This lecture was produced for the VCU-ACE Foundations of ASD Course. The transcript is intended for
use by participants in the online course. Please do not disseminate this material without the permission of
VCU-ACE staff.
Slide 1: Behavior in Autism Spectrum Disorders
Hi. My name is Joy Engstrom. I am the Technical Assistance and Training Coordinator at the
VCU Autism Center for Excellence. I will be presenting on the third primary characteristic of
autism which is restricted, repetitive, and stereotyped patterns of behavior.
Slide 2: Behavior
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The third characteristic that is present in autism as defined in the DSM IV is restrictive
repetitive and stereotyped patterns of behavior.
Think about the person and the behaviors he/she exhibits which are attributed to having
an autism spectrum disorder.
Individuals with autism do not engage in these behaviors to be obstinate or difficult.
Rather, they do it because they get something out of engaging in the behavior.
Examples of behaviors include a preoccupation or intense interest, adherence to routines
or unusual rituals, stereotyped mannerisms, or preoccupation with parts of objects.
The purpose of the behaviors might be to gain your attention, to leave an activity, to calm
down, to regulate, or because it is fun.
The third characteristic that is present in autism as defined in the DSM IV is restrictive repetitive
and stereotyped patterns of behavior. These behaviors present themselves in the following ways:
a preoccupation or intense interest, adherence to routines or unusual rituals, stereotyped
mannerisms, or preoccupation with parts of objects. In order for a person to meet criteria for an
autism spectrum disorder, he must demonstrate at least one behavior that fits into at least one of
these categories.
We have started each presentation by asking you to think about an individual with autism. I
would like you to revisit your image of that person again, but this time I want you to think about
the person and the behaviors he/she exhibits which are attributed to having an autism spectrum
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disorder. I would like you to stop the presentation now and write down behaviors that come to
mind when you hear autism and behavior.
Welcome back! Some of the behaviors you might have listed are hand flapping, body rocking,
spinning, head banging, resistance to change, challenging behavior and preoccupation with parts
of objects. I want to remind you that individuals with autism do not engage in these behaviors to
be obstinate or difficult. Rather, they do it because they get something out of engaging in the
behavior. It is believed these behaviors happen for a variety of reasons. It might be to
communicate that they want your attention, or that they don’t want to engage in an activity. It
might be that engaging in the behavior helps them to calm down or to regulate. It might be that
the behavior is fun. On the next several slides we will look at these behaviors in more detail.
Slide 3: Preoccupation with parts of objects
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Children with autism might become fixated on parts of toys.
The reason I wanted to start with preoccupation with parts of objects is that it’s often one of the
first signs families notice when it comes to young children and play skills. This was discussed
briefly during the presentation about social skills. Young children with autism might become
fixated on parts of toys. The example [that was given] in a previous presentation is being fixated
on spinning the wheel on a car instead of playing with the car by rolling it on the floor. Liam is
twelve years old and has Asperger’s syndrome. He is very interested in screws and becomes very
distracted by mechanical items and furniture containing screws.
Slide 4: Stereotyped behaviors
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Examples of repetitive stereotyped behaviors include hand or arm flapping, spinning,
body rocking, rubbing hands together, head banging, vocal sounds, swinging, eye poking,
and humming.
These are commonly referred to as self-stimulatory behaviors, self-regulatory behaviors,
or stereotypic behaviors.
We all engage in some form of repetitive behaviors.
Individuals with autism might engage in these behaviors more often or their behaviors
may be more overt and more extreme.
On this slide, you see a list of stereotyped behaviors that are commonly associated with autism.
This is not a complete list but provides examples of repetitive behaviors that a person may do
with his/her body. Some of these behaviors were likely on the list that you made at the beginning
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of this presentation. The number or type of behaviors the person demonstrates will vary
tremendously. Some may exhibit many repetitive behaviors and engage in them frequently, while
others may do something as subtle as rocking his body as he is trying to go to sleep.
These were once called “self-stimulatory behaviors” or “self-stim" since they were thought to
stimulate the person, because he would get excited or agitated when he engaged in the behavior.
Others more recently have begun referring to them more often as “self-regulatory behaviors” and
suggest that these behaviors might serve to help regulate the person’s sensory system. We will
talk more about self-regulatory behaviors in the sensory module to be covered later in this course
Without more specific information gathering about a behavior, such as a functional behavior
assessment, we often do not know the true reason for these types of behaviors. Thus, many find
it more accurate to refer to them as stereotypic or repetitive behaviors.
It is important to note that many individuals with autism may exhibit the same pattern of
behavior at different times and for different reasons. Jared engages in body rocking when he is
anxious, frustrated or angry but will also do it when he is excited or engaging in something fun.
