Ever notice that when you get antsy, you start to tap your foot or shake your knee? Or when you’re happy, you can’t help but throw your hands in the air and shout with glee? These are both stims, or examples of stimming behavior. While most people associate stimming with autism, everyone expresses some form of repetitive sensory output, be it for anxiety, self-regulation, or improved focus. For many children with disabilities, however, stimming comprises a wide range of behaviors. While most are beneficial to a child’s development and emotional state, some stims can become harmful to the child or others if not addressed and supported.
It’s a complex topic, so we spoke to several experts to help us understand the nuances and spectrum of stimming; how it relates to children with autism, Down syndrome, or higher support needs; and how parents can help their communities adopt a neurodiversity-affirming approach to stimming: Jackie Kancir, executive director of the National Council on Severe Autism, patient advocacy director of CureSynGAP1, and mother to a child with severe autism; Dr. Sarah Pelangka, PhD, BCBA-D, special education advocate and creator of Know IEPs; Jennifer Torgrude, financial planner and advisor for families with disabilities, board member of the Down Syndrome Association of Wisconsin - Fox Cities, and mother to a son with autism and Down syndrome; Breea Rosas, EdS, NCSP, LEP, neurodiversity-affirming school psychologist and expert in strength-based assessments for neurodivergent individuals; and Dr. Allison Ratto, clinical psychologist at the Center for Autism Spectrum Disorders at the Children’s National Hospital in Washington, DC, as well as associate professor at the George Washington University School of Medicine.
Stimming, as it’s more colloquially referred to, is short for self-stimulatory behavior (sometimes also called autistic stereotypy) and refers to the repetition of certain movements or sensory actions — such as making sounds, seeking out certain smells, or engaging in physical behaviors like chewing or rocking — that may appear to serve a seemingly unknown purpose. Our sources, however, all tell us that stimming does serve a purpose; in fact, it can support the person stimming in multiple ways, especially children with disabilities.
“From a clinical standpoint, it’s considered repetitive behavior. Oftentimes, it’s considered seemingly purposeless, repetitive behavior — the purpose isn’t apparent on the surface,” says Rosas. “The spectrum of stimming is quite broad, and it serves many purposes. The primary one is regulation. So for many of us, it serves as a regulatory process or coping skill.”
This regulation can happen in any combination across the eight major sensory systems, including the five senses of smell, touch, taste, vision, and hearing, as well as the three more internal systems: vestibular, proprioceptive, and interoceptive. While anyone can stim (and just about everyone has exhibited stimming behavior at one time or another), stimming is closely associated with children and adults diagnosed with autism, though stimming plays a part in other disabilities as well, such as ADHD and Down syndrome.
Dr. Ratto adds that as research has developed, stimming as a colloquial term is also sometimes used to refer to some self-stimulatory behaviors for children with autism that are less obvious, such as the need for a rigid and consistent routine or the intense pursuit of a particular interest (more on this later).
In this clip, Rosas explains what stimming is and why people do it.
There are different types of stims associated with each bodily sense or system.
Auditory: this form of stimming involves a person seeking out and creating a particular sound. This might include humming or clicking, listening to music, or, as in the case of Torgrude’s son, Noah, listening to content in foreign languages.
Oral: this form of stimming involves actions with the mouth, such as chewing on things (e.g., jewelry, pencils, fingernails, lips), opening and closing the mouth, biting, and teeth grinding.
Olfactory: this form of stimming involves smells, usually seeking out specific scents (and sometimes tastes) from objects or organisms.
Tactile: tactile stimming centers on touch and engagement with certain objects and textures. This can look like a child seeking out clothes of certain fabrics like wool or silk, touching preferred objects like clicking a pen, or desiring water contact. It can also include certain body-focused repetitive behaviors (BFRBs) such as picking at skin, biting nails, playing with or pulling hair, or repeatedly touching a part of their body. BFRBs are also often associated with other conditions, such as obsessive-compulsive disorder or Tourette’s syndrome.
Visual: visual stimming can appear less obvious than other forms of stimming because it revolves around the child seeking out specific visual stimuli, such as looking out the window at trees or staring at light sources. Kancir, for example, notes that as a baby, her daughter Jadyne hated tactile toys but loved watching videos and programs of talking heads on a screen, zeroing in on a single person. Visual stimming can also include a child arranging toys or objects in a specific order or pattern.
