Tip of the Month – May 2018: Stimming and AAC
When introducing AAC to beginning communicators, it is not unusual for teams to be concerned about “stimming” or repetitive behaviours. Many clients are noted to say the same thing over and over again which can be concerning to those supporting them. However, is it always a problem and what can we do to support our clients?
Typical development of language
When children are developing expressive language it is expected that they will use the same words and sounds repeatedly until they have built up a large enough vocabulary to be able to communicate in a varied way. Repetition is part of exploring and refining your skills, just like needing to practice changing gears many times in a car before being able to complete the task without too much thought or anxiety.
What is stimming?
Stimming or self stimulatory behaviour is the repetition of movements, sounds or behaviours that is often seen in people with developmental disabilities and most often associated with people who have a diagnosis of Autism Spectrum Disorder. Stimming can be a way for an individual to calm themselves or shut out the rest of the world when they are feeling overwhelmed.
Stimming in relation to communication devices, usually refers to the use of repetitive phrases or behaviours in relation to the communication device. For example a person may press a word that has little meaning in the conversation, such as “away” over and over without expecting a response from their communication partner. Alternatively, a person may want or need to press a sequence of buttons before they can use their communication device effectively, e.g. when the device starts up in the morning they may always press “I à see à aeroplane” even though there are no aeroplanes around. It may also be the repetitive turning off and on of a device. These types of behaviours can negatively impact a person’s success with AAC systems. These behaviours might be seen as distracting in a classroom where other peers are trying to complete learning activities or it might just drive you nuts listening to the same word or phrase for the 300th time that day.
Is stimming echolalia?
Echolalia is the immediate or delayed repetition of a word or words. Stimming and echolalia often look very alike. Stimming, generally serves a sensory need whereas Echolalia can have a variety of functions. For example support with learning new words, support to process language, to take turns and to self-regulate.
Often, but not always, if a client is stimming, we will see the behaviour in relation to a specific object or type of communication system. For example we may see stimming behaviour on a high tech communication device but not on a low or mid-tech communication device.
How to manage stimming?
Now that we have identified that the person is stimming here are some suggestions around next steps.
- Ensure that the person has a sensory assessment and a sensory programme in place, so that their sensory needs are being met in other ways. It is a good idea to talk to your Occupational Therapist about this. Perhaps having a fiddle toy in their other hand, having a quick run or bounce on the trampoline or listening to some calming music right before they need to use their communication system during a learning activity or to have a chat would decrease the stimming behaviours. Good sensory diets can support learning throughout the day for our clients.
- Set time in your routine to allow for this behaviour. Remember that we can’t eradicate a behaviour, but rather we can shape it into something more socially acceptable. Perhaps use a visual on your visual timetable that says ‘time to explore your Talker’ and schedule this during a time when it is not going to be too disruptive. You might also want to explain the person’s sensory needs to peers, sibling or flatmates so that they don’t get too frustrated during ‘explore your Talker’ time.
- Don’t take away the device, turn the device off or turn the volume off. You wouldn’t take someone’s glasses away if they were vision impaired and you wouldn’t take their hearing aids away if they had a hearing impairment, so please don’t take their voice away if they have complex communication needs. Use your traditional behaviour management strategies, e.g. Redirect to a more appropriate behaviour, e.g. you could say “remember we are talking about colours, not aeroplanes“ or “first colours, then explore your Talker”. Ignore the behaviour. Respond to the person with a functional comment, such as ‘oh I can’t see any aeroplanes but I can see some books’. Distract them by talking about something else or starting a new activity, e.g. ‘I see your drink bottle, let’s get a drink’.
- Is it truly stimming or is the phrase linked to something in the environment? Waiting is a key component of being an excellent communication partner. Sometimes a person may use a phrase such as “bicycle, bicycle, bicycle, bicycle, bicycle” during a task such as reading a book and therefore it would be easy to assume that this is a stimming behaviour. However on closer inspection you may find that the book has a page with a bicycle and that it is the person’s favourite part of the story.
- Find out the root of the problem. Charts such as ABC (antecedent, behaviour, consequence) charts can help identify any specific triggers to behaviours. Spending time thinking about what happened immediately before and after a stimming behaviour can help identify triggers and therefore solutions.
- Hold the device yourself or put the device in between you, rather than letting the person have the device the whole time. Often stimming behaviours happen when the person has full control of the device and has no functional activity to be busying themselves with, so sometimes having the device accessible but not on the person’s lap can help.
- Try increasing the dwell time on the button (this is the length of time you need to hold the button for it to register the touch). Sometimes having to press the button for 0.5seconds in order for the button to activate and say the word means that stimming takes too long and the device starts only being used when the person really wants to communicate something functional. Don’t just leave the dwell on forever though! Try it for a few weeks and then if the stimming has decreased, turn the dwell off and see how things go.
- Model model model! Model language all the time! Use this as a teaching opportunity and model the language that you’d like them to use in this situation. The more that you model functional and highly motivating language across the day, the more that you will see stimming behaviours decrease.
- At times stimming behaviour is short lived and is a response to a new stimuli which resolves itself within a short time. Exploring is a typical response to the introduction of a new communication device. Give the person the opportunity to learn their device before jumping in to “correct” behaviour.
- Talk to your Speech Language Therapist or Occupational Therapist for more ideas.
To download a PDF version of this Tip of the Month, please click here
Created by Fern Maxwell (Speech Language Therapist) in January 2018.
