by Bret Thayer

An Autism Stereotype

We have all seen an autistic child on T.V. or in the movies, hunched over, rocking, perhaps even biting themselves in a display of behavior that strikes the neurotypical person as bizarre, crazy, or really out there. And yet, many of us, whether we are on the spectrum or not, may use a type of stimming behavior, although we might not realize it.

For example, as a neurotypical person, I often find myself drumming my fingers in odd patterns on the counter top as I am thinking about what to make for dinner; when I’m lying in bed trying to wake myself up, I fidget with my feet and toes.

In my classroom, every time I give a test or an assessment to my students, I see many of them tapping or spinning their pencils. Often, several students are bouncing their legs under their desks. To an autistic person, stimming behavior can be a common occurrence, but it is often met with surprise, annoyance, and shaming as it is often perceived as socially unacceptable behavior.

What Is Stimming?

Stimming or “stim” is self-stimulation which is commonly associated with autistic behavior. According to the DSM-5, a manual to help to diagnose autism, stimming is seen as a repetitive pattern of behavior which may manifest as “stereotyped or repetitive motor movements” (CDC Diagnostic Criteria for Autism).

Why Do People Stim?

Neurologically, one theory associates stimming with the release of beta-endorphins, a feeling of pleasure, due to a stress response (Autism360). Other theories center around the idea that the autistic person is using stimming as a means to comfort themselves given the environment that they are experiencing.

“Theoretical perspectives suggest that stimming has a sensorimotor basis…More recent theories have suggested that stimming my provide familiar and reliable self-generated feedback in response to difficulties with unpredictable, overwhelming and novel circumstances. As such, stimming may provide familiar and reliable self-generated feedback in response to difficulties with unpredictable, overwhelming and novel circumstances” NIH Autism (2019).

Stimming can result from an autistic person experiencing over-stimulation or under-stimulation, for example, or as a way to reduce a painful sensory experience. It can also be a way to manage emotions such as nervousness, excitement, or impatience or as a way to help maintain focus. Cynthia Kim, an autistic adult, sums up her experiences with stimming this way:

“Stimming happens for many reasons. I stim when I’m anxious. I stim when I’m thinking. I stim when my senses are overloaded. I stim when I’m happy. Stimming is a way of regulating my body and my mind. It calms me down when I’m over stimulated and reconnects me with myself when I’m under-stimulated. Often, I don’t even notice that I’m doing it” (Neurodevelopment Center).

Stimming may result in an autistic person having increased focus and attentiveness, it may be soothing and help to regulate emotions, and it may help in expressing pent up emotions. Stimming might actually be easier and more natural for an autistic child to express their anxiety or emotional distress than it is to verbalize their emotions.

Examples of Stimming

There are many different types of stimming behavior which can correlate to an autistic person’s sensory experiences in the moment (Medical News Today).

Stimming behaviors can range from physical or tactile movements, to engaging in smelling, auditory or visual stimuli. Types of stimming also differ among individuals in frequency, duration, and intensity.

The Urge to Stop Stimming

Since stimming is an obvious physical behavior in an autistic person, often neurotypical adults seek to limit or treat this behavior. Many caregivers and teachers might want to limit stimming due to the social repercussions that an autistic child might endure: bullying, alienation, or being socially rejected, for example. Others may feel that this behavior disrupts the learning environment for other students. And some stimming behaviors, such as biting or scratching can be harmful to the autistic student and to others.

Should stimming be stopped? “That’s the wrong question to ask”, according to Karen Wang, a parent of a neurodiverse child.

“First of all, no one can stop self-stimulatory behavior completely, because everyone does it anyway! Secondly, even if one stim can be removed, it will be replaced by another — and the next stim may be less preferable than the current one. The most important reason not to eradicate stimming is that you may cause your loved one to withdraw more and more and lose your opportunity to encourage healthy interactions. The far better question is, ‘Why does my child engage in this behavior?’ Seeking to understand the motivation for a behavior is always a great place to start” (Child Mind Institute).

