Stimming: Repetitive movements by people with autism are essential coping mechanisms

How many of us tap our pen on the table when we are bored, or crack our knuckles when we feel anxious? Or maybe we doodle when a meeting goes too long.

Chances are most of us have some habitual behavior that helps us pay attention or calm down when our nerves get the best of us. People on the autism spectrum are no different except their self-soothing behaviors tend to fall outside societal norms.

Characterized by repetitive motor movements or sounds such as hand-slapping and finger-flipping, “stimming,” short for self-stimulating behaviors, has historically been used as a diagnostic finding in autism.

Much like autism itself, stimming has been widely viewed as a clinical issue to be addressed and fixed, says Christopher Hanks, MD, medical director of The Center for Autism Services and Transition (CAST), The Ohio State University Wexner Medical Center’s specialized primary-care clinic for teens and adults diagnosed with autism spectrum disorder.

At CAST, requests to curtail stimming behavior come up frequently, mostly from parents of patients and sometimes from adult patients seeking to improve social assimilation, Dr. Hanks says.

But in talking with hundreds of patients during eight years with CAST, Dr. Hanks has come to understand that stimming is often an essential coping mechanism that helps people on the autism spectrum manage overwhelming emotions. His view is supported by a limited body of stimming research and a growing community of autism self-advocates.

“The idea of making (stimming) a medical problem concerns me,” Dr. Hanks says. “The last thing I want is for people to get the idea that stimming is bad. Stimming is an activity that is common in all people.”

Can treatment decrease stimming?

The most common treatment to decrease stimming is applied behavioral analysis, which uses positive reinforcement to promote behavioral change. Dr. Hanks believes such treatment can benefit individuals seeking to change their own behavior but has risks when imposed by someone else. When families are seeking advice about stimming, Dr. Hanks makes a point to seek input from his patients who are able to express themselves.

“If the person wants to stop (stimming), then it is reasonable to proceed with treatment. But if someone else is forcing it, that’s where we run into problems,” he says. “One of my challenges is: When individuals are able to communicate, they say, ‘It doesn’t bother me; it bothers mom or dad.’”

A 2019 survey of adults on the autism spectrum found that 80% said stimming reduced their anxiety and helped them calm down; at the same time, 72% had been told at some point in their lives not to engage in the behavior. Titled, “‘People should be allowed to do what they like’: Autistic adults’ views of and experiences of stimming,” the results were published in Autism, a peer-reviewed, international journal that publishes research to help improve the quality of life for people with autism or autism-related disorders.

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Can children outgrow stimming?

At least 50% of children on the autism spectrum stim. Many families wonder if they will outgrow it. Dr. Hanks says there is no perfect answer because stimming has not been well researched. The general assumption is that stimming lessens as people age. However, it is less clear if that decrease is the result of a natural progression or in response to social pressure.

The survey in Autism would suggest the latter: “Participants reported that stimming became less socially acceptable as one got older. … Several participants offered compatible narratives from their own experience, in that they stimmed happily as young children but by secondary school (11-16 years) norms changed, and they hid or transmuted stimming once aware of negative judgement.”

Can stimming be harmful?

Though stimming is generally a positive experience, certain stimming behaviors such as head-banging, slapping and biting can lead to physical harm. In these cases, exploring the underlying cause of the self-injurious stimming is the key next step.

If there are underlying mood or mental health concerns, treatment should be considered. Sometimes, the behavior is a way for the individual to communicate frustration or pain that they don’t know how to express in other ways. In such cases, it helps to identify the cause for concern, and teach alternative communication methods.

Ultimately, if the self-injurious behavior is purely a stimming behavior, working to replace it with a safer alternative is warranted.

A growing community of autism self-advocates

Stimming in autism was first described in the 1940s. Since then, there has been little research into stimming and none until the past decade that asked people with autism for their input, says Dr. Hanks, a clinical associate professor of internal medicine at The Ohio State University College of Medicine. That shift has coincided with a growing community of autism self-advocates, who are organizing through a variety of groups and forums.

In a story on the Autism Speaks website, Anne Nagel, a cognitive engineer and human factors specialist for the group, writes about how she has evolved her stimming over time to more socially acceptable behaviors, like turning her hand-flapping into a joyful raising-the-roof gesture. Along the way, she has invited her non-autistic friends to discover their own stims and uses the conversation to bridge the gap between the autistic and non-autistic worlds.

“Once (non-autistic) people realize the power of stimming,” Ms. Nagel writes, “they often start to do it themselves and can find the benefits from the emotional outlet it provides.”

Are attitudes about stimming changing?

Stimming has been misunderstood and maligned for decades. Attitudes are slowly changing as advocacy groups and physicians like Dr. Hanks help people understand the purpose of stimming. Dr. Hanks hopes public sentiment will shift as non-autistic people come to understand that stimming is how people on the autism spectrum manage the same daily stressors we all face.

“If (stimming) is not truly interfering with learning or work, we need to be a little more accepting,” Dr. Hanks says. “Maybe we as a society need to change our approach rather than changing the individual.”