Vocal: vocal stims are sounds, songs, phrases, words, or any other repetitive vocal expression.
Vestibular: there is some overlap with vestibular and tactile stimming, but vestibular stimming more specifically involves physical motion and engagement of the vestibular system of balance and spatial orientation. Rather than engaging in touch, vestibular stimming manifests as physical actions, such as spinning, hand flapping, pacing, rocking, and hanging off of furniture and equipment.
Proprioceptive: like the vestibular examples, proprioceptive stimming involves physical engagement and often some form of movement. It is distinguished by the desire for deep physical pressure on muscles and joints, such as wearing a weighted vest, sitting or lying in certain positions, self-hugging, or moving heavy objects. Kancir notes that her daughter enjoys helping carry groceries and wheeling out the trash bins as a form of proprioceptive stimming.
Interoceptive: this form of stimming engages the body’s internal systems and their connection to the mind’s self-awareness, such as recognizing signs of thirst and hunger, the need to use the bathroom, and signals or pain and nausea. Some common interoceptive stims are holding one’s breath, clearing one’s throat, engaging in physically intensive movements that change one’s heart rate, eating repetitively to feel digestion, and seeking out changes in body temperature.
Mental: these are internal (often invisible) stims that happen in the mind. They can include repeating words, phrases, sounds, or songs; counting or cycling through numbers; visualizing patterns or detailed images (real or imagined); replaying music or sounds; or silently reciting facts and information.
Sexual stimming: some forms of tactile, vestibular, and proprioceptive stimming can involve movements or touching that may stem from sexual urges or involve stimulation of the genitalia.
As parents, both Kancir and Torgrude noticed their children’s stimming from a young age. Some stims may simply look like typical childhood development, and their purpose isn’t always apparent. Torgrude notes that with her son, who has a dual diagnosis of Down syndrome and autism and is non-speaking, she first saw his vocal stims as a toddler as the babbling children do before they begin using words. “As he got older, we noticed teeth grinding, maybe elementary age . . . a lot of rocking, and then he would do what we call a vocal stim, making vocalizations,” she says.
How a child stims can change as they age. In her work as a school psychologist, Rosas has noted that a child’s stims may change with puberty, as hormonal shifts may lead to more genital self-exploration and self-touching. Sometimes the changes can be random; Kancir notes that her daughter hated water for many years “until she didn’t” without any direct cause — and then desired multiple baths a day. Changes in stims, according to multiple sources, aren’t any cause for concern unless they put the child in a vulnerable position either of self-harming or of drawing negative attention from others around them, which we will discuss in more depth later in this article.
Research on adults with autism suggests that some children’s stims may decrease in intensity once they reach adulthood. An article in the journal Research in Autism Spectrum Disorders states that a child’s stims may remain stable throughout childhood and adolescence, but as their environment changes in adulthood, so might their means of stimming. The article notes, however, that this may be due to how certain stimming behaviors are perceived by other adults.
Rosas adds that, generally, what works for a child stimming-wise will still work once they reach adulthood, but they are most likely to change during childhood, especially during puberty. “Stims generally change and evolve in different ways as we grow and change and develop,” she says. “Once we get into adulthood, they stay fairly stable. I was actually thinking the other day, ‘I used to always crack my knuckles, and I don’t do that anymore. I don’t know why; I just don’t do it.’ You find something else that meets your needs in a better way, or [it] just really isn’t a need anymore.”
Little evidence suggests that boys and girls inherently stim differently, but Rosas suggests that how their stims may appear to differ stems from the same disparity in how autism is perceived and recognized in girls versus boys. As we discuss in our article Autism in Girls, boys are referred to autism assessments at 10 times the rate of girls, and a majority of girls with autism go undiagnosed in childhood. Girls are also more likely to mask their symptoms, which can impact how they stim.
In the context of stimming, Rosas explains, ”There are more nuanced differences between boys and girls in how autism presents in general, but stimming specifically. We see a lot of similar things; we just might not be looking at it through the same lens because girls tend to figure out what’s more socially acceptable,” she says. “Singing the same song over and over again — if a boy did that, we might [say] ‘Oh, there’s something there.’ But if a girl does that, that’s just what they’re doing. Or doing cartwheels over and over again. If a boy does something similar, there’s something going on here, but with a girl, she’s just active. The stims are similar, but our interpretation is just varied based on our gender expectations.”
