Thursday, February 4, 2010

Stim-Sense

This post is a cross-pollination between Barbara at TherExtras and JoyMama at Elvis Sightings –- co-authored by two bloggers who have never met in person, but hope one day they will.

When we move ourselves our bodies are wired to feel that movement. We humans have beautifully intricate wiring (nerves) connecting feeling (sensory) with movement (motor).

Some movement feels good. And with that basic understanding, seeing children who repetitively moved in (sometimes unusual) ways, charter psychologists called this behavior self-stimulation. Early in Barbara’s career, therapists commonly shortened this to self-stim. Currently, parents like JoyMama and others who encounter or engage in self-stim have learned to call these behaviors ‘stimming’.

Stimming is part of the DSM definition of autism, though the definition does not use the word, perhaps because it is not technically-defined, nor even in the dictionary. "Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)." However, one can receive an autism diagnosis without meeting this particular criterion -- and stimming is associated with other conditions as well. Not everyone who stims has autism.

Repetitive movement is important for learning -- a mantra of Barbara’s if you read her blog regularly. But stimming does not fit the "important for learning" category in the same way, and can actually impede learning. Most educational/therapeutic references to stimming are made with negative overtones.

Stimming is sometimes described in words like these: unproductive, obsessive, obstructive, annoying, consuming. These perceptions of stimming are common among people who are observing it, such as parents, educators, bystanders.

In the autism community, some think that since stimming is part of the autism definition, reducing the stimming amounts to a reduction in the autism. Applied Behavior Analysis (ABA), an educational technique intended to reduce autistic behavior, is associated with that approach.

But another list of descriptors implies a different perspective on stimming: pleasurable, centering, meditative, regulating, communing. You are more likely to hear these from people who engage in stimming themselves.

Within this second perspective stimming is viewed as similar to what neurotypical individuals do to calm or entertain themselves: thumb-twiddling, pencil-tapping, leg-jiggling, even knitting. Stimming as regulating activity is seen as beneficial for helping people "keep it together," allowing them to block out negative or frightening input and keep from feeling overwhelmed.

One particularly thought-provoking insider-view comes from Amanda Baggs, an autistic self-advocate. In the first few minutes of the video "In My Language" below, she shares some of her "stereotyped and repetitive motor mannerisms," as the DSM would say. The latter part of the video gives Amanda's own translation of the meaning of her movements, using a voice synthesizer (Amanda's means of speech).



Families of children with autism struggle to find a balance between stimming and education. How does stimming interface or interfere with learning?

Does the behavior stand in the way of beneficial play? Learning is the work of childhood. And stimming can indeed impede learning when it consumes the play-time and energy, or turns educational objects into stim-objects.

JoyMama and Barbara offer the following ideas... in two categories. (This is a brief listing. To find out more, ask the professionals who work with your child.)

Reducing or preventing stimming
  1. regular (daily is best) ‘heavy work’ or strenuous activity/exercise
  2. consultation with a psychiatrist to rule-out or treat co-morbid mental illness
  3. consultation with a neurologist to rule-out or treat co-morbid seizures
  4. structured lifestyle
  5. discovering and avoiding an individual's triggers for stimming (for example, Joy stims on ribbons and strings. Her family sometimes "disappears" such objects when the focus needs to be elsewhere).



Using stimming to benefit the person or enhance their life
  1. stimming as reward-breaks between learning activities
  2. allowing some stim that can be done simultaneously with learning activity - maybe chewing a tube can help your child focus on a book or drawing
  3. use stimming during learning-play -- place a stimmy-toy into a tunnel to crawl & retrieve, take turns with tossing/catching a stimmy-object
  4. enter into the stimming-world together -- letting gravel run between your fingers and toes feels good!



Therapists have a saying that if you take away one stimming preference, another will develop in its place. Complete elimination of a stimming habit might be unrealistic, and not even desirable, depending on what function the stimming serves. Stimming-related goals, like all goals, are best seen in the context of the whole child.

Re-evaluate on a regular basis whether you are satisfied with the progress of your child or the effectiveness of the therapeutic and educational methods being used.

Update September 2010: There's an excellent insider-perspective post at Reports from a Resident Alien about stimming and its purposes and the sensory channels it affects.

Would you share approaches you have used to prevent or incorporate stimming in the life of your child?

6 comments:

therextras said...

I read K's comment on the post below, and decided to 'break the code' on comments here.

Thank you, JoyMama for working with me on this post! I learned more about stimming and benefited from the challenge of putting what I already knew into clear communicative words.
Barbara

Elizabeth Channel said...

For us, identifying how his engine is running through the Alert program has helped him to transfer less desirable habits (like sock shredding) into more tolerable heavy work activities. Keeping his sensory diet in check really keeps the other in control, and the therapeutic brushing has helped a lot with this lately. Thanks for the thoughtful discussion!

Telemommie said...

I usually let my daughter stim away. There are a couple that drive me crazy though. Biting or sucking on a shirt is a bad one and I try to change the shirt ASAP. The one I'm fighting now is odd. She likes me to pick her up a few inches and drop her on her feet. She's 50 pounds and this hurts me, but it's a hour tantrum if I don't comply. We're working on lots of trampoline time and teaching her to jump in place. I'm wondering if this has anything to do with the ear infections we've been fighting for a month.

JoyMama said...

Barbara - and thanks to you as well! A fine learning experience for me too.

Elizabeth - thanks for connecting this with the "how is your engine running" concept. Good to hear that brushing is doing good things for your son -- we did the brushing/joint compressing protocol for quite a stretch when Joy was younger, and while she enjoyed it, it didn't seem to do much for her. Fascinating stuff. Oh, and Joy is pretty rough on socks too!!

Telemommie - interesting about the lift and drop. Joy loves to go up in the air and feel the bump as she comes down, but she puts a pretty big jumping effort into it so it's easier to make happen (plus she's just over 40lbs instead of 50!) Her therapists do a lot of jump-play with her, and she does beg for it but we haven't had the tantrum-level upset when the game can't happen, thank goodness. I hope trampolining helps wiht your daughter. Interesting question about the ear infection.

JoyMama said...

OK, just have to add an additional anecdote connecting knitting with stimming, that didn't quite fit in the actual post. When I was in college I took a philosophy class and one of my fellow students brought in her knitting one day. The prof embarrassed her thoroughly by equating knitting-in-class with m@sturbation -- "and I will not have m@sturbating going on in my class!" As if all self-stim had to have a sexual connection. Heh. But it was interesting to have that old memory be applicable. Besides which, I've since learned to knit somewhat, and can attest to knitting's meditative quality.

therextras said...

Wow. There are some really bad college professors out there.

In college, learning the various physical and psychological benefits of crafts as an OT student, I was struck with how relaxing it was to do needlepoint.

Stopped back in to recommend you read Margaret's compliment of this post, in comments on my top post now. Barbara