Transforming Behaviour Webinar Series - Supporting Repetitive Bahaviours
Transcript:
Hello, hello, good morning. Welcome
to this webinar, Farm Transform Life. My
name is Ella. I’m going to be chatting
today about our supporting repetitive
behaviours. I know that this is
something that a lot of people observe in
either themselves or people that they’re
caring for. So we wanted to make this
resource available to you so that
you can problem solve. You can
figure out what’s problem, what’s not a
problem, and support that person or
yourself. In the best way possible so.
Before we begin. I would like to
acknowledge the Gadigal people of the ER
nation on his land. I live and I work
in from where this women art is being
broadcast today. I’d also like to
acknowledge their elders, past, present
and emerging and any indigenous people
present today.
So today we’re going to be talking about
repetitive behaviours. We’re going to be
talking about what they are, what they
aren’t, what they, why they
happen, what’s the reasoning behind them.
And we’re also going to be talking about.
Why we struggle, Why people struggle with?
Repetitive behaviours in the people that
they care for. We’re also going to be
talking about what we can do. So before
we hop into that topic, I’ll just give
you some background.
My name is Ella. I am the Chief Clinical Officer
here at Transform Life. I’ve been working in
disability support for about 8 years now
and I’ve been lucky enough to learn so
much from from the families that I work
with. My background and qualifications
are in psychology and I was lucky enough
to do my internship with the Marx Baby
Lab Brain Institute at Western Sydney University
as well as involved in some really interesting work
over in Copenhagen in Denmark doing
community disability support.
So let’s get started with talking about
repetitive behaviours, so.
Repetitive behaviours, so.
There are a few different names,
terms, types of repetitive behaviors
and I want tocreate distinction
between all those types of
repetitive behaviours and also give you a
few frameworks through which you could
understand repetitive behaviours.
So. Repetitive behaviours are one
of the hallmarks of.
I guess specifically autism, but
disability and neurodivergent more
broadly. So ADHD, obviously
autism and those sorts of
things. So and there’s a few different
types. But as I say, it’s one of the
hallmark flags of
neurodivergent more broadly and they come
in several different types. Those are
called stereotyping. They could also
be ticks and they can also be stunning.
So those are some
some language, some terms that I’m going
to be using. Don’t worry, I’m going to
define them in a second and they also
come in higher and lower order. So
those are some ways that you can
differentiate between the behaviours that
you’re seeing, understand where they
might fall in that person’s experience
and also have a better way to understand
how you can support them.
So a stereotypy is a repetitive or
a ritualistic movement or
a posture, the way the pharmacy holding
their body or an utterance. So some sort
of sound that somebody make. So
stereotype could be like a bodily
movement, like rocking, or
it could be more complicated, it could
be crossing and uncrossing your legs. I
know a lot of people recognise hand
flapping a lot as being connected with
something like autism.
And they’re especially found, yeah,
as I said, with
people with kind of autism spectrum
experiences, but they’re also found in
folks with intellectual disability and
that kind of thing. But you know,
neurotypical people experience
repetitive behaviours as well If you’ve
ever sat on a bench with somebody who’s
jiggling their leg repetitively,
you’ll probably recognise that.
Or somebody who cracks their knuckles on
going or something like
that. Time. Um.
There’s not a lot. I mean there there
are, you know, studies being done and
whatnot around the why kind of
neurologically and psychologically about
repetitive behavours, but I i think
something that’s really helpful.
To understand is that this kind of
two categories, especially for autistic
folk of the repetitive behaviours that
we see that are one of the.
Diagnostic factors of
autism so repetitive and restrictive
behaviours are one of the diagnostic
criteria that are associated with autism
and clinicians split them into two
types, so a higher order and a lower
order. So a lower order is going to be
something that is more
behavioural, so hand flapping,
fidgeting with objects or your body
rocking and vocalisations such as
Grunting or echolalia, which is something that you
might be familiar with, which is the
repeating of chunked phrases of
speech either immediately after they’ve
been exposed to that speech or a
significant amount of time afterwards,
but specifically repeating chunks or
phrases of speech.
