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How to manage self-stimulations of my child with autism with or without intellectual disability?

Written by Sophie Kerebel, psychologist; Cécile Testud, special educator, Dr Anita Beggiato and Dr Valérie Vantalon, child psychiatrists.

Center of Excellence for Neurodevelopmental Disorders in Ile de France, Robert Debré Hospital, Paris

What are self-stimulations?

# Self-stimulations form a type of behaviour that consist of creating sensations throughout several senses (sight, hearing, smell, touch and taste)

# Self-stimulations are common for everyone, adults or children, with or without neurodevelopmental or sensorial disorder.

# There are different types of self-stimulations. Here are some examples.

In Autism Spectrum Disorder (ASD), self-stimulations are more intense, are more recurrent and could happen in inappropriate places. Sometimes, they make social interactions, environment understanding and object manipulation harder.

Why does my child use more self-stimulations during lockdown?

# Self-stimulations can stand by themselves, without any other functions

- They can keep your child busy. For example, while watching TV, they make an object turning in front of their eyes

- They can help your child managing their stress. For example, they can bite their nails or their hands, they swing.

# Self-stimulations can hide other functions

- To get people’s attention

o Your child sing out loud

o Your child put themselves in danger when climbing or jumping from a piece of furniture.

- To avoid obligations (obligations can be rules, unpleasant sensorial feelings, social interactions …)

o When I ask my child to do something specific, they use self-stimulation that bothers me (screams, jumps, self-mutilation). I stop asking my child to do what I wanted them to do, they escape the obligation.

- To obtain access to an activity

o My child can use self-stimulation when they realize that every time they do so, they get what they want. Every time they do so, I suggest them an alternative to their self-stimulation to make them feel better. My child understands that to obtain something pleasant, they have to use self-stimulations.

Self-stimulations are necessary during lockdown

# My child can use self-stimulations more often than usual during lockdown. Children with ASD use self-stimulation to keep themselves busy, to relax, and to enjoy themselves. During the lockdown, they lose their daily activities (school, consultations, hobbies …) and they do not always know how to get keep busy by themselves, besides using self-stimulations.

# Being locked-down is stressful, therefore it is important to be flexible and to let your child use their self-stimulations.

# If I notice a bigger amount of self-stimulations or new self-stimulations during lock-down, I have to ask myself “why does my child need these self-stimulations?” rather than “How to control and diminish these self-stimulations?”

# During this specific period, I must try to make the difference between

- Behaviours that I can tolerate : they keep my child calm and do not prevent them from doing activities

- Behaviours that I cannot tolerate because they cause physical damages, as self-mutilations.

Organizing access to self-stimulations

Whenever possible, I set specific place and time for self-stimulation:

# I can use a visual timetable to show my child when they are allowed to use self-stimulation

# I can show them a dedicated place for self-stimulation

You can find more information in here: https://www.debrechildpsychiatry.org/post/covid-19-and-autism-spectrum-disorder-what-to-do-at-home-during-confinement

# I can give my child specific tools they can use for self-stimulation. When I give them to them, they understand that self-stimulation is allowed (e.g. I run water for the bath, I give them strings …)

# I can use a timer so my child can understand how long they can use self-stimulation (thanks to the timetable, they know they will be allowed again later or the day after).

# I can regularly alternate between self-stimulation and other activities: educational, communication, autonomous play, daily autonomy activity

If despite everything I am in difficulty, I contact the professionals who usually take care of my child (institute, psychomotor therapist, psychologist, educator, occupational therapist …). They will know how to give me more personalized advice and give me concrete support.

How to use self-stimulations efficiently to help my child improve

I can try to bring variation to my child’s self-stimulation, in order to teach my child functional activities throughout self-stimulations:

# I accept and I join my child when they use self-stimulation (when it is possible). I make them understand that I will not stop them.

- I look at my child at a reasonable distance. I try to understand by myself why this self-stimulation feels nice for my child and I can try them on myself.

- I can imitate my child with my body or with similar objects (I don't take things away from him)

# I bring variation. For example:

- I put on a pearl on a string they move in front of their eyes. I move the string with the pearl in front of my eyes. If my child enjoys it, I invite them to do the same.

- If my child throws objects as self-stimulations, I can suggest them to throw objects in a basket. I show them first how to do so.

# I can use self-stimulation as a reward when my child has accomplished a task

- I can say it : for example, if my child likes to play with their littles cars’ wheels, I can tell them “copy this circle, then you can have a little car”

- I can use pictograms “now – after

- I can use a token contract.

Or even for a token economy system over several days or over the week:


Do not forget:

- I avoid fixing too difficult goals

- I don't hesitate to ask my child's healthcare team if I am in difficulty

- To find out more : https://www.debrechildpsychiatry.org/post/covid-19-and-autism-spectrum-disorder-what-to-do-at-home-during-confinement

Translated by C. LANDEL (psychiatry resident) and W. LAPWORTH

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris