Friday, February 8, 2008
I STIM, therefore I AM; S is for STIM
Stimming is a made up word, short for self stimulation. As that sounds a bit like doing the "bould thing", parents call it stimming.
It can be Twirling, SPINNING, clapping, flapping, finger clicking, hand chewing, clothes chewing, tearing, rocking, humping (yes, a bit bould) and well, the list goes on.
It can also be reciting something obsessively like the "Who's on First" routine from the movie "Rainman" with Dustin Hoffman. I like to call that "scripting". Or reciting all the features of a favourite item, like trains or animals, or the entire cast and crew from a favourite film. Or turning things on and off and opening and closing doors, windows or presses. (cupboards)
Or focusing intently on a particular detail of an object without really seeing the whole thing. It can also be asking the same questions again and again.
And some kids can double stim, focusing intently on something and then flapping, or doing a bit of scripting while finger clicking. And it can be intensely pleasureable for the person. They may appear to become absent while they are doing it; disappearing into a private world of ecstasy for a period.
Adults with autism who have overcome their communication challenges have been able to describe to the rest of us the purpose it serves.
I heard of a lady who was a university lecturer who did speaking engagements for parents of children with autism. She spoke of how she was able to pass an entire day in the company of students and fellow lecturers knowing that she could go home and indulge in a bit of paper tearing when she finished work. Paper Tearing. She had a stack of newspapers shoulder high in the corner of her sitting room.
Sounds no different to a glass and half of Beaujolais to me. Or half a packet of Tim tams. Or a packet of smokes. Healthier in fact.
But the sad truth of the stim, whatever function they serve, is that they make a child or adult stand out as a bit weird. And it can annoy the people around them. It can even upset their parents and loved ones as they appear to use it to block them out.
So what do we do about 'em?
Stamp them out! some of you will say. Allowing stims is just lazy teaching I was once told. (merde!)
I don't agree. Both for the fact that they are usually harmless and because what replaces them can be worse.
Imagine a kid with Autism as a suitcase stuffed full of sensory needs, that you as a parent is trying to zip up; there is too much in the suitcase so even if you sit on it and get the zip done up for a minute, The zip is going to burst in another spot and stuff will fall out.
If you do get it shut and maybe strapped up, you know that as soon as you open it all that stuff is going to burst out everywhere; usually at the most inconvenient place possible. Like when customs ask you to open your bag and you know that 14 pairs of dirty knickers are on the top.
So the first step is to discover the sensory function of the stim, and find a way to reduce or replace it.
We do this by way of a functional assessment. What purpose does the stim serve? Is it because the child has numbness and needs to shake or click or flap to "wake up" their hands? Like when your foot goes to sleep and you keep shaking it or when you come back from the dentist after an anaesthetic and you keep playing with your lip.
Is it because the area is overly sensitive and they like to comfort it? Like when you have a sore tooth that you keep probing with your tongue or a blind pimple you have to fiddle with.
(As in "see, it really hurts when I touch it"
"so dont touch it!"
"but I have to...." etc.)
You can try to work this out by recording when and how often the stimming occurs, and in reponse to what. You should also describe the stim in detail when doing this charting. It really helps to have access to an Occupational therapist or someone who understands the physiology of the body in relation to autism. Behavioural therapists who have worked in schools with a lot of different kids can help too.
A good O.T. will help suggest a replacement activity that serves the same need, but in a more appropriate way. A child that chews or bites things could benefit from regular oral massage with an electric toothbrush or massage toy. Oral B do a thing called a humming bird which is mean't for flossing but is a great little gum and cheek massage tool.
A child that likes to ride or hump things (like furniture) might need deep pressure massage to give them that sense of their body and muscles. For rockers and flappers there could be movement activities that balance out the need.
But you must do these on a regular schedule and not just in response to a spell of stimming. That just teaches the child to request the good massage with a stim!
As in: "If I rock in my chair, Mummy will take me to the living room and give me a good squash with the pilates ball"
You don't want it to work like that.
Regularly top up the sensory need with the suggested activities throughout the day so the need to stim does not occur. You can work out how often they need it by recording the frequency of the behaviour. And then trying to replace it just as often.
Teach the child to request the activity for themselves. This can help balance their internal sensory issues and teach them a valuable lesson in self soothing.
And all this work will help to reduce your child's overall sensory challenges and make the suitcase a little easier to close.
Speaking personally. I feel that many stims are actually a really clever means of self balancing that the child has come up with.
Yes, some stims are genuinely harmful such as face slapping, headbanging or hand biting. So you have to eliminate these as quickly and safely as you can by reinforcing an alternative that serves the same need. Self injurious behaviour should be treated with the utmost priority by everyone involved with your child.
But most stims are actually pretty tame and they just bother you, the parent.
And so I like to suggest that kids be allowed to stim, in controlled circumstances. And there are senior and well respected professionals in the field of Autism Intervention that agree with me.
Letting your child go and have a little bit of a flap or a twirl or even under very controlled circumstances, a little bit of a tear (no currency or cheques please!!)can help them to be happier in their own skin each day.
You can set a timer and allow them the space and time for it on a regular basis. You can even get them to work for it; or schedule it into free time. Give it a name and clearly identify when it is appropriate to do it; and it will give you the power to say when it is not.
We say to our Boo, "No Scripting at homework time" And then "Scripting in the car" or "Scripting on the forest walk". He has a visual reminder at his work station of what stims he is not allowed and we point to it when he indulges.
By the same token I will then tell Mr Hammie to leave him alone if Boo is having a flap while watching the credits at the end of a film, or walking in the forest while we script the "Rugrats in Paris".
I have also learned to insert myself into his verbal stims by repeating what he says and asking about aspects of it, until he was forced to "direct me" in the way he wanted it to go. It reduced its power and also made it a valuable speech exercise as I was eventually allowed to correct pronunciation and tenses, plurals etc. And the exercise has been brilliant for his articulation; which is pretty darn good it has to be said.
So Stims can be used as a power for good rather than evil!!
One of those respected behaviour analysts I mentioned earlier tells the story of a young adult with autism who was undertaking vocational training and had a work placement in a Zoo. The therapist negotiated with the Zoo management to set aside a private space for this young fellow to go and have a twirl break; not the chocolate bar, but a session of spinning and twirling. He could then go and do his job quietly and efficiently in the public eye without scaring anyone.
And stamping them out can also go seriously wrong:
I know of another clinical team that decided a patient in a residential hostel was annoying everyone with her habit of opening and closing curtains. So they came up with an extinction program. No more opening and closing curtains.
Unfortunately the patient began to smash the windows instead.
And everyone longed for the good old days when she used to just open and close curtains.
So that is my stand on Stimming. As a sensory need.
Parents and professionals will disagree with me. Sure there are days when I disagree with me.
But in the absence of comprehensive behavioural analyis and consultative support, reducing and controlling in my case will have to do.