If stimming is leading to physical harm of the child or to those around them, then the behavior should be modified to another stim response that is not as harmful and produces the calming effect that many children on the spectrum are seeking in a stressful environment. If there is a physical cause behind stimming, such as ear infections, chronic pain, or migraines, a medical exam can help to treat these underlying factors.

Another way to manage stimming is to look at the sensory factors that are leading the child to engage in this behavior. Why is the child feeling anxious? What are the sensory stimuli that the child is experiencing? Can these be reduced or managed? What is the child’s emotional response to this environment?

Distracting from the current environment through a change in physical activity or exercise may also help. From my own son’s experience, having a chance to take a break and walk around away from the stressful situation was extremely helpful.

A Bridge To Understanding

In a 2019 UK study, 32 autistic adults were asked to share their perceptions and experiences with stimming. Many reported that stimming was an “adaptive mechanism that helped them to soothe or communicate intense emotions or thoughts” (National Library of Medicine). Participants also expressed their frustration around being in environments that intentionally tried to eliminate the behavior or from those who had negative reactions to their stimming behavior. This often left them with the feeling that they had to try to change their behavior to better fit into the neurotypical world.

“They expressed that others might feel annoyed, stressed or alarmed by their stims and stated that observers might view them as strange, aggressive, sad, ridiculous or childish. Many wished to avoid drawing negative attention and, in response to feeling marginalized, attempted to suppress their stims in public. They also reported stimming when alone, for this reason.”

National Library of Medicine

The study concluded that participants felt that stimming provided an important coping tool and that promoting acceptance through understanding was key to the acceptance of non-harmful stimming in autistic adults (National Library of Medicine).

Ultimately, stimming is a healthy way of self-regulation for those on the spectrum. Schools and businesses would do well to allow this behavior and to offer accommodations for appropriate stimming. If we demystify the reasons for stimming while acknowledging that many of us engage in this behavior, it will go a long way to reduce the stigma behind stimming.

Bret Thayer has been a public school teacher for 27 years in Colorado. He is a parent of an autistic child and is the co-host for the Understanding Autism Podcast.

The post Stimming appeared first on Understanding Autism.

By Bret Thayer

Eye contact is a central part of how we communicate. It connects us to other people in a unique and personal way. In Western culture, making eye contact is a sign of engagement, self-confidence, and a non-verbal sign that, ‘Yes, I am paying attention to what you are saying.’

But what do we think when we are speaking with someone who does not make eye contact with us? Are they oblivious, indifferent, or lack any interest in what we are saying? While many autistic people experience challenges in maintaining eye contact, it is important to remember that not all do; autism is a spectrum disorder, impacting different people in different ways.

Neurological Factors

There are three main causes for lack of eye contact: neurological, sensory, and emotional. In one 2017 study, scientists believe that the subcortical area of the brain (activated by eye contact and responsible for processing emotions and facial recognition) is oversensitive to direct gaze and emotional expression in autistic individuals Mass General Research Institute. When autistic participants were presented with fearful, happy, and angry expressions, over-activation of this region of the brain occurred. This suggests that “there is an imbalance between the brain’s ‘excitatory’ network, which reacts to stimulation, and its inhibitory network, which calms it down” Mass General Research Institute. This over-activation of neurotransmitters results in overwhelm, an aversion in making eye contact, and social anxiety for being in situations that require eye contact with others.

In another study, researchers at the Yale University School of Medicine found that autistic individuals who tried to maintain eye contact showed less activity in another area of the brain. “The experiment found that the dorsal parietal cortex was less active when a person with autism tried to maintain eye contact with their partner. The more severe the ASD diagnosis, the less their brain lit up” Psychiatrist.com. 

“The (Mass General Research) findings suggest that behavioral therapies that try to force individuals with autism to make eye contact could be counterproductive. A better approach may be to slowly introduce these individuals to eye contact so they can learn strategies for managing the accompanying sensations” Mass General Research Institute. 

