Introduction    

      
     

 Repetitive Play Patterns, Perseveration and Self-injurious Behaviors

Question 1.

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted and stereotyped patterns of behavior which include repetitive play patterns, perseveration and self-injurious behaviors.

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Repetitive play patterns, perseveration and self-injurious behaviors are core features of the ASD but what exactly are they and how do they impact a child with an ASD?

The term ‘‘repetitive behavior’’ is an umbrella term used to refer to the broad range of behaviors linked by repetition, rigidity, and invariance. 

Repetitive play patterns are frequently seen in children with ASD.  Play is an integral part of childhood development. If play value is defined as “how much play a child gets out of something” then the child with an ASD frequently does not get the same benefits from play that a typically developing child would.

In play the value of a toy is directly related to how many different options it offers for exploration and learning, for example nesting cups. Nesting cups can be nested inside each other, made into a tower, filled with other objects that can be dumped out, used in water and sand play, or sorted by color or size; and when the child finally masters assembling them together he or she has learned size discrimination. When using the same toy with a child with an ASD his play and exploration might be limited to rolling the cup across the floor. When working with Legos he would perhaps line them up rather than putting them together into any one of a myriad of things. 

So much of our early learning is encouraged by play; experimentation, learning new concepts, synthesis of new ideas, and planning and problem solving are all nurtured by a creative, diverse play experience.

When interacting with toys the child with an ASD appears to not see the toy as a whole but focuses in on details like the wheels on a car, or flipping the pages in a book back and forth without ever looking at the pictures. This form of repetitive play restricts and limits the child’s exploration and learning.

Children with ASD also often develop an attachment to a particular object or toy sometimes to the preclusion of playing with any other toy. This limits learning and social opportunities.

While repetitive play issues may be caused by an underlying issue such as OCD or an anxiety disorder, many children with ASD may use these behaviors because they find them to be soothing, increasing levels of arousal, or providing homeostasis or balance. There is also the possibility that these behaviors might be the result of an inability to understand how to interact with play objects. For instance, if a child is overly focused on the texture of the tires on a toy car, he or she may not understand that the car could possibly roll along on those tires to exciting new places.

Perseveration, a common hallmark of ASD, happens when a person repeats an utterance, a thought, or a gesture long after its usefulness has ended. This is marked by a strong resistance to change. Persevering is the ultimate goal of these actions; the problem is that these actions interfere with purposeful activity. Activities such as repeating phrases, flapping hands, ritualistic behavior, and "stimming" interfere with social activity and can isolate the child from learning activities by disrupting group interaction. 

Following is an example of perseverative behavior; a young child with ASD engaging in repetitive behavior  that may seem to be meaningless to the onlooker, but may have a specific purpose for the child.

Note that the above child repeats a ritualistic behavior at the oven door in spite of the repeated attempts at communication made by the child's caregiver. 

Perseverative behaviors may provide a sense of structure and comfort to the autistic child; it has been noted that many non-autistic people engage in ritualized, repetitive behaviors and find great comfort in them.

Self injurious behaviors are actions that a child performs that can result in direct physical harm to the child's own body.

Many children with ASD engage in self-injurious behaviors; such as biting, headbanging, or hitting oneself with hands.  These behaviors are often seen as very aberrant and disturbing and can be very socially isolating. It is not fully understood why some children with autism self injure. One theory is that children with ASD engage in hitting or hurting themselves in order to get the attention of parents or caregivers.

A similar theory is that a child may engage in self-injury in order to avoid demands that are placed on them; attention is taken away from expectations and focused on stopping the self-injurious behavior, giving the child positive reinforcement for continuing the behavior.
 

Another theory is that the release of chemicals into the brain that are pleasurable, such as endorphins, may occur when an individual self injures. Some research suggests that children may continue to injure themselves because it makes them feel good. 

Most children are thought to have highly complex reasons for self injury that are not fully understood. Most research indicates that it is a combination of these and other things that lead to self injury.
 

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References: 

Honey, Emma; Leekam, Sue; Turner, Michelle: McConachie, Helen: Repetitive Behaviour and Play in Typically Developing Children and Children with Autism Spectrum Disorders 2006

Turner, Michelle: Annotation: Repetitive Behaviour in Autism: A Review of Psychological Research, 1999 


Kuhaneck, Heather M.; Watling, Renee: Autism: A comprehensive Occupational Therapy Approach