Now higher order repetitive behaviours
include things like routines,
rituals and insistence on
sameness in in the person’s
environment, as well as very intense
interests. So those are what’s called
the higher order routine.
Repetitive behaviours. Sorry, ticks are
something that are slightly separate from
a repetitive behaviour. So I think you
something that’s involuntary. It’s
usually some kind of bodily
process. One of the things that people
are familiar with is eye twitching. That
can be something, but also something like
throat clearing can be a tick that we
see often. Something that is also
associated with repetitive behaviours,
especially for autistic folks, is
something called stimming.
So swimming is
something that lots of people.
Do but it’s especially found in
autistic folks is something that’s
spinning. So stunning is a shortened form
of self stimulatory behaviour and what’s
dimming is is a repetitive behaviour
that. Provide
sensory soothing in some way, so
you’ll often find.
Hey, somebody who is
skimming will be doing something that’s
giving them either sensory input or
relief from an aversive sensory input
that is helpful to them and makes their
experience in the world more comfortable.
So stemming, you know the common one that
people see is hand flapping. Now there
could be lots of reasons that somebody
would be engaging in hand flapping as a
stem, but one of the common ones is a
visual stim, so they might be holding
their hands up in front of their. In
their field of vision and flapping their
their hands in front of their eyes. And
that could be something that’s providing
them with pleasant or soothing
visual input. They lack the movement.
They lack the they like the way that that
makes their sensory systems
feel, and that could be
something that’s helping them to feel
sensory regulation, feel more calm. Or
it could be doing the opposite, It could
be giving them. Kind of
excitatory sensory input.
So that’s what repetitive behaviours are.
Next, why does it happen? So
it’s important to know that in terms of
the research, especially around autism
and repetitive behaviours, there’s been
much more research actually focused on
other elements of the autistic
experience. So the research around
repetitive behaviours is . lagging
There isn’t a sort of.
Definitive.
Reasoning that’s come out of the resource
as to why repetitive behaviours
occur for somebody with
neurodivergent of some kind, but.
It’s important to know that repetitive
behviours serve a apurpose for the purpose
for the person that’s engaging in them.
They they’re there’s lots of
things that it could be doing for that
person and I guess the important thing
for us to know is that there’s no
necessarily agreed upon method for how to
ascertain what the driving
motivation behind those repetitive
behaviours are, so.
It’s important to note it happens for a
reason. But the way that we go about
finding that reason has to be super
individualised and it’s not going to be
the same for any two people, but there’s
lots of things that we can understand,
that we can do to understand what’s going
on for that person and the purpose that
those repetitive behaviours might serve.
But there’s no one right way to go about
finding that out. Crucially, it’s super
personal, it’s different for everybody
and your approach needs to
be individualised. But thereare a few
things, as I say, that I’ll mention now,
that we can do to assess the value of
that repetitive behaviour.
And the main way is to observe
the behaviour over time And there’s two
there’s two frameworks that I would
suggest that are going to mean your
observations are going to be valuable in
terms of ascertaining. What is going on
for that person that’s causing these
repetitive behaviours to occur? So the
first one is a very common one and it’s
the ABC.
Observation methods. So the antecedent,
the behaviour and the consequence.
Really all we’re trying to do when we
collect information in this format is to
understand what happens before
a person engages in a in a
repetitive behaviour. What does the
behaviour look like when they’re doing
it and what happens afterwards. That’s
genuinely it. That’s all we want to know
is OK, we’ll say
Jimmy starts hand flapping every time he
goes into a public bathroom.
OK, what happens
directly before the behaviour? Oh, the
hand dryer comes on. We notice over time
as we’re collecting the ABC data. Oh,
there’s actually a pattern here. It’s
that every time the hand dryer goes on in
a public bathroom, that’s when Jimmy
starts to hand flap. Interesting. OK,
could they be connected? What happens if
we change that element?