Sensory Factors

To a person on the spectrum, maintaining eye contact is just one of many sensory experiences that they are processing in a conversation. The tone of the person they are speaking to, their body language, environmental noises, smells other environmental conditions contribute to a flood of sensory inputs that can overwhelm a person with autism.

The challenge of processing all of these sensory inputs can lead to physical discomfort, anxiety, and meltdowns which can have a profound impact for autistic people in socially intensive environments such as school and work.

“If you’re autistic, it might be difficult to explain to other people how a sound, light or sensation makes you feel. One thing that is important to get across is that this is very real, and it’s probably very different from how they experience the same sensory input.” 

Dr. Claire Jack, Psychology Today

Removing the social norm of maintaining eye contact in a conversation might help the autistic person to focus on other sensory factors and reduce the risk of overstimulation.

Emotional Factors

Conversations are an important part in establishing and maintaining human connections. Reading and interpreting emotional queues of a person that we are talking is a skill that we develop over time. Those on the spectrum may have difficulty interpreting facial expressions and experience frustration in predicting the next emotional response of the person they are talking to.

“Humans recognize different emotions, such as sadness and anger by looking at  facial expressions. Yet little is known about how we come to recognize different emotions based on the visual information of facial expressions. It is also not clear what changes occur in this process that leads to people with autism spectrum disorder struggling to read facial expressions” Neuroscience News.

Another factor which may impact a lack of eye contact may be an indication of boredom, that the topic is not engaging or simply that the conversation is taking a long time to develop. Not visually connecting with a person they are talking to may be a nonverbal signal to move on or a want to do something else.

Finally, eye contact is a form of trust building and can relay a connection between two people. Not engaging in eye contact might be a reflection of past experiences of alienation and social judgement or a defense mechanism due to past experiences.

Solutions

Eye contact is important but not in every single social situation. Autistic children should be able to decompress at home and feel safe to be themselves and not have to experience the same social expectations that cause them stress at school or work.

“Autistic children should not have to feel that they have to mask their autism at home. That should be the place where a person with autism can unwind and be their neurodiverse self. They should be able to relax and be themselves around their parents, which would be the most trusting relationship. It is more important for a child to decompress at home than it is to master eye contact” (Nicole Kubilus).

Find a teacher or educate teachers with not requiring eye contact so that autistic students can have a break in their day.

Building understanding with our loved ones and establishing a safe space at home applies to adults with autism as too. “Our best friends and life partner will not abandon us if we struggle to maintain eye contact. We should be able to feel comfortable with being our autistic selves in our closest relationships and not feel that we have to mask our autism all the time” (Nicole Kubilus).

Eye contact should never be forced. Stay away from therapies or practices that force autistic children to maintain eye contact.

“When considering whether you have made a wise choice in what therapy you are providing your child or not, you want to always remember a few cardinal rules: behavior is communication and/or a means of self-regulation. Communication is more important than speech. Human connection is more important that forced eye contact. Trust is easy to shatter and painfully difficult to rebuild. It is more important for a child to be comfortable and functional than to look normal” Maxfield Sparrow, “ABA” October, 20, 2016.

For those with mild to moderate autism, have an honest conversation with your child about eye contact. “Why do you feel uncomfortable making eye contact? When do you feel comfortable making eye contact?” Let them know when it is okay and not okay to avoid eye contact and why. Allow your child to feel comfortable practicing eye contact, in the mirror, with animals, or with toys, for example. Body-based therapies to relieve stress and tension such as yoga, somatic or craniosacral therapies might help too.

In the end, it is important to make your child comfortable with who they are and explain to them that everyone can struggle to maintain eye contact.

Mass General Research Institute 23 June 2017

Bret Thayer has been a public school teacher for 27 years in Colorado. He is a parent of an autistic child and is the co-host for the Understanding Autism Podcast.

The post Avoiding Eye Contact appeared first on Understanding Autism.