What are stereotypes? What is the cause and management?

A stereotypy is a repetitive or ritualistic movement, posture, or utterance that occurs for no obvious goal or purpose. A behavior is defined as stereotypy when it fits the requisite form, which involves repetition, rigidity, and invariance, as well as a tendency to be inappropriate in nature.

Stereotypes are common to individuals with sensory processing disorder, intellectual, or developmental disabilities. They are intensively found in people with mental retardation and autism spectrum disorders.  Restricted, repetitive, and stereotyped patterns of behavior are one of three core diagnostic features of autistic disorder and are a frequent target of behavioral interventions for children with autism. 

Stereotypic behaviors are highly heterogeneous in presentation. Behaviors may be verbal or nonverbal, fine or gross motor-oriented, as well as simple or complex. Additionally, they may occur with or without objects. Some forms involve stereotyped and repetitive motor mannerisms or use of language. Common examples of stereotypy are hand flapping, body rocking, spinning objects, sniffing, immediate and delayed echolalia, and running objects across one’s peripheral vision. Other forms involve more complex behaviors, such as restricted and stereotyped patterns of interest or the demand for sameness. These forms may involve a persistent fixation on parts of objects or an inflexible adherence to specific, nonfunctional routines or rituals. For example, a child engaging in stereotypic behavior may attend only to specific parts of objects (e.g., car wheels, doll eyes). Alternatively, a child may insist on playing with his or her toys in a very specific fashion (e.g., lining blocks up in identical rows repetitively).

There are several possible explanations for stereotypy, and different stereotyped behaviors may have different explanations. A popular explanation is stimming, which hypothesizes that a particular stereotyped behavior has a function related to sensory input. Other explanations include hypotheses that stereotypy discharges tension or expresses frustration, that it communicates a need for attention or reinforcement or sensory stimulation, that it is learned or neuropathological or some combination of the two, or that it is normal behavior with no particular explanation needed.

          First, stereotypy is socially stigmatizing. Because of the existing obvious bizarre movements, the child’s involvement in the community, peer and adult interactions, or typical education settings may become severely restricted. Second, stereotypic behaviors interfere with learning to a large extent. Obsession to repetitive play or behavior will block the child’s access to matured play and learning through exploring the environment. This in turn will obstruct the child’s overall psychosocial development.

Stereotype Vs sensory demand

The most common cause of stereotypic behavior is found to be a strong need or aversion towards one or more sensory input. The subcategory of stereotypy, commonly referred to as self-stimulatory behavior (SSB), is a behavior, which is maintained automatically by the reinforcing sensory stimuli that it produces. Automatic reinforcement infers that the reinforcer and the behavior are one and the same. Self-stimulatory behavior, arguably a primary reinforcer, is resistant to social consequences. Although the particular sensory function being stimulated may not always be visually apparent to an observer, stereotypies often provide an obvious source of sensory input (e.g., visual, auditory, tactile, Proprioceptive, vestibular, taste, or smell). Also a stereotype of a specific sensory back ground is presented in order to mask or overcome the acceptance of one or more of other sensory stimulation. For example a child might engage in monotonous singing to overcome the noise of a spinning fan or child might flap hands at times of excitement to seek proprioceptive input which is expected to give a calming effect.

Stereotypes Vs Play

Apart from sensory background, stereotypes must also be viewed from a cognitive strategy’s point. Inadequate cognitive abilities to explore and manipulate toys and materials in an environment will also account for repetitive behaviors. A specific way of manipulating a toy, done accidently, can provide a sensory input or meaning to the child according to his/her level of play or cognition. This will result in repetitive or restricted pattern of play which is considered to be stereotypic. In such case, the child will not be able to stop this pattern of behavior and engage in purposeful play or behavior until the cognitive inadequacies are filled.

Stereotype Vs reinforcement/stress

Sometimes stereotypes which have begun due to a sensory need or lack of play skills may turn out to be a behavior that is controlled by external reinforcers. The most commonly environmental contingencies include social positive reinforcement (e.g., praise, attention), social negative reinforcement (e.g., escape or avoidance), non-social positive reinforcement (e.g., demand for a material or a tangible), non-social negative reinforcement (e.g., removal of or escape from a task or aversive physical stimulus), or some combination of social and non-social reinforcement. Here, stereotypes are increased or decreased depending upon the variables in the reinforcers. Forms of self-injurious behavior and stereotypes that increase with increase in stress/ demand can be grouped under this category. Careful analysis of social and nonsocial reinforcers and monitoring the level of stress is necessary to intervene in such case.

Example

Repeated banging/throwing/tapping/spinning or lining up if rings from a stacking ring set can be analyzed in terms of the above mentioned causes.

Lining up/ spinning/ tapping the rings might give visual, auditory or proprioceptive input to the child which might serve as a means to meet the sensory demands of the child. Providing adequate visual, auditory and proprioceptive stimulation through a sensory diet and providing alternative sources of matched stimulation through toys in a socially accepted manner will be useful in reducing stereotypes.

Note: Detailed explanation on sensory diet is given in sensory integration page in this blog.

The same pattern of behavior like lining up or tapping can also be because of the lack of the concept of size and shape that is required to stack the rings on the stand. This makes the child to be less successful in age appropriate use of the given toy. Here, adequate training of perceptual skills and concepts is the key to management.

The child may also throw, spin, bang or tap a ring to escape from or avoid a demand or stress. A previous incident of positive or negative, social or non social reinforcement would be a common cause that makes the child to attempt the same behaviors in these situations. Managing demands according to the child’s level of performance and controlling the immediate positive or negative reinforcements to the stereotypes will result in marked decrease in such behaviors.