-based treatments are lacking. This can be attributed, in part, to our incomplete knowledge of the underlying biological and environmental risk. Several studies implicate various neurotransmitters, brain circuits, anatomical loci, and pre- and post-natal environmental influences in stereotypy onset and symptom severity. However, there are few points of convergence among a relatively small number of studies, indicating that more research is needed to confirm the underlying bases of risk. Of particular note is the lack of published genetic studies of stereotypies, despite evidence for Mendelian inheritance patterns in some families. Focusing future studies on typically-developing children with primary motor stereotypies may be a useful approach to minimize potential biological, environmental, and genetic heterogeneity that could theoretically hinder consistent findings. Ultimately, a deeper understanding of the underlying biology and risk factors for motor stereotypies will lead us closer to more effective targeted therapies that will alleviate suffering in affected children.
Primary stereotypies can be classified into two groups, common (e.g., pencil tapping, hair twisting, nail biting) and complex (e.g., hand flapping, waving, finger wiggling etc.) (Singer, 2009). About 20% of children exhibit common types of primary motor stereotypies, while primary complex motor stereotypies are estimated to affect 3–4% of children in the U.S. (Singer, 2009). The typical age of onset for motor stereotypies is before 3 years, with 80% of cases exhibiting repetitive movements by age 2 (Harris et al., 2008; Singer, 2009). Motor stereotypies usually occur when a child is engrossed in an activity or experiencing excitement, stress, boredom, or fatigue. They may last for seconds to minutes and are completely absent during sleep (Singer, 2009). Children may report feeling satisfied and happy when exhibiting stereotypies, while others may be unaware of their own stereotypies and do not consider them to be disruptive or anxiety-provoking (Singer, 2013). However, in many cases, motor stereotypies can be self-injurious, socially offensive, or disruptive to desired activities (Maraganore et al., 1991; Symons et al., 2005).
Secondary stereotypies most often occur in children with ASD. Forty-four percent of patients with ASD report some form of stereotypic movement. Furthermore, the severity and frequency of motor stereotypies in ASD is correlated with severity of illness, degree of ID, and impairments in adaptive functioning and symbolic play. The frequency of self-injurious motor stereotypies is higher in individuals diagnosed with ASD compared to children with typical development, and highest among children who are diagnosed with both ASD and ID (Ghanizadeh, 2010).
Children with autism often display repetitive behavior that does not appear to be maintained by social contingencies (Turner & Durham, 1999). For example, children with autism may engage in non-contextual vocalizations, or vocal stereotypy (Gunter, Brady, Shores, Fox, Owen, & Goldzeweig, 1984). This behavior may consist of vocalizations unrelated to the context such as repeating portions of conversations, videos or books previously heard, and general unintelligible vocalizations. Several studies have used functional analysis methods to assess repetitive vocalizations in adults with various disabilities and mental illness.
Vocal stereotypy is a common problem behavior in children with autism spectrum disorders and may considerably interfere with the social inclusion of individuals who emit the behavior (MacDonald et al., 2007). Researchers have shown that noncontingent access to auditory stimulation may be used to reduce engagement in vocal stereotypy (Lanovaz, Fletcher, & Rapp, 2009; Rapp, 2007), but its application is restricted by the low number and limitations of studies conducted to date.
In general, vocalizations emitted by children and adults are maintained by access to or avoidance of social consequences provided by listeners. Skinner (1957) recognized that vocalizations often have a social function and coined the expression “verbal behavior” to describe behaviors that mediate the behavior of others. Although sounds or words produced by individuals are typically forms of verbal behavior, researchers have shown that some vocalizations persist despite the absence of a listener.
In children with autism spectrum disorders, vocalizations with a nonsocial function can be problematic because the behavior may (a) occur at significantly higher rates than in typically developing children and (b) interfere considerably with learning and social inclusion (MacDonald et al., 2007). These repetitive vocalizations share defining features with stereotypy, which are repetitive and invariant movements that persist in the absence of social reinforcement (see Rapp & Vollmer, 1995). Thus, the term “vocal stereotypy” is often used to refer to repetitive vocalizations that are maintained by nonsocial consequences. In this paper, vocal stereotypy will be used to refer to any repetitive acontextual sounds or words produced by an individual‟s vocal apparatus that persist in the absence of social consequences.
Other terms such as aberrant vocalizations and echolalia have also been used to refer to repetitive vocalizations that share similar topographical characteristics with vocal stereotypy (e.g., Gunter et al., 1984; Mancina et al., 2000). The term vocal stereotypy should be preferred when the function of the repetitive vocalizations has been confirmed as nonsocial because other terms only describe the form of the behavior; thus, their utility in facilitating the identification and implementation of function-based interventions is somewhat limited.