One research article from 2021 that looked at sex differences in sensory processing for people with autism showed some evidence that girls with autism are slightly more sensitive to auditory stimuli while having slightly more difficulty processing tactile stimuli, but the authors admit that the small sample size makes it difficult to draw any concrete conclusions about how this would affect stimming between girls and boys.
Stimming serves a myriad of functions regardless of whether the person stimming has a disability. Despite a growing body of research, understanding the full spectrum of why people stim is, as Dr. Ratto puts it, “the million-dollar question.” Most often, stimming serves as a self-soothing method and a means of emotional and sensory self-regulation. In an article published in the journal Autism, interviews collected from people with autism saw stimming often described as “a feedback loop that regulated excess emotion and was self-perpetuated because of the soothing comfort or control afforded by the behaviour.” This means that stimming applies to helping navigate both negative and positive emotions.
The presence of stimming’s repetitive actions is also one of the DSM-5’s criteria for a diagnosis of autism, but stimming has so many more layers to it, especially for children who have severe autism and/or higher support needs that don’t allow them to communicate their needs and emotions in traditional ways. The primary reasons people stim include:
Emotional regulation/management: in other words, for calming or grounding. It can be for a release of any “high emotion,” as a response to either positive emotional states (e.g., excitement) or negative emotional states (e.g., anxiety). It can also serve to communicate a mood, such as joy, pleasure, boredom, or anxiety.
Sensory regulation - overstimulation: If a child is feeling overstimulated from a variety of stimuli, such as too much noise, too many people in close proximity, or the sensation of certain textures (like their clothes), they may stim in ways that help them block out access to stimuli, such as separating themselves from loud environments, vocalizing their distress, or expelling anxiety through physical movement.
Sensory regulation - understimulation: some children who are sensory seeking may need to feel intense sensations to regulate themselves. They may seek out consistent access to specific sounds, look at dynamic visual stimuli, or need the feeling of heavy weight and pressure on their body.
Focus and attention: particularly for children with ADHD, stims such as shaking legs, chewing on pencils, or sounding things out loud can help them focus their attention on the task at hand and expel excess energy.
Self-regulation: beyond the functions above, stimming can also help children and adults with overpowering thoughts and other ways their sensory differences influence how they engage with the world, such as how they communicate and build relationships with others.
Nearly all forms of stimming come from a child’s sensory needs and how to balance them with the demands of everyday life. Kancir explains that she sees stimming as part of her daughter’s sensory diet, a term related to the broader study of sensory processing differences, which a majority of people with autism also have. A sensory diet, as we explain in our article about sensory processing, is “a set of compensatory strategies and activities created by an occupational therapist to help a child better cope with sensory processing difficulties.” This can look like, for example, making sure a child has consistent access to stimming toys (such as those for chewing or fidgeting), devices such as noise-cancelling or audio headphones, and a consistent schedule of activities they like (in Kancir’s case, her daughter loves baths and heavy play).
Beyond addressing a child’s own sensory needs, stimming can also help parents, educators, peers, and others around the child recognize a specific need. As The Transmitter has reported, stim behaviors provide others with information about the child’s mood and emotional state, especially for children with higher support needs and/or who are non-speaking. Kancir describes this as “if your child is clapping their hands, they’re often very excited and happy, whereas there might be other stims that are more covert and harder to pick up on, that the parent notices and [it means] they’re getting a little anxious right now. Maybe it’s time to take a break on this and be able to de-escalate a situation before it unfolds.”
As Torgrude describes, her son’s stims reflect a wide spectrum of emotions and coping mechanisms. “He will sometimes bite really hard, and that’s when I know he’s upset . . . he will use that stimming to calm,” she says. For auditory sensory relief, he has an iPad and custom headphones to regulate what he hears in public spaces. And in communal spaces with a lot of sound, like public concerts and church, he likes the motion of rocking or swaying.
She adds that while stims can also be signals and convey information that he can’t convey through speech, they don’t always align with the emotion that a neurotypical person might associate with them. “We’ve noticed his vocalizations will increase when he needs to use the bathroom; then he goes and then he’s quiet.” He also has what she calls a “drunken sailor laugh,” an auditory stim that may sound joyful to others but is actually one of his primary signals of overstimulation. Being able to distinguish between similar stims and learning what children who stim respond to helps parents and others refine the child’s sensory diet.
While stimming behaviors are not specific to autism, autistic kids are more likely to stim than neurotypical people. The DSM-5 defines stimming in the context of autism as “stereotyped or repetitive motor movements, use of objects, or speech” and says that “symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.” Stimming is closely associated with diagnoses of autism and sensory processing differences, which research has indicated more than 90 percent of people with autism have, so accommodating stimming often comes with accommodating autism. Often, with a more pronounced form of stimming, the child may have a co-occurring disability.
“Each person, regardless of what level of support needs they have, has their own stims, their own frequency or severity and manifestations of them,” says Kancir. “But when we’re talking about it in the context of autism, we’re talking about it as offsetting the cognitive load. It’s a really important part of the sensory diet that we have. . . . And because [members of] the severe autism population — we’re talking about people who are nonverbal or minimally verbal as well — often have an intellectual disability that is severe or profound, . . . when you combine those two components, the lack of functional communication is there where this individual doesn’t have the communication tools that we do to express our everyday anxiety or anything like that or our joy.”
How autism and stimming intertwine also varies depending on the context; a child’s medical diagnosis won’t be addressed or assessed the same as how their autism is assessed as an IDEA category for supports and services at school. From an IEP eligibility perspective, Rosas says, “We look at characteristics associated with autism, and one of them is engaging in repetitive behaviors — stimming. When we make that determination for an individual, they really do have to meet all three criteria: the verbal and nonverbal differences, the differences in how they interact socially, and then the repetitive behaviors. There’s a lot of variability and interpretation depending on the team. For a clinical diagnosis, obviously we have a lot more flexibility in what we can identify as stimming. We’re always looking at multiple sources and multiple factors . . . really looking at it more holistically, rather than just ‘does this individual stim?’ How intense is the stimming? How important is stimming for that individual? What kind of purpose is it serving for them on a regular basis?”
Dr. Ratto adds that some people use stimming to talk about other areas of rigid thinking or the need for routine, which can make it distinct from how it can manifest in children who have a variety of disabilities, including intellectual disabilities, ADHD, and mental health conditions such as anxiety or bipolar disorder.
It’s not the presence of stimming that may indicate autism, she says, but rather how it manifests: “We often see it in ways that look much less expected, so flapping your hands is not something that most people that we see in the community are going to be doing on a day-to-day basis, or spinning and spinning without apparently getting dizzy. These are individuals who are often doing these behaviors more often, more frequently, in a more intense or more obvious way. They are sometimes doing these behaviors at times when we would be expecting them to do something else.” This could look like, for example, a child rocking and not making eye contact with a teacher in class; to the teacher, it may look like inattention, but it is in fact how the child can best focus on the material being taught.
Stimming is a universal behavior that tends to appear more noticeably in people with autism, but stimming can also manifest in other populations of children with disabilities, namely those with cerebral palsy, Down syndrome, and ADHD — and of course, in children with these and co-occurring disabilities. But how stims serve children and how to support their needs varies, and the nuances of their disability “has a huge impact on how we intervene,” says Rosas. “We always want to be looking at individual factors, like what’s causing this individual distress, and that’s when we want to intervene. What’s bringing them joy, what’s bringing them comfort, what’s aiding in their expression.”
When looking at stimming for people with cerebral palsy and Down syndrome, the approach differs from the approach for a child with autism. Rosas adds, “Stimming isn’t technically a diagnostic factor in Down syndrome, for example, but we know some sensory differences or sensory needs can occur, so it’s always looking at what that threshold is like. Is this what you would expect to see in an individual with Down syndrome? Is this what you would expect to see in an individual with cerebral palsy? Or is it different? Is it presenting in a different way that you wouldn’t really expect?”
For children with ADHD, the Drake Institute asserts that stimming often stems from the need to mitigate external and internal stimuli that children with autism and intellectual disabilities need. While Dr. Ratto adds that there isn’t conclusive research to indicate that different forms of disability have unique forms of stimming associated with them, both the Drake Institute and the Attention Deficit Disorder Association suggest that stimming for children and adults with ADHD may come from a need to focus and expel excess energy and may not necessarily be used to express positive emotions as seen in other populations.
Dr. Ratto adds that stimming on its own isn’t a definitive indicator of autism or ADHD, even as a co-occurring condition. “If you look at some of the research that’s been done on this, and you look at sensory processing issues across all of these different neurodevelopmental conditions, you will see them in all of them. They’re not a really good, clear indicator on their own that autism is present.” This makes thorough assessments and diagnoses for a child’s disability crucial for the supports they need, especially when it comes to how their stimming and its function can be accommodated.
Both Rosas and Dr. Pelangka emphasize that just because autism is closely associated with stimming, not all repetitive behaviors are stims, nor do they stem from the child’s autism. One of the biggest sets of behaviors often confused with stimming are the rituals exhibited by people with obsessive-compulsive disorder (OCD).
“Especially for individuals with higher-support needs who aren’t able to tell us about their internal thoughts,” says Rosas, “there is a lot of overlap. But I think the big thing is really the function.” Children who have OCD may also exhibit repetitive motions, sounds, or engagement with certain objects, but these are not necessarily stims and do not serve the same purpose as stimming. For children with OCD, Rosas says, “If I’m engaging in repetitive behaviors, I’m distressed . . . whereas, generally speaking, autistic individuals, when they’re engaging in stimming, they’re using it as a regulation function. So the reason that they’re doing it is different.”
Dr. Pelangka adds that it’s entirely possible for a child to have both autism and a co-occurring disability, such as anxiety, OCD, or ADHD, that can influence how their stimming manifests and how it is subsequently perceived by peers and teachers. She gives an example of a student who has both autism and anxiety who repeatedly seeks out glue sticks during class for what, to the school team, appears to be for the sensory experience of peeling them; when she is not able to access the gluesticks, behavior escalations ensue. Dr. Pelangka has argued that, rather than simply being a tactile stim, the student’s seeking of the glue sticks reflects an underlying anxiety; viewing the behavior strictly through a stimming lens leaves the student and her anxiety unsupported. The school team has also suggested limiting access to glue sticks to be reinforcer-based, versus free access as a coping/regulatory tool. While the behavior of seeking the gluesticks may have originally provided her the sensory input or output she needed, attributing it only to her existing diagnosis of autism means that her anxiety and her means of coping aren’t adequately addressed, which can lead to more challenging behaviors and potentially harsher punishments from her school.
“Is this a compulsion situation where she can’t stop herself from doing it because of some underlying thought in her head, or is it, ‘I just need that sensory input,’ or both? If it is just an autism-related behavior, you can support it in certain ways. If it’s truly an anxiety-related behavior, there are other ways that we can be supporting it,” she says.
In this clip, Dr. Pelangka explains the differences between stimming and the repetitive behaviors that impact children with other conditions, such as OCD:
What those supports look like, Rosas says, should come from a deep, holistic, and “big picture” look at the child’s family and medical history. “You always want to take a really good developmental history. You want a really good family history because on both sides are potentially genetic conditions or traits that we’re passing down to our kids a lot of times. It’s a lot of work, and you have to have a really good understanding of both,” she says, “but they are different.”
Additionally, many children with disabilities may develop a niche and special interest or hobby that they want to do all the time, such as watching favorite movies or doing preferred physical activities and playing with preferred toys. However, these are also not necessarily stims. “Maybe it brings them joy [and] they find a lot of enjoyment out of it,” says Rosas. “Those are things that people are very interested in and spend a lot of time learning about and engaging in, but they’re not necessarily considered stims.”
While they aren’t “stims” as we may understand them more colloquially, Dr. Ratto adds that for children with autism, hyperfixations and the need for consistency in routine are closely associated with stimming. “Stimming as a term helps us capture what the research has started to show, which is that there’s lots of different behaviors that get included in this large group that we look at when we’re making an autism diagnosis. So there’s sensory behaviors. There’s also repetitive behaviors and repetitive motor mannerisms. There are also things that get put into this category that are intense, focused interests,” she says. “We also see what we sometimes think of as insistence on sameness or rigidity or a need for ritual and routine, where people might really need to know what’s expected or do things in a certain way or in a repeated way.”
While most forms of stimming are harmless, there are situations when a child’s stimming could escalate to a point that they could cause harm to themselves or potentially another person. For Torgrude, her son’s teeth grinding poses a risk to his long-term dental health. Kancir notes that her daughter, when her sensory diet isn’t being met, has sometimes resorted to stims that hurt herself, such as picking her nails off.
“That’s where it can get really challenging, when those behaviors are something that could potentially harm them,” she says. “The only ones we were trying to kind of redirect away from were ones that might hurt her or someone else. But it was never a punishment-based elimination practice — we saw it as a deficit of some other part. For example, fecal smearing — if she’s doing that, then she’s not getting enough sensory input in an appropriate way. So how can we resolve it? Instead of scolding her or shaming her, find the way that she needed to stim.”
In cases where stims escalate to self-injurious behavior, Dr. Pelangka and Rosas advise that parents meet as soon as possible with their child’s medical team, such as their pediatrician, occupational therapist, and speech pathologist, and their IEP team to determine the best means of redirecting, rather than eradicating, the stim. Following are some of the more common forms of stims that could potentially be harmful.
Stimming that involves sexual self-touching and gratification can also present risks to the student and their classmates. When it comes to intervention or redirection, Dr. Ratto, Dr. Pelangka and Rosas recommend a shame-free and safety-first approach.
Sexual stimming is more prominent in children who have intellectual disability and higher support needs, which makes the need for safe interventions even more important as the child ages out of school. Dr. Pelangka emphasizes, “That is something that obviously needs to be supported pretty immediately. I really recommend approaching it from an educational lens: teaching the student about their body, the changes, why they’re engaging in that behavior, and then where it is safe to engage in that behavior. Certain kids aren’t at a level where they can understand why it’s dangerous.”
Rosas adds, “Ideally, we’re able to teach them time and place when that can happen, to really help them, and then give them a replacement.” These replacements can look like redirecting the child’s hands to fidget toys. In more extreme cases, the child may be given gloves, or garments like a onesie that zips in the back and prevents the child from touching their genitals directly. If the child doesn’t respond well to these or they don’t show any change in stimming, then accommodating them can be a matter of giving them a safe space to stim. This not only protects the child stimming, but also the child’s peers who shouldn’t be exposed to that stim.
Because stimming is so closely tied to a child’s sensory processing, it can often manifest in ways that are painful to the child, even if they don’t realize it. Due to differences in sensory processing with certain children with autism and other disabilities, Dr. Ratto says, some children she has worked with have even broken bones without being able to recognize that painful sensation. As a result, some children may develop stims that can inflict pain on themselves, and many of them may fall under the category of body-focused repetitive behaviors (BFRBs), such as pulling out their hair, picking at their skin or nails, or banging their head on surfaces.
While the DSM-5 and organizations such as the International OCD Foundation identify BFRBs as being under the umbrella of obsessive-compulsive conditions, many children with autism, ADHD, Down syndrome, intellectual disability, or a combination thereof can also demonstrate BFRBs. While BFRBs can be classified as a form of stimming, identifying the nuances and the origin of a child’s BFRB makes a world of difference in how these behaviors are addressed, because supporting a child with OCD differs greatly from supporting a child with autism. Dr. Ratto adds, “Some of these stimming or repetitive behaviors can look like the compulsive behaviors we see in OCD. It’s really difficult, if not impossible, for a parent or a school team to pull that apart on their own. That really starts to get into the land of clinical specialists — people like psychologists and psychiatrists, who can really do a deep-dive evaluation — because what’s different is what’s driving those behaviors.”
Dr. Ratto and Rosas acknowledge that how adults perceive stimming can vary by the child’s gender and race. More physical stims such as hand-flapping, spinning, pacing, rocking, or engaging with certain objects can be perceived as dangerous to others, even if the child has no intention of engaging with another child or adult.
Rosas adds that race can complicate how adults perceive a more outwardly expressive stim. “There’s a totally different conversation when we’re talking about racially minoritized individuals,” she says. “If you are a six-foot-two Black male autistic individual and you like rocking a lot,” it’s very possible that you may be treated more punitively for stimming by teachers or school resource officers. For more vulnerable children, these conversations should “teach context around when it can happen.” Rosas emphasizes the importance of “being realistic with kids and with families about the realities of our world.”
As the research shows, suppressing a stim creates more negative feelings and distress for the child in the long run and can lead to challenging behaviors as a result. But in some cases, simply accommodating the stims, especially reactive stims, does more harm. For children whose stims are harmful, there are a few ways that parents can help support their child’s stimming while mitigating harm to the child and to others.
To be clear, stims such as hand-flapping or manipulating objects are not inherently dangerous and don’t necessarily warrant intervention. The degree that parents, the child’s healthcare team, and school personnel should intervene with a child’s stims depends entirely on what the parent and child (if they can advocate for themself) are comfortable with.
If a child’s current IEP, sensory diet, and accommodations aren’t helping them cope with a harmful stim, Dr. Pelangka says that the school may see the stim as “maladaptive” and recommend some form of behavioral intervention by a district behaviorist or school psychologist, like a token system. However, she says, a behavior-based intervention is often superficial, and more effective solutions keep the stimming in mind but change how the child engages with their environment.
“Really, it’s a skill deficit. When we see individuals with high rates of self-stimulatory behavior to the degree where it impedes learning or social experiences,” she says, it more likely comes from a combination of stimulus overselectivity (where the child will only respond to a limited range of stimuli or cues from others), sensory needs, and communication needs. “Looking at it from a whole-team approach versus just a behavior need is what needs to happen. So helping the learner cue into their environment, being more aware of what’s going on there, leading to hypothetically more social interactions and communicative progress. . . . I recommend working on onlooker play or joint attention — helping the student be more aware of their surroundings and their environment. . . . Bring them into an experience.”
Kancir acknowledges that her daughter and children with similar high-level needs have some stims and behaviors that are harmful to the point of drawing blood and can’t always be redirected. “Knowing that I had a child who did not fully understand all the different possible things that happen in a day at school that you can’t prepare for, that might escalate her and her response might be to toss the desk. There are times where she might get aggressive. What are you going to do if she goes to grab your hair, she’s biting her own hand, and you’re starting to see blood drip down her arm?”
While the use of interim supports or tools, such as arm guards, can help mitigate harm in the short-term, parents should be working with their child’s pediatrician and IEP team to determine the origin of the stim. “Is it a medical manifestation that they’re having right now?” she says. “Or if it is behavioral, what is the cause of it and how can we replace [it] with something that’s more appropriate in the interim? That’s not the long-term, permanent solution. It’s just an interim solution so that we’re reducing the harm while we try to figure out what’s going on.”
In this clip, Dr. Ratto describes some options for helping a child with harmful stims.
Creating a plan of action to add to the IEP that accounts for such situations before they occur is crucial to ensuring everyone involved is safe. The IEP should clearly outline how to engage with the student and limitations on the interventions the parent will allow in the event of a crisis. This should include:
Kancir adds, “When I first started having these conversations, the teachers said, ‘We’re not seeing these behaviors yet in school.’ And I said, ‘Great, hopefully you never do. But if you do, I want you to know how to respond to this so that you’re not instinctively reacting.’ How do you safely back away without harming that individual and then at the same time be working to de-escalate them? Those are conversations we have to be more willing to openly have, instead of just saying, ‘Under no circumstances, under no time ever possible, would it ever be appropriate to use a restraint. I prefer the word ‘safehold’ because I think that also helps better define what we’re talking about, versus we’re just going to mechanically or chemically restrain them — and that’s what we’re trying to avoid.”
Learn more about this in our article Should You Stop Your Child's Stimming? What Parents Need to Know.
Find your people
While online support groups and local chapters of disability organizations are a great way to find community and other families, Torgrude wants parents to know that they don’t have to agree with everyone in the group, and they can leave at any time if they don’t feel it’s a good fit for their family. Seeking out other community spaces that affirm their child’s stims rather than try to assimilate the child can be great for both the child and the rest of the family.
For example, Torgrude’s family changed churches to one with a pastor who welcomes her son Noah’s stims with open arms and notified the congregants of his vocalizations. And as Kancir puts it, “I am so much happier being able to have that wherewithal of who gets access to ruin my day or not. The people that are in my life are super supportive and love her, and there’s none of that judgment, and I’ve built a whole world of community around us.”
Let your child lead
As Kancir can attest, her daughter didn’t follow typical tastes in toys or stimuli that other children were interested in. “Instead of saying, ‘Here’s a toy, and this is how we use it, and push this button,’ following your [kid] and seeing what it is that they’re interested in” can help clarify a child’s sensory needs as early as possible so you can implement the ideal sensory diet.
“We need to be more understanding of it as a society,” says Dr. Pelangka. “I think that’s where, oftentimes, families get concerned. They don’t want their kid to get bullied, they don’t want them to get picked on, they don’t want them to look different culturally. I say this to families: if self-stimulatory behavior for your child has a reason and a purpose — whether they’re coping, whether that’s how they express their excitement — if they’re still able to go to school, learn, access the content, they’re making progress . . . then why are we stopping it?”
To learn more about stimming, head over to our articles Stimming at School and Should You Stop Your Child’s Stimming? What Parents Need to Know.
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