Using Redirection to Avert Harmful Stimming

right-arrow-hiRepetitive behaviors such as spinning objects, opening and closing things repeatedly, rocking, arm-flapping, squealing, making loud noises or even hitting are common in those on the autism spectrum. Often ritualistic, they are known as perseveration or self-stimulatory behavior (stimming). While they may seem pointless and “weird” to us, they fulfill a very important function for the person carrying them out, such as relieving anxiety, counteracting and overwhelming sensory environment, regulating the nervous system or simply letting off steam. The frequency and severity of the behaviors varies from person to person.

When Stimming Becomes Dangerous

When responding to a call involving an autistic individual, you may encounter someone stimming in response to the stress of the emergency situation you’ve been called to. I always advocate letting the behavior continue, as it typically helps the person self-calm. The only exception is when they are hurting themselves or others. Self-calming may quickly escalate into self-injurious behavior such as hitting themselves, head banging, chewing their hands or biting themselves.

Redirection by definition means to direct again; to change the direction or focus; to channel into a new direction. It is a tool that can help interrupt the behavior. If the scene is safe you may be able to use this technique to modify harmful behaviors and help direct the person to an alternative, safer one. It may take a few attempts, but can successfully take the focus off negative coping behaviors and de-escalate the situation.

To redirect you need to quickly interrupt the negative behavior, with as minimal attention as possible. Of course, done at home in a calm environment a caregiver has an opportunity to teach, practice and continue positive reinforcement until the person can successfully recognize and modify the behavior. In the field, you may have to use a more dramatic interrupting method. Remember that you are not punishing the person for inappropriate behavior – a behavior that is serving a purpose for them – you are more or less “shocking” their system to allow for a new focus. This may look like using a different tone of voice, issuing a job or task, or even doing something outlandish, like breaking out into song. Yes, I have done this before with successful results!

I recently saw this on Facebook… definitely a true story for me.

redirection for autism meltdown

Initially you want to start with a high-probability request: one the person is LIKELY to comply with on the first request, without further prompting (“point to your nose”, “stand up”, etc.). Follow that with a series of two or three more high-P requests together and one low-P request (one the person is UNLIKELY to comply with). Keep it simple and offer praise after each successful high-P compliance. Extend and magnify praise when they comply with the low-P request.

When you are redirecting behavior, remember the whole point is to emphasize the replacement behavior that you want. If there is no replacement option, it will be impossible to redirect.

OW! Why Did You Just Punch Me?!?

One of the most challenging of my son’s behaviors on a daily basis is his impulsivity. It has also been magnified greatly since the onset of precocious puberty.

What is impulsivity?

On MedicineNet.com, it is defined as:

Inclined to act on impulse rather than thought. People who are overly impulsive, seem unable to curb their immediate reactions or think before they act. As a result, they may blurt out answers to questions or inappropriate comments, or run into the street without looking. Their impulsivity may make it hard for a child to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset.

What this would look like in school in our experience was my son blurting out a noise, walking up to something and knocking it down, bumping into someone, hitting his head on the desk, etc. This was probably the number one category of behaviors he repeatedly got in trouble for.

The teachers, the para professionals, the counselors, and the principal would always ask the same thing of him: “Why did you…? Why? What were you thinking?”

And he would always answer, “I dunno.” Sometimes he would giggle.

I got told the same thing over and over – that my son must have done whatever he had done on purpose, because he showed no remorse for his actions and refused to tell us why. They were infuriated. They would even go so far as to suggest for a behavioral blowup on a Tuesday morning that I punish him over the weekend by taking away TV and video games. Um… have you ever disciplined a dog 10 hours after he ate a shoe? How’d that work out for you?

Of course he doesn’t know WHY  he did it. Of course he feels no remorse – he doesn’t understand that he did something wrong.

It is NOT a calculated action.

It is NOT a manipulative behavior.

It is NOT intentionally disrespectful.

As a parent, it takes a lot of reminders for me to remember these things in the heat of the moment. When he rides the puppy, sticks his foot in my face, punches me, knocks into me while I have a cup of hot coffee in my hand, blurts out a screeching noise close to my face… this is impulsivity. He doesn’t think, “Hmmm… if I do THIS, it will make Mom yell.” (that’s my daughter’s job, ha ha)

Now, before you start yelling that I am giving him a free ticket to be a butt whenever he wants, that is not the case. I am always striving to find the delicate balance of understanding his actions but teaching him that they are inappropriate. In order to communicate with him in a way he will receive it, I have to remember that he is not doing it on purpose to physically hurt me or irritate the living crap out of me. (Again… teen daughter for that :) Kidding! She’s awesome!)

I also have to remember that sometimes he is just being a boy. My world is submerged in the study of Autism and I can sometimes forget that little boys can be imps.

