Restricted Patterns of Behavior, Interests, & Activities
Overview
As a mother of a child with autism, author Clara Claiborne Park describes what restricted patterns of behavior, interests, and activities look like in her book The Siege: A Family's Journey into the World of an Autistic Child (1967):
We start with an image-a tiny, golden child on hands and knees, circling round and round a spot on the floor in mysterious, self-absorbed delight. She does not look up, though she is smiling and laughing; she does not call our attention to the mysterious object of her pleasure. She does not see us at all. She and the spot are all there is, and though she is eighteen months old, an age for touching, tasting, pointing, pushing, exploring, she is doing none of these. She does not walk, or crawl up stairs, or pull herself to her feet to reach for objects. She doesn't want any objects. Instead, she circles her spot. Or she sits, a long chain in her hand, snaking it up and down, up and down, watching it coil and uncoil, for twenty minutes, half an hour-until someone comes, moves her or feeds her or gives her another toy, or perhaps a book. (p. 3)
Park gives testimony to the power that restricted patterns of interest can have over a person with autism. One of the primary characteristics of autism spectrum disorder (ASD) is restricted and repetitive behaviors, interests, and activities. The behaviors occur more often and for longer periods of time in children with ASD than in typically developing children. The behaviors can range from looking at a spot on the floor, to flapping hands, to repeating favorite phrases, to lining up cars, to talking about bathroom scales. They can include wanting routines to remain the same, needing people to behave the way they did the last time they were in a given situation, or only wanting to play with the wheels on a truck positioned upside down.
Why do we need to know about this characteristic? Restricted patterns of behavior, interests, and activities serve a purpose for persons on the autism spectrum; we need to try to understand why they do what they do and how we can help them make changes to allow learning and growth to happen.
Definition
Autism is determined by looking at a triad of characteristics: impairment in social interaction, impairment in communication, and presence of restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Each characteristic has traits listed in the handbook mental health professionals use to diagnose disabilities called the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, 1994). To be diagnosed with ASD, one must show at least one trait from the area of restricted patterns of behavior, interests, and activities listed below (see http://www.autism-pdd.net/checklist.html#299.00 for other areas):
o encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
o apparently inflexible adherence to specific, nonfunctional routines or rituals
o stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
o persistent preoccupation with parts of objects
The next sections will examine each area and describe what the traits look like in a person with ASD.
Stereotyped/Restricted Interest Area
Case Study: Carlos
Carlos is sitting at the lunch table in the school cafeteria. He is with several other boys from third grade. Carlos begins talking about caves. He tells about some local caves he has visited, about stalagmites and stalactites, and then about underwater caves. Carlos was so absorbed in talking about caves that he did not realize his classmates stopped listening. His classmates have heard Carlos talk about caves often and are tired of it; they roll their eyes and move away from him, but he just keeps talking. Carlos cannot believe everyone is not interested in caves!
Carlos' story demonstrates how an interest can become an obsession and interfere with the ability to have friends and talk to other people. Special interests may involve objects, such as vacuum cleaners or trains; it may involve places, like caves, oceans, or Italy; or it may involve a subject, such as geography, racing, or music. What sets these special interests apart is the amount of time and energy spent learning about it, the time spent sharing with others, the vast amount of information gathered, or the refusal to talk, read, or write about anything other than the special interest. Or, the interest may be odd for the person's age or may just be unusual. The person with ASD may love High School Musical, but is 27 years old, or may know everything about Beethoven and his music when she is in first grade. Sometimes the interest is in a strange topic, such as electrical cords, yarn, beetles, or fire alarms.
Case Study: Tyler
Mr. Ace was getting a new student named Tyler in his preschool multiple-disabilities class. Tyler arrived on the bus carrying a spoon. The bus driver told Mr. Ace that Tyler's mom said he does not go anywhere without that spoon and that it is important not to lose it and to make sure it comes home with Tyler. Mr. Ace thought he would observe Tyler for a while, talk to his mom, and maybe his previous instructor before figuring out a plan to ease Tyler into activities without his spoon.
Case Study: Gina
Gina's sophomore English class is writing a paper about a book they just finished reading. They are to write about one of the characters and how the character changed in the story. Gina chose the main character and wrote about how he decided to become a paleontologist and study dinosaurs. She turned in a 10-page paper about her character. The teacher was upset about Gina's paper, because there was no mention of dinosaurs in the book. The teacher tried to talk to Gina about her paper, but all Gina could talk about was dinosaurs and how everything she had written was true. The teacher ended the conversation and decided to talk to the guidance counselor about how to help Gina write about something besides dinosaurs.
Aspy and Grossman (2007) note that symptoms in the areas of communication and social interaction usually become "less severe over time" (p. 247) while the area of interests can become more challenging. Especially for persons with high-functioningautism or Asperger Syndrome, the ability to research a subject and gain more academic skills gets easier. As adolescents, persons on the spectrum may want to develop friendships, so they talk about topics that are comfortable for them. Unfortunately, their abilities to interact socially may make it tough to share their interest in a way that helps them make friends.
Special Talent
Some persons with ASD can develop a special talent or savant skill that becomes a special interest. They may excel at playing or singing songs by ear, or maybe they know the make, model, and car of every teacher in their school. Some individuals can tell you which day of the week any date, past or future, occurs on.