2. Unusual Sensory Behaviours
People with autism often have unusual responses to sensory stimuli. They may be hypersensitive — that is, over-sensitive — to some of the information coming from their senses. They may find common textures, tastes, smells, noises, or lights unbearable, or they may shrink from another person’s touch. At the same time, they may be hyposensitive — that is, under-sensitive — to other stimuli, or sometimes even to the same ones.2 Noise can be experienced as so nerve wracking that a child claps his hands over his ears and retreats into a closet, or noise can be utterly ignored to such an extent that a child with intact hearing appears deaf. It is part of the perplexing puzzle of autism.
In many studies, children with autism have been shown to experience such sensory issues much more often than either typically developing children or children with developmental issues other than autism. Unusual sensory experiences can therefore serve as a “red flag” for the disorder.
Due to sensory sensitivities, someone with autism might:
The seven senses
Alongside the commonly recognised “5 senses” (taste, touch, hearing, sight and smell) a person on the autism spectrum may also over-react or under-react to two additional senses: the vestibular and proprioceptive senses. These senses impact balance, motor skills and body awareness.
Hyper or hypo?
Many people with autism have difficulty processing everyday sensory information. They can be either hyper sensitive (over-reactive) or hypo sensitive (under-reactive) to sensory input, or experience fragmented or distorted perceptions.
A person’s responses to sensory experiences may fluctuate from one day to the next. Some days he or she may seek out certain sensory experiences but on other days he or she may actively avoid that same experience.
All people engage in behaviours to help regulate their sensory environment. When these behaviours are overt they become known as “stimming”. The amount and type of stimming an individual on the autism spectrum uses varies a lot from person to person. For example, some individuals with autism may just have mild stimming mannerisms, whereas others spend a lot of time stimming. Most forms of stimming are repetitive or unusual body movement or noises. Stimming can include:
3. Routines and Rituals
Some children with ASD have rituals. For example, your child might keep a favourite object in a specific place, like the bottom corner of a drawer in the bedroom. She might have to get it out and touch it before bed. Or she might drink only from a particular cup, or ask the same questions and always need a specific answer.
Routines are often important to children with ASD. They might like to eat, sleep or leave the house in the same way every time. For example, a child might go to bed happily if you follow his regular bedtime routine, but won’t settle if the routine is broken. Another child might get very upset if his route to preschool is changed, or might insist he puts his clothes on in the same order each morning.
Children with autistic spectrum disorder (ASD or autism) have difficulties making sense of their surroundings. They struggle with social interaction and social understanding, which makes the world appear frightening and unpredictable to them. They often develop routines and rituals to impose some kind of order or structure, and they may need to perform and repeat these rituals on a daily basis. These rituals can take the form of lining up objects, hand washing, or switching lights on and off, which eventually can become an obsession because the child feels compelled secured in completing the routines.
Many routines and rituals are harmless and are necessary for our day-to-day living. Normal routines and rituals, such as washing, tooth brushing, and bedtime rituals, are essential. Performing these tasks at a set time every time is beneficial to young children as it provides a level of predictability and security.
Routines and rituals are even more important to children diagnosed with autism as these help create structure in a world that appears chaotic and unpredictable to them. A change in routine can cause a child with autism to become very distressed, as the child needs that routine to feel safe and secure. This distress can result in aggressive behaviors or tantrums as the child struggles to try and maintain some control and familiarity in his environment. It is therefore important to prepare the child ahead of time of certain change or changes that may occur in his routine. This will greatly reduce any risk of distress or tantrums in the child.
Some rituals, however, can be potentially harmful such as poking fingers in electrical sockets or attempts of swinging from a ceiling light. One way of dealing with this is to distract or divert the child\'s attention away from the ritual and to find another point of interest that your child can focus on.
A way of incorporating a healthy everyday routine or ritual into the life of a child with autism is by gradually introducing a sequence or series of steps into the routine. This helps the child focus on one thing at a time and helps him slowly build on the previous steps until it becomes a complete series of steps. These essential routines help the child acquire the essential life skills needed to adjust to and fit in his surroundings and be independent.
4. Play behaviours
Autism has been shown to be associated with deficits in play behavior. The play behaviors of children with autism indicate that they tend to have severe deficits in play, both with toys and with regard to social behaviors. A consistent finding in the literature has been that both symbolic play and symbolic language are areas in which children with autism show specific impairments. Interventions to promote the play behaviors of these children have involved the use of either nonhandicapped or disabled peers, the use of specific instructions or verbal and physical prompts, highly structured one-to-one interactions involving adults and peers, or manipulation of the setting. Although different intervention techniques have been successful in promoting play behaviors, there is some concern about lasting effects after the intervention.
Because ASD affects the development of social skills and communication skills, it can also affect the development of important play skills, like the ability to: