Autistic Obsessions, Repetition, Routine
Obsessions, repetitive behavior and routines can be a source of enjoyment for people with autism and a way of coping with everyday life. But they may also limit people’s involvement in other activities and cause distress or anxiety. Repetitive behavior in people with autism is not the same as OCD (Obsessive Compulsive Disorder), which is an anxiety disorder in which people experience repetitive thoughts and behaviors that are upsetting to them.
Obsessions
My mind was constantly whirring with thoughts, worries and concerns. The time spent with my obsession was the only time in which I had a clear mind – it gave me that much sought-after relaxation.
People with autism have many different obsessions but some of the more common ones include computers, trains, historical dates or events, science, or particular TV programs. Many younger children with autism like Thomas the Tank Engine, dinosaurs or particular cartoon characters. Sometimes, people develop obsessions with things like car registration numbers, bus or train timetables, postcodes, traffic lights, numbers, shapes or body parts such as feet or elbows. People with autism may also become attached to objects (or parts of objects), such as toys, figurines or model cars – or more unusual objects like milk bottle tops, stones or shoes. An interest in collecting is also quite common: it might be Star Trek DVDs, travel brochures, insects, leaves or bus tickets.
It is the intensity and duration of a person’s interest in a particular topic, object or collection that marks it out as an obsession. People will often learn a lot about a thing they are obsessed with, be intensely interested in it for a long time, and feel strongly about it.
People with autism may develop obsessions for several reasons, including:
* obsessions may provide structure, order and predictability, and help people cope with the uncertainties of daily life
* people who find social interaction difficult might use their special interests as a way to start conversations and feel more self-assured in social situations
* obsessions may help people to relax and feel happy
* people can get a lot of enjoyment from learning about a particular subject or gathering together items of interest.
Is it an obsession or a hobby?
We all have hobbies and interests and – generally – a strong preference for routine. Here are five questions that can help us distinguish between hobbies and interests, and obsessive behavior.
* Does the person appear distressed when engaging in the behavior or does the person give signs that they are trying to resist the behavior? (that is, someone who flaps their hands may try to sit on their hands to prevent the behavior.)
* Can the person stop the behavior independently?
* Is the behavior impacting on the person’s learning?
* Is the behavior limiting the person’s social opportunities?
* Is the behavior causing significant disruption to other people, eg parents, carers and family? (Clements and Zarkowska, 2000)
If your answer to any of the questions above is ‘yes’, it may be appropriate to look at ways of helping to reduce obsessive or repetitive behavior. Think about whether, by setting limits around a particular behavior, you are really helping the person with autism. Is the behavior actually a real issue for them, for you, or for other people in their life? Focus on developing skills that the person with autism can use instead of repetitive or obsessive behavior. Try to understand the function of the behavior, then make small, gradual changes and be consistent.
Autistic and Repetitive Behavior
“I quickly become overwhelmed [in social situations]. Is it surprising that I then feel like blocking the world out and literally putting my thoughts back in order? That I start to rock to tell myself which feelings are mine? That I start speaking to myself or groaning to block out other sounds and so that I know which thoughts are mine? I think anyone experiencing life this way would do the same.” Adult with autism
Repetitive behavior may include arm- or hand-flapping, finger-flicking, rocking, jumping, spinning or twirling, head-banging and complex body movements. You may also see the repetitive use of an object, such as flicking a rubber band or twirling a piece of string, or repetitive activities involving the senses (such as repeatedly feeling a particular texture). Many people with autism have sensory sensitivity and may be over- or under-sensitive to sights, sounds, smells, taste and touch. This sensitivity can also affect people’s balance (‘vestibular’ system) and body awareness (‘proprioception’ – knowing where our bodies are and how they are moving). Repetitive behavior can be a way to deal with sensory sensitivity. Although repetitive behavior varies from person to person, the reasons behind it may be the same:
* an attempt to gain sensory input, like rocking may be a way to stimulate the balance (vestibular) system; hand-flapping may provide visual stimulation
* an attempt to reduce sensory input, like focusing on one particular sound may reduce the impact of a loud, distressing environment; this may particularly be seen in social situations
* a way to deal with stress and anxiety and to block out uncertainty. Some adolescents or adults may revert to old repetitive behaviors such as hand-flapping or rocking if anxious or stressed
* a source of enjoyment and occupation.
Routines and resistance to change
“Reality to an autistic person is a confusing, interacting mass of events, people, places, sounds and sights… Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life. Trying to keep everything the same reduces some of the terrible fear.” Jolliffe (1992) in Howlin (2004), p.137.
Many people with autism have a strong preference for routines and sameness. Routines often serve an important function – they introduce order, structure and predictability and help to manage anxiety. Because of this, it can be very distressing if a person’s routine is disrupted. Sometimes minor changes such as moving between two activities can be distressing; for others big events like holidays, birthdays or Christmas, which create change and upheaval, can cause anxiety. Unexpected changes are often most difficult to deal with. Some people with autism have daily timetables so that they know what is going to happen, when. However, the need for routine and sameness can extend beyond this. You might see:
* changes to the physical environment (such as the layout of furniture in a room), or the presence of new people or absence of familiar ones, being difficult to manage
* rigid preferences about things like food (only eating food of a certain color), clothing (only wearing clothes made from specific fabrics), or everyday objects (only using particular types of soap or brands of toilet paper)
* a need for routine around daily activities such as meals or bedtime. Routines can become almost ritualistic in nature, having to be followed precisely with attention paid to the tiniest details
* verbal rituals, with a person repeatedly asking the same questions and needing a specific answer
* compulsive behavior, for example a person might be constantly washing their hands or checking locks. This does not necessarily mean they have obsessive compulsive disorder (OCD) but if you are concerned about this, speak to your GP in the first instance.
People’s dependence on routines can increase during times of change, stress or illness and may even become more dominant or elaborate at these times (Attwood, 1998). Dependence on routines may increase or re-emerge during adolescence. Routines can have a profound effect on the lives of people with autism, their family and carers, but it is possible to make a person less reliant on them.
Setting limits
Here is an example of how to set limits.
* Identify the repetitive behavior, obsession or routine of concern. Jane likes to talk about train engines. Jane currently starts talking about train engines after about ten seconds of conversation for up to 15 minutes.
* Think about reasonable limits you can put in place that your child can manage. Behavioral change is most likely to be successful and your child less likely to be distressed if you start small and go slowly. Jane is allowed to talk about train engines after 20 seconds of conversation for five minutes only. She is also getting social skills training.
* Gradually increase time restrictions and introduce other limits. Jane is first allowed to talk about train engines three times a day. Then, Jane is only allowed to talk about train engines with her family three times a day. The eventual goal is for Jane to speak about train engines to her family only for one minute, twice a day.
* If you place limits around obsessions or repetitive behavior, you might need to think about things your child can do instead: perhaps joining a club or group; taking up a sport or leisure activity; or entering further education, job preparation training or employment if possible.
How to respond
People with autism might have obsessions, repetitive behaviors and routines for a variety of reasons. Some things to think about respond the behavior in a helpful way.
* Understand and intervene
* Increase structure
* Help with skills development
* Set limits
* Make use of obsessions
Understand and interveneUnderstand the function of the behavior
Obsessions, repetitive behavior and routines are frequently important and meaningful to people with autism, helping them to manage anxiety and have some measure of control over a confusing and chaotic world. For others, the behavior may help with sensory issues. Take a careful look at what you think might be causing the behavior and what purpose it might serve. For example, does the person with autism always seem to find a particular environment, like a classroom, hard to cope with? Is it too bright? Could you turn off strip lighting and rely on natural daylight instead?
Intervene early
Repetitive behaviors, obsessions and routines are generally harder to change the longer they continue. A behavior that is perhaps acceptable in a young child may not be appropriate as they get older and may, by this time, be very difficult to change. For example, a child who is obsessed with shoes and tries to touch people’s feet might not present too much of a problem, but an adolescent or adult doing the same thing – especially to strangers – will obviously be problematic. It will help if you can set limits around repetitive behaviors from an early age (see the section on setting limits) and look out for any new behavior that emerges as your child gets older.
Increase structure
Making the person with autism’s environment and surroundings (including social situations where possible) more structured can help them to feel more in control and may reduce anxiety. If anxiety is reduced, the need to engage in repetitive behavior and adhere strictly to routines may also, in time, be reduced. Here are some suggestions for creating a more structured environment.
Visual supports
Visual supports such as photos, symbols, written lists or physical objects can really help people with autism.
* A visual timetable could help your child to see what is going to happen next (for example, across the course of a day). This makes things more predictable and helps them to feel prepared. It may lessen their reliance on strict routines of their own making.
* Visual supports like egg timers or ‘time timers’ (available online) can help some people with autism to understand abstract concepts like time, plan what they need to do, when in order to complete a task, and understand the concept of waiting.
* Visual supports can also be useful if your child asks the same question repeatedly. One parent wrote down the answer to a question, put it on the fridge and, whenever her son asked the question, told him to go to the fridge and find the answer. For children who can’t read, you could use pictures instead of words.
Pre-planning
You may be able to help someone with autism to cope with change, or activities and events that could be stressful, by planning for them in advance. Change is unavoidable but it can be really difficult for many people with autism. You may not always be able to prepare for change a long time in advance, but try to give the person as much warning as possible.
* Gradually introducing the idea of a new person, place, object or circumstance can help them cope with the change. Try to talk about the event or activity when everyone is fairly relaxed and happy.
* Presenting information visually can be a good idea, as the person with autism can refer to it as often as they need to.
* You could try using calendars so that the person knows how many days it is before an event – such as Christmas – happens. This can help them feel prepared. They might also like to see photos of places or objects in advance so they know what to expect, for example, a picture of their Christmas present (not all children with autism like surprises), or a photo of the building they are going to for an appointment.
* Using social stories could also be helpful. These are short stories, often with pictures, that describe different situations and activities so that people with autism know what to expect.
