Autism spectrum disorder (ASD), is a neurodevelopmental disorder that consists of three core symptoms namely, impaired social communication, difficulties in sensory processing, and the presence of repetitive and restrictive behavior. Restrictive and repetitive behaviors are highly misunderstood and often chosen to be prohibited using various behavioral interventions. Stereotypical behavior is defined as being repetitive, restrictive, and contextually inappropriate in nature (for e.g. arranging cars in a pattern or hand flapping). These behaviors differ from individual to individual and come in different forms (for instance, verbal or non-verbal).
Research has shown that stereotypical behaviors are not only restricted to individuals with ASD but also extend to individuals with other psychological conditions (for instance, intellectual disability, sensory processing disorder), healthy controls (individuals without a diagnosis) in various forms (for instance, shaking legs, biting nails, smoking), and very often in infants and toddlers without ASD. A pivotal difference in the display of stereotypical behaviors between individuals with ASD and without ASD is simply developmental (lack thereof in individuals with ASD) i.e., whether it follows the “normal” lifespan development course and whether or not it is used in socially appropriate manner. Hence, a fundamental question that comes to mind is whether it is ethical to change or stop this behavior without understanding its implications and role in the life of individuals with ASD?
Research shows that the presence of stereotypical behavior leads to deficits in learning and play behavior; and this link rightly categorizes this behavior as a candidate for various behavioral interventions. Unfortunately, what is not taken into consideration is that stereotypical behaviors are heterogeneous and not all the stereotypies hamper learning; for instance, verbal stereotypies are fundamental to developing language. This insight then warrants us to be cautious in choosing which stereotypies should be targeted for behavioral interventions versus which ones should be built upon.
Essentially, the stereotypical behaviors seem problematic when seen from the social lens i.e., when exhibited in social situations, these behaviors act as a barrier to adjusting and being accepted by the society. However, this isn’t the complete story. A study explored attitudes of 4 to 7 years old non-autistic children towards characters that portrayed symptoms of ASD. It was observed that except for poor gaze patterns, all their behaviors inclusive of stereotypical behaviors like hand flapping were not judged negatively by the non-autistic children. The exception of poor eye-gaze (while the teacher talks in class) was explored in an extended research study and the results show that the less favorability of this behavior was due to it being non normative (i.e., it being an indicator of disrespect and low attention in class). Furthermore, the behavior of hand flapping should only be a source of worry if it hampers the daily functioning of the child or garners negative social attention from peers.
Another reason why stereotypical behaviors should not be viewed negatively is that intervention models that function on the premise of stereotypical behaviors being adaptive and socially relevant seem to be more beneficial in bringing about a change than models that consider stereotypical behaviors as “problematic behaviors”. A theory relating to stereotypical behavior, claims that it is an automatic behavior maintained by sensory feedback. If this were the case, abruptly limiting these behaviors may lead to sensory overload in individuals with ASD. Hence, it is suggestible that a functional analysis of stereotypical behaviors should be carried out and the individual should be allowed to retain it in case the behavior is adaptive and socially relevant. In situations where the behavior is a barrier to either learning or maintaining social interaction, it should be replaced by an age-appropriate and contextually relevant alternative behavior.
In summary, it is essential to keep in mind that every individual, with(out) ASD is unique and hence it is essential to not change or alter any behavior blindly simply because it is non-normative. Newer interventions and mental health models should take this into consideration and look closely into the implications, function, and usage of a particular behavior in an individual’s life before deciding its fate (i.e., altering, changing, or completely stopping the behavior).
Urvi Mange
