What Is Stimming?

Stimming describes self-stimulatory behaviors that involve repetitive movements or sounds. It commonly refers to behaviors displayed by people with autism spectrum disorder (ASD), such as flapping one's arms or rocking back and forth.

You don't have to be autistic to "stim." For example, tapping your foot when you're nervous could be an example of stimming. Stimming does look different, though, when it's a sign of autism. For instance, behaviors like finger flicking and twirling can become excessive and/or obtrusive in someone who is autistic.

This article lists examples of stimming. You will also learn why autistic people stim and how to help them manage stimming if it creates problems for them.

Examples of Stimming

If you're wondering if your loved one or child is stimming, pay attention to their behavior. Stimming suggests repetitive behavior that goes beyond what is considered culturally or socially acceptable.

For example, nail-biting and hair-twirling can be distracting but are usually acceptable in most social situations, like at work or school. Hand-flapping or spinning in circles—stimming examples that are common in autistic people—are less socially accepted.

Other examples of autistic stimming include:

• Finger-flicking
• Rocking back and forth
• Pacing back and forth
• Repeating words or phrases (echolalia)
• Humming
• Hard blinking
• Opening and closing doors
• Flicking switches
• Finger-snapping
• Spinning or tapping objects
• Covering and uncovering the ears
  

Reasons for Stimming

Although there is some debate about the actual cause of stimming, most experts consider it a tool for emotional self-regulation.

Autistic people often have sensory processing dysfunction. Depending on the type of response to stimuli this causes, they may over-respond or under-respond to things like sounds, light, textures, and smells.

For example, with a hypersensitive reaction, they might be overcome by a strong odor and experience sensory overload. With a hyposensitive reaction, someone might not react to or even noticing a loud noise.

In these sensory situations, stimming can:

• Block out excessive sensory input when someone is hypersensitive.
• Provide necessary stimulation to someone who is hyposensitive.
  
• Help manage emotions (positive and negative) that may feel too "big" for an autistic person to handle.
• Help distract from physical discomfort and pain.
  

Stimming Triggers

People with autism may stim in certain situations and in the presence of certain types of sensory input. Examples of stimming triggers include:

• Anxiety or stress
• Joy, happiness, or excitement
• Frustration, anger, or unhappiness
• Loud, crowded places
• An unfamiliar setting or unfamiliar people
• Boredom
• A change in plans
  
• An injury
• Uncomfortable clothing or shoes

Is Stimming Harmful?

Many autistic people stim when they're excited and happy, not just to defuse feelings of being overstimulated or distressed. While most stims aren't harmful, some behaviors can be.

Stims that may need to be managed to prevent physical harm include:

• Excessive self-rubbing or self-scratching
• Excessive nail-biting
• Head-banging
• Hand-biting
• Ear-clapping
• Slapping or hitting oneself

Stimming can also become a problem if behaviors persist for hours or become a daily occurrence. In these cases, they may actually cause distress and further impair the ability to self-regulate emotions.

These stimming examples often reinforce the stigmatization of autistic people. Potentially harmful stimming behaviors may continue and get worse if someone feels ostracized or alone.

ADHD Stimming

Some of the reasons why autistic people stim are shared by people with attention deficit disorder (ADHD) who stim. A person with ADHD who is "fidgety" is often trying to self-regulate their need for stimulation in a situation where they are feeling under- or unstimulated.

There are also some differences: For example, an autistic student may stim in class because the light and sound in the room are overwhelming, while a student with ADHD may find that stimming helps them focus. For other people with ADHD, stimming simply becomes a habit.

How to Manage Stimming

There is no reason to stop someone with autism from stimming if it's not causing problems. It's only when stims are very disruptive (such as in a school classroom) or dangerous (e.g., causing injury) that they need to be managed.

It can be hard to change stimming behaviors. Caregivers may think punishing an autistic child when they stim will make them stop, but it can actually make the situation worse. Punishment ignores the core reason that a child is stimming.

Remember that stimming is a tool for coping. It is not "bad" behavior—it's not even necessarily an intentional behavior.

There are a few techniques for helping an autistic person manage stimming:

• Applied behavior analysis: This is a form of behavioral therapy aimed at getting autistic children to adapt to social situations that they may not understand. It involves positive reinforcement for positive behaviors and consequences for negative ones. ABA therapy is controversial. Some experts do not think it is appropriate or an effective way to help autistic people.
• Sensory diet: A "sensory diet" is a form of occupational therapy that tries to reduce stimming by scheduling activities into a child's day to meet their individual sensory needs.
• Environmental changes: Reducing environmental and social stresses can reduce the risk of sensory overload. This may involve placing a child in smaller classrooms, soundproofing windows and rooms, and removing textures or lights that might be upsetting to them.
• Stress management tools: Introducing objects like a stress ball or fidget can help some people transition to different stims. A swing set or a dedicated quiet space with sound-blocking headphones can also be useful.
• Medications: If needed, medications like Risperdal (risperidone) and Abilify (aripiprazole) can be prescribed to reduce the irritability and aggressiveness that can fuel excessive stimming. These may be continued or used just until adaptive strategies begin to work.

Can Tests Diagnose the Cause of Stimming?

While it's a central feature of autism, stimming itself is not a disorder.

Diagnosing autism can be difficult. There is no single medical test that can specifically identify it. As a spectrum disorder, autism presents with a range of symptoms and severity in different people.

The diagnosis of autism is made based on criteria that are outlined in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual, Fifth Edition (DSM-5).

To be diagnosed with autism, a person needs to meet all three of the following DSM-5 criteria:

• A deficit in social-emotional reciprocity: A person is unable to have normal back-and-forth conversations, share interests or emotions with others, or start or respond to social interactions
• A deficit in non-verbal communications: A person is unable to comprehend social cues or express themselves nonverbally (such as with facial expressions)
• A deficit in developing, maintaining, and understanding relationships: Includes difficulty adjusting behaviors to social situations, engaging in imaginative play, or exhibiting interest in friendships or making friends

When to See a Healthcare Provider About Stimming

Stimming does not need to be medically treated unless it is harmful to the person or people around them. For example, aggressive behaviors like head-banging or hand-biting, or actions like nail-biting, self-scratching, or ear-clapping can cause physical injury.

Speak to a healthcare provider if stimming behavior fits this description. They may suggest making changes, such as taking medication if not already prescribed.

Summary

Stims are behaviors like rocking, hand-flapping, and repeating words or phrases. Autistic people engage in stimming to help manage their emotions or block out overwhelming sensations.

Stimming does not need to be treated unless it is constant, disruptive, or causes harm. In these cases, behavioral therapies, environment changes, stress reduction tools, and even medications can be used to help manage stimming while a person learns skills to regulate their emotions.