I wish I could tell you WHY impulsivity is such a huge part of Autism. In fact, I tried to write this blog last week based on the science behind it and it just wasn’t happening. It is what it is, and I’m sharing what we experience and what helps. That’s all I can do!

So what does help?

Create a separate room for “free behaviors”. One of my favorite things to say to my son when his noises and behaviors are at their peak in the common living area is, “This is the quiet room. You may go in the noisy room to scream, throw things, punch your pillow (or keep doing whatever it is he is doing). Out here you need to be quiet and respect the rest of the family.” I even do it with the dogs – send them to another place when they are severely disrupting things in the family room.

Redirection. Ah, the magic answer that comes up a lot… because it works! Changing the focus, getting out of the power struggle and into a silly joke, task, or game will almost always set the stage for peace.

Social stories. My son lacks empathy – he is not currently wired to experience theory of mind (putting himself in another’s shoes). I have actually seen some pretty exciting gains when it comes to this, but for the most part I have to remember that saying, “How would you feel if…?” never gets the answer I want. Not because he’s being a butt, because he doesn’t know. Social stories – observing a third party in a similar situation – help him make a connection.

I’ve always been amazed that my son could do high school math but would burn his hand on our stove and go back and touch it again. The cause and effect factor is completely missing. This helps me understand that coming up to me and knocking down something I’ve just built does not warrant the punishment a parent might normally feel the need to dispense. I have to stop and think, just as much as I am teaching my son to do.

What about you? What challenging behaviors do you see that you can attribute to impulsivity? What helps? I’d love for you to comment below or share your experiences on the SOA Facebook page!

Regression or Progression?

I recently did my mid-integration checklist and interview for Justin’s Listening Training. As he is getting ready for his next intensive, I wanted to share some amazing gains I observed – new behaviors that I attribute to his first round of EnListen® and additional supports from home, including:

  • Introduction of Chewelry to redirect chewing (I’ll be dedicating an entire blog post to this great product shortly!!)
  • Addition of digestive enzymes, probiotics, and Omega Fatty Acid oil to his diet
  • Increased yoga and fitness routines after school

Understand that every child is different and may or may not show the same gains or at the same rate, especially after only the first intensive. These are things that improved in my child:

  • He now understands and carries out multi-step instructions (e.g., “Put on your socks, brush your teeth, and meet me in the kitchen.”)
  • Bathroom experience: his body now signals that he has to go – no more accidents (thank you!); it is an easier experience – 15 minutes in the bathroom instead of 45!
  • He is aware of possible consequences before proprioceptive crashing – Justin will now run up to things and stop and think first about whether or not it might be a good idea. He redirects himself for the first time.
  • Empathy, remorse – he consciously apologizes after accidentally hurting someone and doesn’t repeat action!
  • Fine motor improvement – he is better able to dress himself; he even wore jeans for the first time and buttoned them with no assistance!
  • Initiating bedtime on his own – he’s getting tired earlier in the evenings, and bedtime is no longer a long and drawn out process (except when he’s being a typical kid!)
  • Aware of why he has certain behaviors – when asked why he is displaying a certain behavior he is able to provide a logical answer rather than tuning out or shrugging it off
  • Report card improvement
  • Little to no spinning – much less stimming (excluding the return of recent verbal outbursts)
  • Realizing where he is in space – there is much less holding the walls when walking and chair tipping when sitting
  • Coordination, balance improvement – squatting, skipping, hurdles and obstacle courses, jumping improvement
  • Tactile gains – introduction of new clothing materials that previously were not tolerated
  • Initiating affection – this is a biggie! He is equating more with people and less with things.
  • Showing more independent thought and less echolalia (and much less regurgitated TV speak!) when asked questions or engaged in a conversation

Less than desirable changes noticed:

  • Expressing more frustration – this is due to experiencing certain feelings for the first time. Listening Training has begun the process of allowing him to be receptive to and in touch with his emotions. Justin will need to now learn how process those appropriately.
  • More meltdowns
  • The return of noises, verbal outbursts and personal space issues
  • Less motivation to complete schoolwork

Although this may appear to be a regression in behavior, I realize that Justin is experiencing a reorganization of how he sees the world and processes information. It’s going to take time for these changes to be integrated into daily practice. I have to dig a little deeper. Some of these behaviors are not necessarily a regression, rather familiar ways of coping with new feelings and experiences.

He is also reflecting his new feelings of frustration through verbal stimming and needs to learn new and appropriate ways of expressing them.

The next intensive will continue to address sound sensitivity as well as introduce organizational skills and theory of mind.

It is easy to focus on the behaviors we don’t want from our child when we see them, and immediately assume things are headed south once again. I don’t know about you, but raising a child with Autism is a roller coaster ride full of gains and regressions. It’s part of the process and I wouldn’t have it any other way.

Looking at this progress now on paper, he truly has made some incredible gains. It is imperative that the school and I continue to support him with reward systems, redirection, and behavior alternatives as he learns to integrate information in a new way.