Then we can look at what happens
afterwards. OK, so every time Jimmy
hand flaps in the presence of a
hand dryer, his mom or his
dad or whoever is with him
takes him out of the bathroom, for
example, or they feel like they they
they’re kind of rushing out of the
situation. Oh, OK, So if we’re putting
that in the ABC context, that means that
the consequence of him hand flapping in
the bathroom. In response to the hand
dryer is that he gets to be removed from
the situation. OK, interesting. That
tells us a lot about the function that the
behaviour is serving. Jimmy
knows that in any situation
that he begins to hand flap.
He’s learned over time and observed other people’s
responses. He knows that any situation in
which he handclaps means that he’s going
to be removed from that environment is
the hypothetical situation. I’m not. You
know, I’m speaking from memory or
anything like that. Given
that this that this consequence
is something that’s being consistent,
what do we think? What can we hypothesise?
Is the function that this behaviour is
serving. Jimmy in this case is trying to
escape potentially the
aversive stimuli,
sensory stimulation of the hand dry going
on. He feels really uncomfortable in the
presence of that hand dryer going and he
knows that if he flaps his hands, his
parents will remove him from that
situation and the aversive sensory
stimuli of the hand dryer will cease to
be part of his environment, right? So
he’s using the hand flapping as a. As a
way of. With the scaping, a
situation that he is uncomfortable in.
There we go. So that’s why an
ABC format of
observing A repetitive behaviour over
time can help us to understand what
function that behaviour serves.
The other type of observation that I want
you to think about when we’re talking
about repetitive behaviours is the pre
and post regulation observation, so.
Again, it’s a lot to do with the ABC, but
specifically in terms of that person’s
regulation, so is a person.
Upregulated. Highly stressed,
anxious, Um, you know,
busy feeling overwhelmed before they
engage in the stem. Then after
they engage in this team, they will calm,
they feel more settled, they feel more
grounded, OK, based on the pre
stem regulation or pre behaviour
regulation and post behaviour regulation.
What might go tell us about the
regulatory search function
that this behaviour might ? serve Or it
could be it could be the opposite, for
example a. Person might be
engaging in, might be very
mellow and chill.
Lying around, maybe you know not doing too
much in a quiet environment. Then they
start to engage in a repetitive behaviour
like for example toe
jumping or toe walking or
repeating phrases from
their favourite YouTube . video I know
that this is a common one. And that get
them really excited to get them pumped
up. They get really happy and
excited and you can see this often
in younger kiddos with autism.
And that’s something
that they’re doing because that they
enjoy it. They feel good when they’re
when they get to engage in that repetitive
behaviour, it helps them feel energetic
and switched on and all those good
things. So observing the pre
behaviour regulation. Then the behaviour
occurs and then observing the post
behaviour regulation is gonna be a key
way for us to understand what
that behaviour is doing for that person
in terms of regulation. And this is also
very much LinkedIn with a sensory
experience and stunning.
So. I think it’s important to
stress that. Repetitive behaviours are
not inherently in and of themselves
negative. Repetitive behaviours can
often be seen as something that need to
be redirected simply because they’re
repetitive and that that.
Because that’s a hallmark of autism,
or neurodivergent more broadly that that
is enough reason to need to.
To need to redirect it or
suppress the repetitive behaviour.
I want to stress that
repetitive behaviours are not inherently
negative. There is nothing inherently bad
about a person wanting to repetitively do
the same thing. We all do it. We all
create routines in our lives that make
our lives easier by doing the same thing
every day. We all for
example. I use the same coffee cup.
Every day I don’t change and
it makes my life easier and it makes my
life more enjoyable. I know it works, and
that’s something that I do every day. Is
that inherently bad? No, it isn’t. And
that has the exact same value as an
autistic person being engaged in
their specific topic of interest
consistently every day. In the same way,
it’s not inherently bad. Repetitive
behaviours can become an issue.
