Self-Soothing Repetitive Behavior
Self-soothing repetitive behaviors are mainly caused by three variables; behaviors aimed at reducing akathisia, behaviors aimed at shutting out sensory stimulation, and behaviors that occur because of motor control issues such as motor planning difficulties and low muscle tone. Akathisia (muscle restlessness) can be relieved by ballistic gross motor movements, repetitive hand flapping, pacing, or shacking of objects. Most repetitive gross motor movements will temporarily remove feelings of akathisia. Sensory stimulation can be reduced by familiar environments, familiar activities, symmetry, or anything that decreases the demand for attention. Finally, children will often gravitate to behaviors that can be performed easily when they are incapable of more complex movements.
Our general strategy for dealing with self-soothing repetitive behaviors is to help the child become more productive at self-soothing, to shape the self-soothing behavior to become more socially appropriate and to teach behaviors that are more complex that will be more enjoyable and productive for the child. Self-soothing repetitive behaviors can also be used to increase the frequency of low frequency behaviors. Combining all of these strategies to shape minimally productive, odd, or ritualistic behaviors toward socially appropriate more productive behaviors is usually the best strategy. For example one young child who pushed a small toy lawn mower for hours out of the day was by the age of 8 to cut lawns with a real lawnmower and since the age of 10 he had been cutting laws for neighbors and making more money than all of his friends. Another who flapped spoons all day was directed toward playing the drums.
Inappropriate, socially odd, or unproductive self-soothing behaviors can be shaped easily through a process of adding a response cost. One five year old girl who had a number of sensory sensitivities would lie on the floor and rub her pelvis into the floor often throughout the day. This self-soothing repetitive behavior was very distressing to the family. Since she didn’t like to have her hair brushed we decided to brush her hair for 5 seconds every time she began to rub her pelvis into floor. The response cost was that we were desensitizing her to having her hair brushed. Rubbing her pelvis on the floor became predictive of hair brushing, the sensory qualities associated with hair brushing transferred on to rubbing her pelvis on the floor and the behavior stopped. The end result was that she no longer rubbed her pelvis into the floor and she became comfortable with people brushing her hair. The goal is usually not to make the self-soothing repetitive behavior go away. The goal is to shape the inappropriate behavior into a behavior that is less inappropriate. We may provide an alternative behavior to substitute or we may just start the procedure and watch as the child tries alternatives to see if the alternative also evokes the response cost. As we watch the child try alternative behaviors, behaviors that are not as inappropriate do not bring the response cost and hence the behavior is shaped toward a more appropriate behavior.
Another way to deal with an inappropriate self-soothing repetitive behavior is to place a demand into the preexisting chain of events. For example, a child likes to line up toys. This is a self-soothing repetitive behavior that takes advantage of repetition and symmetry to decrease attentional demands. When the child is doing this he/she is escaping from the social world of relating to another human being. If we join with the child in the activity by handing the toys to the child, assisting in the behavior of lining up toys, the child has to relate socially to continue the self-soothing repetitive behavior. By using intrinsically gratifying self-soothing repetitive behavior to increase low frequency behaviors and inserting ourselves into the existing chain of events we can begin to teach the child the values of social interaction.
We could also use the proactive approach described earlier. In the example of the child rubbing her pelvis into the floor may times throughout the day. Rubbing her pelvis into the floor is an excessive behavior. We would identify the incompatible deficit behavior and reward that behavior on a variable interval schedule. We could also combine strategies. We could reward and incompatible behavior when the child is not actively pursuing the inappropriate behavior and provide a response cost when the child engages in the inappropriate behavior.
We also work on gross and fine motor abilities and teaching a child adaptive skills, sports activities, preschool games, and toy play to give the child a wider behavioral repertoire. We will specifically try to teach skills that will take advantage of the self-soothing repetitive behavior with the goal of giving the child a higher level option to self-sooth. Self-soothing behavior is observed and recorded and a plan is then designed to help the child self-sooth in a more productive, socially appropriate way.
Some parents ask, why not allow the child to continue the self-soothing repetitive behaviors as they are? Problematic self-soothing repetitive behavior is behavior that will not lead to social integration and acceptance. If the self-soothing repetitive behavior will increase the social gap between the child and his or her peers or interfere with independent self-sufficient functioning than it is a behavior that we target and develop a plan to move the behavior toward behavior that will help the child be accepted by their peers and/or help them live more productive self-sufficient life. All of these strategies are based on the premise that social interaction and affiliation is productive for the child.