Repetitive Behavior

Is your child:

• Repetitively spinning in circles?
• Bouncing, flapping his arms, or pacing when excited?
• Constantly tensing muscles, clenching hands, making faces?
• Moving in circles to match the movements of the ceiling fan?
• Unintentionally doing these repetitive behaviors?
• Challenging to interrupt when doing these behaviors?
• Causing other children to ask what he or she is doing?

Some children have repetitive motor behaviors that they feel driven to complete. Many children will say that they need to bounce or flap and cannot control it. Some behaviors may be subtler, like finger flicking or brushing fingers across one’s face.

Other behaviors like bouncing and repetitively spinning, can be very noticeable in a movie theater, library or at the park. These behaviors will appear repetitive and seem unusual when your child does them in public.

A toddler who is playing by laughing, smiling, looking at you and bouncing or waving her arms is not exhibiting this behavior. Repetitive behaviors look more compulsive, and your older child may or may not feel embarrassed by the behavior.

Children are generally aware they are engaging in repetitive behavior, but many find it challenging to control.

Clinically, repetitive motor behaviors are an example of motor overflow. Motor planning is controlled by the parts of the brain (parietal lobe and basal ganglia) responsible for planning and executing gross motor movements. In the case of motor overflow, this motor planning part of the brain may not be working smoothly.

Motor overflow is excess movement that does not serve a function. It is more common in infants, older adults and those with neurological differences.

Motor stereotypies: Motor movements such as flapping, bouncing, and spinning, are often referred to as Complex Motor Stereotypies. These behaviors are patterned, repetitive and rhythmic involuntary movements [3]. They can occur in children who are otherwise developing typically and are considered to be a part of executive dysfunction.

Restricted & repetitive behaviors: Repetitive movements often occur in children with Autism Spectrum Disorders. A neurological difference is present in this context and the behaviors are referred to as restricted and repetitive behaviors.

Restricted and repetitive behaviors are only one of the many symptoms of autism. Thus, if a child has only repetitive behaviors but no social or communication problems, autism would not be diagnosed.

Coordination issues: In a child without autism who displays repetitive movements, clinicians would call this behavior ‘complex motor stereotypies’. In this case, a child may have co-occurring ADHD, Tic Disorder or OCD.

A number of children with complex motor stereotypies are also diagnosed with Developmental Coordination Disorder, which refers to challenges with motor movements and may indicate difficulty with writing and fine motor skills and also clumsy motor movements [3].

While many children who exhibit these behaviors do have diagnoses of Autism, ADHD, Tic Disorder or OCD, it is possible for children with repetitive behavior to have typical neurological profiles.

Typical toddlers tend to do repetitive things, but these behaviors do not have the quality of releasing tension. That is, the child may move repetitively but the behavior is not serving the function of relieving anxiety, tension, or meeting a significant sensory need.

As a parent, you would notice that it does not appear that your child has to do them. It is certainly worthwhile to further explore your child’s symptoms, which may include anxiety, social communication challenges, inattention, repetitive or compulsive language and challenges with fine or gross motor skills. If your child has any of these additional symptoms, he or she would likely benefit from treatment.

If you suspect your child has repetitive behaviors that may be interfering with his or her functioning in any way, it would first be important to consult with a Psychologist regarding your concerns. Having diagnostic clarification and identifying any areas of difficulty will help a comprehensive treatment plan be developed.

If a Tic Disorder is suspected, it is recommended that you consult with a Neurologist and potentially a Child Psychiatrist to assist with medication management.

In terms of strategies for someone who struggles with repetitive behaviors, it may be helpful to guide your child to participate in another motor behavior when you see the repetitive behavior. Encouraging bouncing on the trampoline, squeezing a stress ball, playing with putty, or even clapping may help your child direct the motor behaviors into something more acceptable.

Some children benefit from time and space at home to have repetitive behaviors; as well as, sensory breaks with an Occupational Therapist at school that involve opportunities for frequent movement. Sometimes with these allowances, a child can refrain from flapping/bouncing/finger flicking/posturing in class or other social situations.

In other situations, it may be helpful for your child to share with friends that, “I bounce when I’m happy.” This way other children expect this behavior and may be less likely to be alarmed by it. Peers tend to get used to seeing the behavior when a child is open and transparent about it.

If your child’s motor needs are high, it will be important to involve the school. Providing frequent movement breaks and OT consultation can help to make things go more smoothly during the school day.

At home, you may consider medicine balls, a trampoline, and incorporating activity like swimming, biking, or hiking, to increase motor output. If your child meets criteria for Autism, AD/HD, Tourette’s, OCD or Developmental Coordination Disorder, he or she may need an IEP or Section 504 Plan to provide additional supports and services at school. It will be important to share any diagnostic information or reports with your School Psychologist to get the ball rolling.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Motor coordination (Moving & Sensing): repetitive behaviors could be related to a general motor control problem
• Executive functions (Organizing): repetitive behaviors are often associated with executive functioning deficits in multiple areas
• Attention challenges (Focusing): repetitive behaviors may be associated with attention deficits
• Social challenges (Socializing): repetitive behaviors may be associated with the social deficits often seen in children with Autism Spectrum Disorder or ADHD
• Sensory sensitivity: repetitive behaviors are often seen in children who have sensory sensitivities. In this case, Autism Spectrum Disorder should be considered.
• General anxiety: repetitive behaviors or compulsions may be displayed in some children as a method of managing their worries and fears

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Developmental Coordination Disorder: challenges with fine motor, likely including poor handwriting
• Tic Disorder: characterized by involuntary motor and/or vocal tics
• Autism Spectrum Disorder: deficits in social communication and restricted interests and/or behaviors [1, 2, 3]
• ADHD: challenges with attention, hyperactivity and impulsivity, often with executive functioning deficits
• Obsessive Compulsive Disorder: characterized by obsessions and compulsions. If compulsions are not carried out, anxiety is exacerbated

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child, or to consult ‘live’ with a psychologist
• Psychologist or Neuropsychologist: to consider symptoms in a mental health and brain-based context
• Neurologist: to consider tics or other neurological causes for repetitive behavior
• School Psychologist: to consider for 504 plan or IEP

These professionals may recommend or administer the following tests for this symptom:

• ADOS-2: test of social communication and restricted and repetitive behaviors or interests [1]
• Beery VMI sequence: test of visual-motor integration, visual perception and motor coordination
• TOVA, TOL-2, CTMT, and WCST: test of sustained attention and executive function
• Emotional rating scales and projective assessment: test of emotional concerns and anxiety

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

• Springer
• Amazon

[2] Fein, Deborah (2011).  The Neuropsychology of Autism.

Amazon: https://www.amazon.com/Neuropsychology-Autism-Deborah-Fein/dp/0195378318/

[3] Mahone, Mark E.; Ryan, Matthew; Ferenc, Lisa; Morris-Berry, Christina; Singer, Harvey, S. (2014). Neuropsychological function in children with primary complex motor stereotypies. Developmental Medicine and Child Neurology, 56(10), 1001–1008. http://doi.org/10.1111/dmcn.12480

Image Credit:
Description: Full length portrait of a little girl dancing in the park a warm autumn evening
Image ID: #322526054
By: Nataliia Zhekova
Behavior-of-autistic-child
Previously Licensed on: May 13, 2017
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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