In specific circumstances and that’s what
we’re going to address. So if they end up
causing harm to themselves or others
physically or emotionally. They
cause social isolation. Or is that cool
disregulation to others? Now
those are fairly limited, you know,
there’s a fairly limited situations and I
think that. It’s going to be
important to recognise that often a lot
of the time.
Why people struggle with with repetitive
behaviours is actually their own
experience. It’s actually their own
sensory overwhelm or frustration. And
that’s OK. It’s OK to find
the repetitive behaviours of somebody
that you’re caring for. Difficult
to tolerate or difficult, or fast or
frustrating or overwhelming. But what
we want to do is recognise that that’s
what the struggle is, right?
So we don’t want to be addressing A
repetitive behaviour because it’s a
repetitive behaviour and therefore it
needs to be reduced. It’s not
inherently bad. If it’s because we
find it frustrating and difficult to cope
with, that’s OK as long as we
recognise that the reason that we are.
Engaging in the behaviour is for our
own um. Sensory comfort,
Sense of frustration, that kind of thing.
And that will change the way that we
engage with supporting and
repetitive behaviour. Understanding that
actually it’s not something that’s
inherently bad about this behaviour.
There’s nothing wrong with engaging in
repetitive behaviours, but that it’s
something that can cause sensory
discomfort to the people around that
person when they’re engaging with, you
know, possibly vocal stimming or
something like that. That’s going to
change the way we address it, and it’s
and it should. It should change the way
we address it. So let’s talk about that.
The way that we intervene with repetitive
behaviour needs to
depend on the function that it serves to
that person. And so that’s why it’s
important a few slides ago that we talked
about observing our behaviour over time
so that we can ascertain the function of
that behaviour. So we can ascertain you,
does it just feel good for that person,
right? OK, they can go ahead and do that,
does it.
But you know, if we
are observing over time that that
person engages. In a social harming
repetitive behviour in a aspecific social
context, then that also teaches us
the way that we can intervene with the
repetitive behaviour
to. Help the person meet
the need that they’re trying to meet with
the repetitive behaviour, but could be
met in a less harmful way.
So for example, a lot of
repetitive behaviours soothe anxiety. So
for somebody with for example
OCD, the repetitive behaviour of doing
something like checking the locks
or washing hands or.
Whatever it might be. Serves a self
soothing purpose, that is.
Driven by an anxiety mechanism
so that so that repetitive behaviour is
onlygoing to be able to
be better supported when that person has
other anxiety management tools in their
toolkit that they feel comfortable,
comfortable and confident using, but also
genuinely meet the need. So if we’re
trying to, for example, stop a person
checking the locks, compete compulsively.
Um. It’s not appropriate
for us to remove that repetitive
behaviour that’s an anxiety coping
mechanism if we’re not providing them
also, for example with
maybe some CBT strategies to help them
work through the anxious
rumination and obsessions that they’re
thinking through. If we’re not giving
them, say, for example, breathing
techniques that are going to help them
regulate their body and feel less anxious
if we’re not adding in other anxiety
management tools to their. Toolkit.
We can’t. Be expecting that person
to reducing. Repetitive
behaviours. So if you if
you observe over time that somebody’s
repetitive behaviours are serving to
manage their anxiety in some way, the
best way for us to intervene is to be
supporting that person in managing their
anxiety in a number of different
ways, all of which help them to meet
the need of soothing their physical or
emotional anxiety symptoms.
If for example the repetitive behaviour
is a self stimulating a self
stimulating sting type
behaviour and that could be something
like a vocal stim that could feel good
or a. I don’t know, a sensory seeking stimulus
of some kind rocking or shaking their
head or that kind of thing.
Again, that’s not inherently bad. When it
becomes a problem is if, say, for
example, there’s a person who’s
who’s. Stimming repetitive
behaviour is a very loud vocalisation and
thatis really tricky to tolerate for the
people that are in their environment. OK,
well, this person has a sensory need
they’re trying to meet. In order for us
to best support that repetitive
behaviour, we’re going to need to help
that person meet that meet that sensory
need in a way that.