When introducing AAC to beginning communicators, it is not unusual for teams to be concerned about “stimming” or repetitive behaviours. Many clients are noted to say the same thing over and over again which can be concerning to those supporting them. However, is it always a problem and what can we do to support our clients?
Typical development of language
When children are developing expressive language it is expected that they will use the same words and sounds repeatedly until they have built up a large enough vocabulary to be able to communicate in a varied way. Repetition is part of exploring and refining your skills, just like needing to practice changing gears many times in a car before being able to complete the task without too much thought or anxiety.
What is stimming?
Stimming or self stimulatory behaviour is the repetition of movements, sounds or behaviours that is often seen in people with developmental disabilities and most often associated with people who have a diagnosis of Autism Spectrum Disorder. Stimming can be a way for an individual to calm themselves or shut out the rest of the world when they are feeling overwhelmed.
Stimming in relation to communication devices, usually refers to the use of repetitive phrases or behaviours in relation to the communication device. For example a person may press a word that has little meaning in the conversation, such as “away” over and over without expecting a response from their communication partner. Alternatively, a person may want or need to press a sequence of buttons before they can use their communication device effectively, e.g. when the device starts up in the morning they may always press “I à see à aeroplane” even though there are no aeroplanes around. It may also be the repetitive turning off and on of a device. These types of behaviours can negatively impact a person’s success with AAC systems. These behaviours might be seen as distracting in a classroom where other peers are trying to complete learning activities or it might just drive you nuts listening to the same word or phrase for the 300th time that day.
Is stimming echolalia?
Echolalia is the immediate or delayed repetition of a word or words. Stimming and echolalia often look very alike. Stimming, generally serves a sensory need whereas Echolalia can have a variety of functions. For example support with learning new words, support to process language, to take turns and to self-regulate.
Often, but not always, if a client is stimming, we will see the behaviour in relation to a specific object or type of communication system. For example we may see stimming behaviour on a high tech communication device but not on a low or mid-tech communication device.
How to manage stimming?
Now that we have identified that the person is stimming here are some suggestions around next steps.
- Ensure that the person has a sensory assessment and a sensory programme in place, so that their sensory needs are being met in other ways. It is a good idea to talk to your Occupational Therapist about this. Perhaps having a fiddle toy in their other hand, having a quick run or bounce on the trampoline or listening to some calming music right before they need to use their communication system during a learning activity or to have a chat would decrease the stimming behaviours. Good sensory diets can support learning throughout the day for our clients.
- Set time in your routine to allow for this behaviour. Remember that we can’t eradicate a behaviour, but rather we can shape it into something more socially acceptable. Perhaps use a visual on your visual timetable that says ‘time to explore your Talker’ and schedule this during a time when it is not going to be too disruptive. You might also want to explain the person’s sensory needs to peers, sibling or flatmates so that they don’t get too frustrated during ‘explore your Talker’ time.
- Don’t take away the device, turn the device off or turn the volume off. You wouldn’t take someone’s glasses away if they were vision impaired and you wouldn’t take their hearing aids away if they had a hearing impairment, so please don’t take their voice away if they have complex communication needs. Use your traditional behaviour management strategies, e.g. Redirect to a more appropriate behaviour, e.g. you could say “remember we are talking about colours, not aeroplanes“ or “first colours, then explore your Talker”. Ignore the behaviour. Respond to the person with a functional comment, such as ‘oh I can’t see any aeroplanes but I can see some books’. Distract them by talking about something else or starting a new activity, e.g. ‘I see your drink bottle, let’s get a drink’.
- Is it truly stimming or is the phrase linked to something in the environment? Waiting is a key component of being an excellent communication partner. Sometimes a person may use a phrase such as “bicycle, bicycle, bicycle, bicycle, bicycle” during a task such as reading a book and therefore it would be easy to assume that this is a stimming behaviour. However on closer inspection you may find that the book has a page with a bicycle and that it is the person’s favourite part of the story.
- Find out the root of the problem. Charts such as ABC (antecedent, behaviour, consequence) charts can help identify any specific triggers to behaviours. Spending time thinking about what happened immediately before and after a stimming behaviour can help identify triggers and therefore solutions.
- Hold the device yourself or put the device in between you, rather than letting the person have the device the whole time. Often stimming behaviours happen when the person has full control of the device and has no functional activity to be busying themselves with, so sometimes having the device accessible but not on the person’s lap can help.
- Try increasing the dwell time on the button (this is the length of time you need to hold the button for it to register the touch). Sometimes having to press the button for 0.5seconds in order for the button to activate and say the word means that stimming takes too long and the device starts only being used when the person really wants to communicate something functional. Don’t just leave the dwell on forever though! Try it for a few weeks and then if the stimming has decreased, turn the dwell off and see how things go.
- Model model model! Model language all the time! Use this as a teaching opportunity and model the language that you’d like them to use in this situation. The more that you model functional and highly motivating language across the day, the more that you will see stimming behaviours decrease.
- At times stimming behaviour is short lived and is a response to a new stimuli which resolves itself within a short time. Exploring is a typical response to the introduction of a new communication device. Give the person the opportunity to learn their device before jumping in to “correct” behaviour.
- Talk to your Speech Language Therapist or Occupational Therapist for more ideas.
To download a PDF version of this Tip of the Month, please click here
Created by Fern Maxwell (Speech Language Therapist) in January 2018.