Autistic adults’ experience of restricted repetitive behaviours

Research Tuesday. Collins E., Gavin J., Russell A. and Brosnan M. (2022), Research in Autism Spectrum Disorders 90, 101895.

Restricted and Repetitive Behaviours (RRB) are a core characteristic of autism. According to DSM5-TR (2022), they include repetitive motor movements such as hand flapping and finger flicking and repetitive use of objects such as spinning coins or lining up objects.

RRB may seem functionless to an observer, and treatments such as Applied Behaviour Analysis (ABA) seek to eliminate this behaviour, while those autistic individuals who camouflage their autism may deliberately suppress RRB. However, RRB may have adaptive qualities that need to be recognised.

In the study by Collins et al. (2022), twelve autistic adults were interviewed to understand RRB from their perspectives. Thematic analysis identified four key themes: self-regulation, positive impacts, negative impacts, and suppression.

Self-regulation:

Repetitive movements can help regulate attention and emotions as illustrated in a quotation from one of the research participants.

"I got myself a fidget spinner and started playing with that, and it was nice to just spin that in my fingers, knowing that I don’t have to look at it and can still watch the telly and what’s going on."

Actions such as pacing or rolling dice can regulate emotions and provide a comforting sensory experience. They can also distract from depressive thoughts and sensory issues, clarify thinking, and stave off boredom. For many participants in the study, stillness was reported as uncomfortable but was alleviated by RRB.

Positive impact:

One of the functions of RRB is enjoyment; for example, one of the research participants explained that:

"It’s not exactly like euphoric but it’s like a lesser version of that. It just feels nice, it’s a nice kind of feeling like in your stomach."

And another explained:

"I do like a fidget spinner. It’s quite a nice surreal feeling."

Negative impact:

Engaging in RRB can lead to problems with losing track of time and potentially becoming so absorbed it affects sleep and other activities. Some participants reported feelings of a lack of control over the behaviour and apprehension about whether it could become an addiction.

Suppression:

The research participants described their awareness and concern about how RRB might affect or be perceived by others as illustrated by:

"I just feel like people will think it’s a bit odd, a bit unusual."

The participants also described being reprimanded, bullied, or physically restrained for RRB in childhood and that they felt ashamed when they engaged in such behaviour. This may lead to attempts to self-police and suppress or substitute the behaviour. One participant was reprimanded by their manager for repetitively taking apart a pen and said:

"I didn’t really stop, but I didn’t take it apart, I just had it in my hands."

Some practical strategies can help, such as sitting on one’s hands. However, not engaging in RRB was reported as creating more stress in an already stressful situation.

The authors of the research paper encourage future research to help maximise the positive impacts and minimise the negative, and further explore the impact of suppressing RRB on mental health and functioning.

Where to from here:

Understanding And Supporting Non-Speaking Autism course 28 June 2024.

This course educates participants about the interplay between severe speech and language disorders and autism, emphasising the development of practical strategies to support non-speaking autistic individuals. It covers a range of topics, including sensory processing, emotional management, social engagement, and movement disorders, drawing from scientific research, clinical insights, and autobiographies.

WEBCAST EVENT: Understanding and Supporting Non-Speaking Autism - 28 June 2024 - Attwood and Garnett Events

Tony Attwood and Michelle Garnett