Case Study: Rich
Rich, a 35-year-old man with Asperger Syndrome, was out with his coworkers one night for dinner. Terry, a coworker, told the waiter to ask Rich any question about baseball. The waiter asked him what Babe Ruth's batting average was, and Rich knew. Then he asked a couple of questions about Sabathia's pitching, and again Rich knew the answers. The waiter brought the owner of the restaurant to the table to ask more questions, and Rich still answered every one correctly. Rich remembered every fact and stat he had ever read or heard about baseball. As the conversation turned to other topics, Rich sat quietly and ate his dinner, not sure how to join in.
Many times, these special interests interfere with learning and socializing. Later in the module, we will talk about why these interests may exist and how to use them in a positive way. Next, we will discuss routines and rituals.
Routines and Rituals
Case Study: Phil
Phil loves to drop items that make noise. He will grab anything from anywhere and drop it on the floor to hear the sound. Phil's teacher would like to make his ritual serve a purpose. She has had difficulty with Phil completing his assembly work tasks independently, so she decides to add a new task to his session. She makes a task using a large metal coffee can and several objects that will make noise when dropped into the can. Next, she teaches Phil how the task works by demonstrating it and having him practice. Using Phil's work system (see AIM: Structured Work Systems and Activity Organization), the teacher puts the newly acquired task at the end of his independent work. The first time, Phil tries to do the new task first, but he is reminded of how his shape match work system operates. The next time, Phil completes his independent work correctly and then does the new task with great enthusiasm. As illustrated, the teacher used his interest in noise and his work routine to help make a ritual a reinforcer.
Rituals are a pattern of behavior regularly performed in a specific sequence with no obvious function. People with ASD can be very rigid and always want to do things the same way at the same time. Since life tends to include change, expecting things to remain the same can cause trouble for the person with autism and those around him or her. One of the reasons persons with ASD like to watch videos or DVDs so much is that they are the same every time; same people, same actions, same voices, same order; nothing changes. They are predictable. Persons with ASD wish their lives were like a video: same people, same actions, same voices, same order, with nothing changing. This would allow them to move calmly through their life by not having to learn anything new, which can be upsetting for them.
Case Study: Ginger
Ginger, a 13-year-old on the spectrum, is waking up at home on a weekday morning. She looks at her morning routine picture schedule and gets started. First, she gets up; next, she goes to the bathroom; then she gets dressed; and lastly she heads for the kitchen to have breakfast. After she has eaten, she brushes her teeth and gets her backpack. Now she gets to watch television for 20 minutes until the school bus comes. Twenty minutes passed and Ginger's show is over. Where is the bus? Five minutes later, Ginger is feeling anxious. Ginger's mom is starting to feel a little anxious, too. Ginger's mom suggests watching a little more television until the bus comes, as it must be a little late today. Ginger starts humming and rocking forward and back; she does not like that her routine has changed. Then mom and Ginger both hear the bus turn the corner. Ginger approaches the bus and gets on. She is ready to move on with her day.
Case Study: Kaleb
Four-year-old Kaleb is on a walk down the hall with his preschool class. He is closing every open classroom door on the way. As the paraprofessional notices his behavior, she decides to stop him at the next open door. As Kaleb reaches for the door, the paraprofessional tells him "door open" and blocks his hand. Kaleb reaches for the door again-with the same result. He then drops to the floor in a full tantrum. The paraprofessional waits for him to calm and then reminds him it is almost lunch time. Kaleb is distracted by the thought of lunch and gets back in line with his class. He makes it to the room without touching a door, but he does look at every open door.
Rituals can be very strong for people on the spectrum. If the ritual cannot be carried out, anxiety and anger may set in very quickly. A nonfunctional ritual may include touching the same spot on the wall on the way to the bathroom every time, opening and closing a lunchbox five times before eating, or eating a bite of foam soap before washing hands. Some rituals build over time while others are part of the repertoire from the very first time they happen. Being aware of the person with ASD, watching for rituals, and helping build change into his life is important. Learning about change can reduce anxiety and stress. More on that later in this module.
Case Study: Lee
Lee is an 18-year-old young man with autism. He is on a community trip with the Special Olympics track team at the local high school track. Practice is almost over, and Lee hears the bus coming to pick up the team. Lee has been practicing for the one-mile race, which is four times around the track. He has only finished two laps. His coach is watching Lee and sees him start to go around the track again. The coach calls to Lee, but he keeps on running. As Lee comes around, he tells the coach, "One more lap and then I can leave." The coach waves him on to finish and knows that next time he will need a strategy so Lee will interrupt his routine and leave when the bus comes.
Learning a positive routine, such as the order of events in the school day, is a good skill to achieve until the order has to change. When there is an all-school assembly, a fire drill, or a speaker in class, most students embrace it as a welcome change to their "boring" day. However, the student with ASD sees this as a threat to her routine and has difficulty transitioning to the unexpected activity. Building in a way to let the person know when a change is coming can help her cope with the change. Supporting the verbal notice with visuals can be especially helpful (see AIM on Visual Supports).
Repetitive Motor Behaviors
Repetitive behaviors may include motor movements, also referred to as self-stimulation, or verbal repetitions, such as words, phrases, or lines from songs. These behaviors can happen in any situation at any time. The purposes they may serve will be addressed in the next section of the module.