Doesn’t cause sensory distress to the
people around them, or at least reduces
the sensory distress to the people around
them. So for example. If a person
was, I don’t know how many,
for example.
If person was hunting for example, and
that was something that they found
really. That they
found really soothing and something that
they found was a very pleasant sensory
sensation then we are going
to. Yeah.
We’re going to want to.
Help them to meet that humming need in a
way that is going to be.
Meeting the same need again made the same
need, but not in a way that is unhelpful.
So. The sensory
sensation that they might be seeking is
humming, causes of vibration in the oral
cavity. It comes from the vocal cord and
it sends us a slightly
vibrating sensation. You can try it now.
A slight vibrating sensation through the
oral cavity, through the mandible and
through kind of the throat and
jaw. You can feel it all the way through
your palm. Something and and but
that might be something that’s really
difficult for the folks around this
person to tolerate. Something that we
might be able to do is to provide them
with a vibrating chew toy that
they can place in their mouth or against
their jaw that provides the same
vibrating feeling through the oral
cavity, through the pallets, but doesn’t
involve that loud or,
you know, disturbing.
Sensory stimming behaviour, the
repetitive stimming behaviour. So that
could be a way that we help meet that
person’s need without
necessarily just, you know,
causing distress to the people around
them. I think it’s also important to talk about
echolalia in this context. So echolalia
is something that we’ve see especially
in. Folks who have a difference in the way
that they verbally communicate or might
have a delay behind typical markers of
verbal communication, and it’s something
that. Speech pathologists will
be able to support you with but also that
they say. Is is good.
You know, echo echolalia is a can be a
step developmentally towards
functional speech. So
echolalia again is a repetitive
behaviour. Talk to your speech
pathologist about the way that you can
help to shape that echolalic repetitive
behaviour into functional communication
and the best way to respond to that
repetitive communication style. It’s
going to be helpful to support
that person to moving towards.
Um, speech that helps them communicate what
they’re trying to achieve. The other
thing is that it’s OK to meet your own
needs when it comes to supporting
somebody with repetitive behaviours. If
you’re struggling safer with your child’s
vocal stimming, it is OK for you to seek
auditory respite. It is OK for you to
find that stressful,
recognise that’s what’s going on and
meet your own needs without.
And by doing that you can allow your child to
continue to do whatever behaviour it is
that’s feeling good for them. That was
not denying the fact that
you need support to manage that situation
too, something that an example that I
have is that a family that I worked with
from Melbourne. They had
a little boy who’s most
favourite, most favourite self
stimulatory behaviour was to watch the
same 10 seconds of the Dora Explorer.
Opening song on repeat. Really, really
loudly. He just loved it. It made him
feel so good. It was regulating for him
just that 10 seconds, over and over and
over and over again. And as you can
imagine, that would become grating for
anybody. So I worked with his
mom, who was at home doing the primary
caregiving at the time. And we found
different options that would allow her to
reduce the sensory
auditory overwhelm of
of that kind of.
Sound of that kind of sound but
whilst still obviously being able to um
keep an ear out for any kind of safety
things and what we end up using was
something called loop earbuds. So loop
earbuds are non electronic
earbuds that you can bring
down auditory input by a certain amount
of decibels or in a certain frequency
range. So if you are particularly
struggling with high
high frequency sounds you.
Can’t use loop earbuds that just shut out
high frequency sounds and everything else
is undisturbed. Or in her context
she used loop earbuds that just brought
down the volume by a little
bit by by 30 or 40
decibels and that was something that
allowed her to cope with the
sounds of her son self regulating
with that self stimulatory behaviour. So
it’s OK for you to need something to
help you cope with the self stimulatory
um?Behaviours or repetitive behaviours
that somebody else is engaging in.
Find the support options that you need so
that that means that person can continue
to engage in behaviours that they find
helpful, regulating or soothing Start.
We love your questions, we’d love to
answer them. And if you have any
questions at all, shoot me an email
[email protected] Thank you
so much for coming and we will
be back again next fortnight for
another webinar on supporting behaviours.