Pre-planning can also involve structuring the environment. For example, a pupil with autism might go to use a computer in the library at lunchtime if they find being in the playground too stressful. Or if a child has sensory sensitivity, minimizing the impact of things like noises (like school bells) or smells (eg perfumes or soaps) can help them to cope better. It is possible that more structured environments may reduce boredom, which is sometimes a reason for repetitive behavior. You might prepare a range of enjoyable or calming activities to re-direct the person with autism to if they seem bored or stressed.
Skill development
Self-regulation skills
Self-regulation skills are any activities that help a person with autism to manage their own behavior and emotions. If you can help the person to identify when they are feeling stressed or anxious and use an alternative response (such as relaxation techniques or asking for help), you may, in time, see less repetitive and obsessively habitual behavior.
Research has also shown that increasing a person’s insight into an obsession or repetitive behavior can significantly reduce it. This includes people with quite severe learning disabilities (Koegel et al, 1995, in Howlin, 2004).
Social skills training
Teaching social skills such as how to start and end a conversation, appropriate things to talk about, and how to read other people’s ‘cues’ (eg, we sometimes raise our eyebrows slightly if we want to speak or say something like ‘Yes, but…’) may mean someone with autism feels more confident and doesn’t need to rely on talking about particular subjects, such as a special interest.
Coping with change
See the section above on pre-planning for information on this. However, if unexpected changes do happen and the person with autism is finding it hard to cope, try re-directing them to a calming activity, or encourage them to use simple relaxation techniques such as breathing exercises. You could use praise or other rewards for coping with change. In the long term, this may help make the person more tolerant of change.
Explore alternative activities
One way to interrupt repetitive behavior is for the person with autism to do another enjoyable activity that has the same function. Here are some examples:
* a person who rocks to get sensory input could go on a swing
* a person who flicks their fingers for visual stimulation could play with a kaleidoscope or a bubble gun
* a person who puts inedible objects in their mouth could have a bag with edible alternatives (that provide similar sensory experiences) such as raw pasta or spaghetti, or seeds and nuts
* a person who smears their poo could have a bag with play dough in it to use instead.
Set limits
Setting limits around repetitive behavior, routines and obsessions is an important and often essential way to minimize their impact on the person with autism’s life. You could set limits in a number of ways depending which behavior concerns you:
* ration objects (can only carry five pebbles in pocket)
* ration times (can watch Thomas the Tank Engine DVD for 20 minutes twice a day)
* ration places (spinning only allowed at home).
Everyone involved with the person should take the same consistent approach to setting limits. Have clear rules about where, when, with whom and for how long a behavior is allowed. You could present this information visually, with a focus on when the person can engage in the behavior. This may help if they feel anxious about restricted access to an obsession or activity. Read an example of setting limits.
Make use of obsessions
Obsessions can be used to increase a person’s skills and areas of interest, promote self-esteem, and encourage socializing. You may find you can look at a particular obsession and think of ways to develop it into something more functional. Here are some examples.
* An obsession with computers could be developed into someone studying or working in IT.
* A person with a special interest in historical dates could join a history group and meet people with similar interests.
* A person with knowledge of sport or music would be a valuable member of a pub quiz team.
* An obsession with rubbish could be used to develop an interest in recycling, and a child given the job of sorting items for recycling.
* An interest in particular sounds could be channeled into learning a musical instrument.
* A strong preference for ordering or lining up objects could be developed into housework skills.
You can also use obsessions to motivate and reward the person with autism. Follow a less desired activity (such as homework) by a chance to do something the person really loves (such as extra time on the computer). If you and other people the person knows can show an interest in their obsession this may be welcomed and help to boost their self-esteem. “Showing an interest in a child’s obsession can help a parent to enjoy a level of communication that had perhaps never seemed achievable before.” Young person with Asperger syndrome
To sum up…
* Ask yourself if the obsession, routine or repetitive behavior restrict your child’s opportunities, cause distress or discomfort or impact on learning. If not, is it really necessary to intervene?
* Think about the function of the repetitive behavior, routine or obsession. What does your child get out of it?
* Intervene early: set limits around repetitive behavior and obsessions from a young age (and new ones if they emerge).
* Make the world a more structured and predictable place. Try using visual supports (such as daily timetables), social stories, or pre-planning strategies to prepare for change or events that might be stressful. This may limit reliance on routines or repetitive behavior.
* Help your child to develop skills where possible, for example social skills training, learning relaxation techniques or learning to identify emotions. These can all be ways of managing stress or uncertainty (which may lead to repetitive behavior).
* Look at things that your child can do instead of carrying out a repetitive behavior or focusing on an obsession.
* If you need to, set clear, consistent limits – for example, ration an object, the time your child is allowed to spend talking about it, or the places where they can carry out a particular behavior.
* Remember that obsessions and repetitive behavior can be therapeutic and help your child to relax, or calm down if agitated. Don’t take away all access to an obsession or try to change behavior overnight – this could be distressing. Make gradual changes.
* Make use of obsessions, they could be a way to socialize, learn a new skill or improve self-esteem. People may eventually be able to study or work in related areas.