Children with autism demonstrate repetitive behaviors and restricted interests referred to as RRBs.
This is part 2 of the diagnostic criteria for autism. For another look at part 1, see this post.
These behaviors are atypical for young children and constitute a major barrier to learning and social interaction and must be noted in at least two of the following areas:
1. Repetitiveness in how they talk, move their bodies, or use objects.
• Repetitive speech includes echolalia (excessive repeating of what others say), jargon (unintelligible sentences), rote language (such as frequent counting or singing rather than generating their own new sentences), or self-directed vocalizations like humming, grunting, or blowing. They may also use perseverative speech or appear “stuck” on a word or phrase.
• Repetitive body movements include hand flapping, rocking, toe walking, picking at skin, or unusual body posturing or body movements.
• Repetitive object use includes non-purposeful object use, such as lining up toys, spinning toys, opening and closing doors, and “fidgeting” with or holding objects rather than playing.
These repetitive patterns of speech, movements, and actions with items are referred to as “self-stimulatory behaviors” or “stims.”
Children with other kinds of significant developmental disorders or sensory processing differences may also stim.
However, when language delay is the only issue, children don’t use patterns of self-stims.
(More about self-stimulatory behaviors in Monday’s email!)
2. Insistence on sameness and inflexible expectations, such as:
• Strict adherence to their own expectations; they get upset when a well-established routine is disrupted. This includes self-limiting diets like eating only a few foods or only “white” foods.
• Ritualized patterns of verbal or nonverbal behaviors, such as saying or doing the same things the same way each time they repeat an activity.
• Distress at change including transitions between activities and difficulty with anything that’s new or unexpected. A child’s parents may never go out and leave him with a sitter or they may never spend the night at the grandparents’ home because the child is miserable.
• Little variety noted in play with toys. A child may like only one type of toy. For example, he may be obsessed with his dinosaurs and reject your attempts to get him to play with other toys.
3. Intense fascinations and obsessions, including:
• Unusual exploration, attachment, or excessive interest with “sticky” attention to objects or toys in that it may be difficult to redirect their attention away from a preferred object. An example is when a child’s favorite thing in the world is an upright Hoover vacuum and he insists that his parents keep it beside his bed at night.
• Hoarding or clutching favorite items and resisting removal or redirection. For example, your child has a death grip on all 7 of his Paw Patrol characters, but he never puts them down long enough to play with them. When his brother’s friend is over for a playdate and he tries to touch Chase, he loses it.
• Persistent focus on parts of an object. For example, obsessively watching wheels spin on a car or train.
• Preoccupation with visual information such as letters, numbers, colors, or shapes. This fixation can be noted verbally or nonverbally.
• Atypical or excessive fearfulness not commonly noted in other young children. For example, a child may be reluctant to cross the threshold in a door so you must pick him up or pull him through. Or a child becomes terrified when he sees leaves falling from a tree in autumn.
4. Sensory issues, including:
• Unexpected and unusual reactions to sounds, textures, or other sensory input. For example, a school may call a parent to come pick up a child who cannot calm down after a fire drill.
• Overreactions or underreactions during everyday experiences. For example, a child may not cry at all even though he’s taken a hard fall and is bleeding or a child may cry for 2 hours after she’s scraped her knee.
• Difficulty regulating their own emotions. For example, abrupt changes in mood or excessive difficulty calming down.
Symptoms of autism become apparent in early childhood and cause moderate to significant difficulty in a child’s daily life. These characteristics are best attributed to a diagnosis of autism, and not due to intellectual impairment or better explained by a diagnosis like Global Developmental Delay.
If you’d like some very specific guidance for working with a child who has red flags for autism, I have gathered the best help out there and put it all in one therapy manual devoted entirely to treating autism in toddlers and preschoolers called The Autism Workbook. The worksheets and questions in every chapter will guide you through deciding which areas to work on with a child — and then what to do next! Strategies and beginning activities are right there in the book. Get started today!