Repetitive Behaviors in Autism

Repetitive, purposeless behaviors are a common symptom of autism. Such behaviors might include repetitively lining up toys, spinning objects, or opening and closing drawers or doors. Repetitive behaviors can also involve talking or asking about the same thing over and over again.

Most often, repetitive behaviors are a tool for self-calming. They can become a problem when they get in the way of ordinary activities or make it tough to get through school or work.

This article explains the so-called stereotypical behaviors associated with autism as well as what these behaviors look like. It also looks at whether repetitive behaviors are a problem and discusses various treatments.

Autistic boy playing with toy cars
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Behaviors and Autism

Repetitive, apparently purposeless behaviors and obsessive, highly selective, and rigid interests are described as symptoms of autism in the DSM-5 (the official diagnostic manual for mental health disorders).

Autism experts sometimes call these behaviors "stereotypy" or "perseveration." Different types of stereotypy and perseveration are present in other neurological conditions as well. As their prefixes might hint at, "stereotypy" refers to the persistent repetition of an act; "perseveration" refers to the persistent repetition of words, phrases, or details that have been vocalized before.

According to the diagnostic criteria, showing a preference for routine (preferring to follow a set schedule, for example) isn't enough to suggest autism. Rather, the behavior must be "abnormal in intensity or focus," and changes to these behaviors must cause "extreme distress," according to the DSM. Furthermore, "restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following" are indicative of autism:

  • Stereotyped or repetitive motor movements, use of objects, or speech. Examples include simple motor stereotypes, lining up toys, flipping objects, echolalia, idiosyncratic (or unusual) phrases. Echolalia refers to when an autistic person repeats the words or noises they have heard someone else make. 
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior. Examples include extreme distress at small changes, difficulty with transitions, rigid thinking patterns, greeting rituals, and the need for the same route or food every day.
  • Highly restricted, fixated interests that are abnormal in intensity or focus. An example includes a strong attachment to or preoccupation with an object.

What Stereotypy Behaviors Look Like

Repetitive behaviors in autism can vary radically from person to person. For some, it involves saying or talking about the same things over and over again. This can include things like listing all of Marvel's Avengers and their powers, reciting scripts from TV, or asking the same question many times in a row.

For others, it involves physical actions such as repetitive rocking, flicking, or pacing. In more severe autism, stereotyped behaviors can be violent, like head-banging. Some people on the autism spectrum engage in repetitive behaviors constantly while others only occasionally perseverate when they're stressed, anxious, or upset.

Even people who are not autistic may become annoyed when they're asked to stop or change a certain behavior. But people with autism may respond to such a request in the extreme.

Exaggerated Responses Possible

When a person with autism is asked to change a routine, the response can be overwhelming anxiety or anger, even if the person is otherwise very high functioning.

Sometimes, perseverative or stereotypy behaviors are obvious because they're so unusual. Rocking back and forth for long periods, repetitively opening and closing doors, or rapidly shaking the head back and forth are clearly unusual behaviors.

Autistic perseveration may not be obvious to the casual observer. For example, an autistic person may ask, "Do you like Marvel movies?" If you say "yes," they may run through the same speech about "Iron Man" that they've recited 10 times before—in exactly the same words and with exactly the same tone and gestures. As a parent or close friend, you might know the speech backward and forward.

Are Repetitive Behaviors a Problem?

These types of behaviors aren't unique to people with autism. Most people engage in some such behaviors. Common forms of perseveration include:

  • A strong "need" to watch the same TV shows or sporting events, without fail
  • Compulsive cleaning
  • Nail biting
  • Pacing
  • Pencil or toe-tapping

For some people with autism, perseveration poses really no problem at all since it arises at the same times as it would for other people—usually under stress—and the behaviors are fairly unobtrusive.

Perseveration can even be a plus for people with autism since it may relate to a passionate interest that can lead to friendships or even careers. Someone with a perseverative interest in computer games, for example, can join gaming clubs and find others with a similar passion, thereby improving their enjoyment of life.

For many people with autism, though, perseveration or repetitive behavior is not only disturbing to others but is also a major roadblock to communication and engagement in the world. For example, a person who compulsively flicks their hands to the exclusion of anything else is clearly unable to attend to the world around them or take part in real-world activities. And while there is nothing intrinsically wrong with talking about the same subject in the same way over and over again, such behavior can cause a variety of social and practical problems.

Two Groups of Behaviors

Researchers separate repetitive behaviors into two groups: "lower-order" and "higher-order" repetitive behaviors. You might recognize the former if you've seen behaviors such as fidgeting, hand-flapping, or repeating certain words or phrases. The latter is typified by a desire for sameness, a preference for routine, and intense interests.

Causes and Treatments

No one really knows what causes perseveration in people with autism, though there are a variety of theories. The theory you espouse may cause you to select a particular treatment (or no treatment at all). Of course, if a behavior is dangerous or risky, it must be changed. Some treatments have been more fully researched than others, but all have had some success with some people and less success with others. Consider:

  • If you believe perseveration is a behavioral issue, you may use behavioral techniques (rewards and, in some cases, consequences) to "extinguish" the behavior.
  • If you believe repetitive behaviors are a self-calming technique used to block out too much sensory input, you may be inclined to use sensory integration techniques to help the person self-calm and regain a sense of control.
  • If you believe perseveration is a manifestation of real interests on the part of the person with autism, you may turn to therapeutic techniques such as Floortime or SonRise to connect with them and turn perseverative actions into meaningful activities.
  • If you believe the perseverative behavior is caused by anxiety or a chemical or neurological issue, you may prefer to control these behaviors with medication.

Summary

Repetitive and apparently purposeless behaviors and obsessive, highly selective, and rigid interests are known symptoms of autism. Experts sometimes call these behaviors "stereotypy" or "perseveration." The former refers to the persistent repetition of an act while the latter refers to the persistent repetition of words, phrases, or details that have been vocalized before.

These behaviors manifest in different ways, depending on the person. Some people may rock, flick, or pace repeatedly; others may talk about the same things over and over again. In severe autism, stereotypy behaviors can be violent, like head-banging. Some people on the autism spectrum engage in repetitive behaviors constantly while others only occasionally perseverate when they're stressed, anxious, or upset.

At times, these behaviors can present a problem. At other times, they don't—demonstrating that autism defies hard and fast rules.

A Word From Verywell

Contrary to what you may have heard, read, or feared: Autism is treatable. And you can take it from the researchers at the Autism Research Institute. Autistic people may progress through life slower than others, but they can still live happy and productive lives with the appropriate support.

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