Definitions of Repetitive Play, Perseverative Behavior and Self-Injurious Behaviors

Background/Introduction

Stereotyped or ritualistic behaviors and patterns of interest, along with social interaction and communication deficits, comprise the three major domains of autism. Repetitive Behavior is an umbrella term used to refer to behaviors linked by repetition, rigity, invariance and inappropriateness. Lewis and Bodfish (1998) discuss various abnormal repetitions in autism including; stereotypy, rituals, compulsions, obsessions, insistence on sameness, echolalia, self-injury, tics, dyskinesia, akathisia and perseveration. They point out that there is little consensus on the terminology, which can be problematic in defining and reviewing various repetitive behaviors. For example, one professional might view hand flapping as stereotypic, another as self-stimulatory, and still another as ritualistic.

Michelle Turner (1999) breaks repetitive behaviors into:
1. Lower level behaviors characterized by repetition of movement such as dyskinesias, tics, stereotyped movements, repetitive manipulation of objects and repetitive forms of self-injurious behaviors
2. Higher level behaviors including object attachments, insistence on sameness, repetitive language and circumscribed language

Repetitive play- difficulty forming a visual percept of an object and abstracting its potential uses can lead to play that is stereotypical and repetitive (Ayers, 1979). Repetitive play limits meaningful exploration with the environment and preoccupations can limit meaningful interactions. This maybe a reflection of the developmental play level or delayed fine motor abilities (Miller-Kuhaneck). Repetitive play is the repetition of the same motor or other behavioral activities used in play, such as lining up of animals over and over, the exact same placement of an object in a container over and over, or repeating the script from a cartoon or movie. A child may stack blocks over and over again without demonstrating pride in the accomplishment of the stacking, a child may line up toys or dump toys repeatedly. Individuals with autism often display stereotyped or repetitive use of language, such as perseverating on the same subject.

Self-Injurious Behaviors – any behavior that can cause tissue damage (bruises, redness, open wounds). Common forms include head banging, hand-biting, and excessive scratching or rubbing.

Perseveration – used to describe situations in which continuation of something (as repetition of a word) is to an exceptional degree or beyond a desired point, responses are repeated beyond what is necessary for completion of the goal (Lewis and Bodfish, 1998).

Information reviewed from Increasing Expressive Skills for Verbal Children With Autism by Susan Stokes, describes perseverative speech or incessant question asking as persistent repetitions of speech or questions which can have a communicative or non-communicative purpose.

When used with a communicative purpose, the perseverative speech or incessant questions are used by the child when he is anticipating a response, however, the child repeats the speech act either immediately or shortly thereafter, even after receiving a response. Example: A child with autism repeatedly says, "Watch Goof Troop", and becomes increasingly anxious and repetitive until someone responds to his perseverative utterance. Even though a response is given, the child continues to repeat the utterance.

Perseverative speech and incessant question asking may be related to the child's processing difficulties and/or his emotional state. Example: A child with autism is very anxious about where he will be going after school as the destination changes frequently. He says repetitively throughout the day, "Go to grandmas? "

When used with a non-communicative purpose, the perseverative speech and incessant question asking occurs when the child is not anticipating a response and can be used to provide a pleasurable or calming experience. Example: A child says the words, "New Haven Coliseum", repeatedly throughout the day for no communicative purpose, yet exhibits a big smile. He also engages in repetitive motor movements while saying the word.

http://www.youtube.com/watch?v=0ATPhinzAzc

"Written by Susan Stokes under a contract with CESA 7 and funded by a discretionary grant from the Wisconsin Department of Public Instruction. "

Turner, Michelle. "Annotation: Repetitive Behaviour in Autism: A Review of Psychological Research." Journal of Child Psychology and Psychiatry 40.6 (1999): 839-849.

Watt, Nola, et al. "Repetitive and Stereotyped Behaviors in Children with Autism Spectrum Disorders in the Second Year of Life." Journal of Child Psychology and Psychiatry 49.8 (2008): 826–837.