Behaviour

In the past few years, whether we should modify or stop some behaviour has become a heated debate. Namely, should we stop or modify what is known as stimming, and should we try and make people with Asperger’s integrate into society even if it against their wishes? So I am doing a two part blog on these, first, looking at stimming.

Firstly, what do we define as stimming? In short, stims are compulsive movements that can serve to de-stress and aid concentration – alternatively when stimming is not performed it can be a cause of stress. For example, someone with aspergers syndrome may rap their fingers on the table, click or spin a pen, jiggle their leg or make small repetitive mouth movements (often in time to breathing). You can also get some more complicated stims like cutting fruit or vegetables, bending bits of metal, or, in some cases, self harming.

Stimming isn’t limited to just people with Asperger’s, or just people with autism, it occurs throughout the spectrum. For instance, I know a child with severe autism who hand flaps. Equally, I know an able girl with mild aspergers who is a regular leg jiggler. However, this is NOT obsessive compulsive disorder, OCD is when you have obsessive thoughts for which compulsions develop to ease the obsessive thoughts (i.e., constantly worrying about health and so spending hours washing hands)

So we have three options, do nothing, try and replace the stimming, or stop it outright. Ok, there are obvious problems with self harming stimming, not only is it dangerous, but it could be interpreted very differently. The fact is, many people will interpret this as a sign of depression, and, coupled with the fact that a lot of people with autism and especially aspergers get bullied quite often, they may well meet the diagnostic criteria for a diagnosis of clinical depression.

Now I have no doubt that they would be feeling down if they were getting bullied, but the self harming may not be because they want to punish themselves, or try to kill themselves (the two common reasons for self harming). It may simply be because it is the way they concentrate/relax. While this may need to be treated, it should obviously be treated in a very different way.

With self harming and depression, the standard treatment is a course of antidepressants (often Selective Serotonin Reuptake inhibitors (SSRIs) like Prozac) along with intensive therapy with a clinical psychologist, and try to stop the self harming – cold turkey. However, this may be the worst possible course of action for someone with a self harming stim.

If someone is stimming to relax, going cold turkey may in fact make them more anxious, and result in them becoming depressed. Admittedly by this time they may well be on antidepressants for the self harming, which will help with the anxiety, and so it may be that going on the antidepressants isn’t a bad thing, but telling them to stop the self-harming behaviour is.

What would, in my opinion at least, be a better option is to try and change the stimming. For example, imagine a boy who taps the side of the table with his hand when he is working, this would be very distracting to his peers. However, instead of getting him to stop it outright, what about trying to get him to move it to something, else, like tapping his leg? This may be less distracting. Then reduce it from using the whole hand to just one finger.

Or for cutting, changing it to scratching where they would be cutting, then to scratching through clothing, then scratching something which isn’t even on them. Yes this may take longer to achieve, but by transferring the stimming, it may enable them to function just as well as before.

However, is it really that easy to change stimming behaviour? The short answer, sadly, is often no. Although it may work for a time, it usually quickly returns. The trouble is, can be an unconscious habit, some, like leg jiggling or finger tapping are often unconscious, and people who do it are often unaware they are doing it until someone shouts at them for distracting them.

If you tell these people to stop it cold turkey, then they will spend there time thinking “I mustn’t stim, I mustn’t stim, I mustn’t stim” which stops them from concentrating on the task at hand. Which leads to more stress, which makes the desire to stim stronger. So we have just made things worse. So short of nailing their feet to the floor, or tying their hands behind them (which will just infuriate them) all that is left is just lots of small gentle reminders to try and stim in a different way.

The only other option is to just let it continue, do nothing, and trust in people’s tolerance. Personally, I tend to think that it is best to leave behaviours if you can, but if they are disruptive to others, cause harm, or are in some other way, detrimental, then I think that trying to change the stimming to some similar movement, which may have the same effect, but be less disruptive, is the best way to go.

I also think that when someone exhibits self-harming behaviour, it is crucial to consider whether this is a sign of depression, or simply a stim. However, this is just my opinion, I am not a qualified psychologist (well not yet!). So I don’t mean this blog as something to tell you what to do, just something that should be considered. More on this next week.

Joshua Muggleton – Fretting over A Level Finals!