Perseveration… Perseveration… Perseveration…

Many children with severe disabilities, particularly those on the autism spectrum, perseverate. Perseverating means they do certain actions over and over again, like repeating a phrase, shutting a door, twiddling fingers, lining up toys, rubbing hands together, spinning objects, etc. It is almost as if these children are locked into an endless cycle of meaningless, odd behaviors.

Why do children perseverate?

There are a couple of reasons. First, they might find life to be so chaotic and confusing that they crave some sort of control. The repeated door slamming, for example, gives the child a sense of predictability, order, and power over his domain. Another reason for perseverating is that the sensory input received is stimulating in some way. Children with Sensory Integration Disorder may find normal sounds or experiences overwhelming, but twiddling fingers in front of their eyes, for example, provides visual stimulation that is calming.

For my son, Kyle, perseveration has taken several forms throughout his childhood. As a young toddler, he lined up bottles and cars in a systematic order, memorizing their numerical positions. Today Kyle perseverates by rolling rubber bands, strings, hair elastics, or ribbon in his hands. It is rare to find Kyle without a small piece of string or elastic. I’ve even seen him fiddling with the little piece of plastic that is discarded when opening a gallon of milk. At school, his fiddling became problematic when other students were irritated and distracted by it. “Could you tell him to put that string away?” one of his peers demanded.

Rather than insist that he stop this behavior, his teacher has focused on making it less noticeable. The sensory input seems to calm him and keep him from wandering around the classroom. And he’s able to do his work and concentrate, so it’s not causing any serious problems. So why insist that he stop, if it soothes him? The rule for Kyle now in class is that he can fiddle with the rubber bands if his hands are under his desk. Once he demonstrates that he’s formed a habit of keeping his hands under the table, the goal will be for him to keep the item in his pocket, and fiddle with it there.

Should perseverative behaviors be tolerated, or should parents try to stop them?

This depends upon, as in the example above, whether the behavior interferes with relationships, schoolwork, or normal life experiences. In many cases, perseverating is an attempt for the child to “tune out” of his chaotic world. Thus, it’s anti-social. Ideally we’d like to encourage these children to be social and relate to other people around them, so anti-social behaviors should be redirected. Even a behavior which doesn’t interfere but simply looks strange should probably be addressed, because it may cause others to reject and alienate the child.

How can I redirect my child’s perseverative behaviors?

It will take time and effort. You will need to give meaning to the behavior, by turning it into a game or activity of some sort. This will take creativity and patience. In my blog “My Child Won’t Let Me Touch Him.” The Avoidant Child, I offer some suggestions, but here are a few more: For example, if your child lines up objects, get on the ground and begin counting them. Help him add more to the line. Try making a line with a new pattern, like…car, car, block–car, car, block, etc. See if your child picks up on the new pattern. Gently try withholding an item he wants, looking at him inquisitively, to promote speech. “You want the block? Block.” All of these actions are adding meaning to a nonsense behavior. And with your participation and his responses, you are making it a social activity as well. Little by little, your child should learn to accept your participation.

If your child rocks back and forth, you could imitate his actions and say, “I’m a tree blowing in the wind,” or get under a blanket and rock, then peek out and say, “There you are!” The point is, redirect the behavior into play. Your goal should be to gently, over time, coax your child to change his behavior by creating obstacles to his perseveration. Say, “Oh NO! The cars can’t be lined up! A train is coming!” Your child may initially respond with irritation, but eventually he will adapt. You’re trying to promote language, encourage sharing and turn-taking, and to assign purpose to his actions.

Will it ever stop?

Probably not completely. A lot depends on how much intervention is done and the age of the child. The earlier these behaviors are redirected, the better. Some children’s tendencies to perseverate decrease when they reach puberty. Others struggle with it throughout their lives. It is certainly possible to lessen the behaviors, reduce them, and redirect them. And YOU play a major role.

If your child has irregular motor behaviors such as spinning, whirling, flapping, jumping, etc., please refer to my blog, “Flapping, Spinning, Waving, Whirling: The Child with Irregular Motor Behavior.”