Thomas jumps up and down when he is watching a favorite movie, while Jaleen does this when
she is frustrated. Each person is different; therefore, each behavior and function is different.
It is important to mention that we all engage in some form of repetitive behaviors. You might
jiggle your leg when you are nervously waiting in the doctor’s office or when you are sitting and
listening to a speaker because you are bored. You might bite your lip repeatedly as you watch the
end of a suspenseful movie. We all do these behaviors to calm ourselves or to help us pay
attention. In other words, to help us regulate. The difference is that individuals with autism might
engage in these behaviors more often or their behaviors may be more overt and more extreme.
Slide 5: Stereotyped Behavior
In the upcoming video you will see a boy engaging in a repetitive hand wringing behavior. He
engages in this behavior when he is asked to sit and wait.
Slide 6: Stereotyped Behavior
Video
Slide 7: Resistance to change
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This behavior can have a negative impact on the person and the loved ones around him.
Sometimes the person’s desire for order and sameness can interfere with participating in
the activities and events in his life.
Sometimes the person’s desire for order and sameness can interfere with participating in
the activities and events in his life.
Changes in the environment may result in challenging behaviors, which can interfere
with learning, forming relationships, and interacting with others.
Many individuals with autism require some sort of order in their environment.
Another feature of restrictive or repetitive behavior associated with autism is the resistance to
change or what might also be called a need for sameness. This can take many different forms.
For example, Breanna likes to wear only blue t-shirts. Liam becomes very distressed when there
is a substitute teacher or when his clothes in his closet are switched from summer to winter
garments.
It’s important to understand this behavior as it can have a negative impact on the person and the
loved ones around him. Sometimes the person’s desire for order and sameness can interfere with
participating in the activities and events in his life. For example, Liam insists on eating the same
brand of waffles each morning. When the store is out of this brand, his mother will go from store
to store until she finds them. One time, she was unable to find any. This resulted in a terrible start
to their day. As we all know, our environments are constantly changing. These changes can
help us to learn and grow. They can help us to be more flexible and open. It stands to reason if a
person requires strict adherence to order, then he will be challenged constantly. Their desire is
so strong that they may display challenging behavior. By exhibiting the challenging behavior,
the person is communicating to you that things are not as they should be and he is feeling
anxious. This type of behavior can also interfere with learning, forming relationships, and
interacting with others. Change is a part of life, and such resistance can limit engagement
Resistance to change can be demonstrated in a person with autism in many different ways. We
will discuss each one on the following slides. First, many individuals with autism require some
sort of order in their environment. In other words, things have to be arranged a certain way.
Some of the students I worked with liked it if all books in the reading area were in one place (on
one shelf) while others had to have them in alphabetical order on the shelf and others wanted
them arranged by size (smallest to tallest). I actually had one student who, when he walked in to
the room, would be able to scan everything and pick out anything new added to the room. I once
added a new book to the book shelf and he walked over to the books, pulled the new one out and
began looking at it.
Slide 8: Adherence to routines
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Individuals with autism often require routines and become upset when the routine is
changed or disrupted.
Routines are a necessary part of life.
Too much of a good thing can be a bad thing!
Why do these routines and requirement for sameness develop?
There is another way resistance to change impacts a person. Individuals with autism often
require routines and become upset when the routine is changed or disrupted. Routines are not a
bad thing. They are a necessary part of life. We all have our routines. They help us feel safe and
secure and keep life somewhat predictable, as well as foster independence. Without routines and
structure, life is stressful. I know for me, I like my morning routine to be predictable. I like to
take a shower right after I wake up. I like that my coffee is ready and waiting for me when I go
downstairs. I don’t like it when something happens to disrupt the regular flow of that routine
like when I wake up and there is no electricity. That means that I can’t take a hot shower or have
my coffee or dry my hair. When that happens, I become anxious and sometimes frustrated,
particularly if I have a morning meeting to attend. The natural order of things is off and I am
distressed.
What is the old saying? “Too much of a good thing can be a bad thing.” It is when we become
too entrenched in our routines and become inflexible that problems can occur. If you have to do
the same thing in the same order day after day, the chance is pretty high that there is going to be
a problem. Have you ever tried to do the same thing in the same way day after day? Have you
ever just tried to eat dinner at the exact same time every day? My guess is you probably haven’t
because you know that it is next to impossible to juggle your busy day-to-day schedule and eat
dinner at the exact same time every night. But some people with autism have a desire to have
things happen at the same time or in the same way.
Here are some examples of strict adherence to routines. Liam desires his night time routine to be
the exact same every night. It must involve: 1. Put on pajamas, 2. Brush teeth, 3. Say goodnight
to dad, and 4. Mom reads three stories to him. This routine takes over an hour to complete. By
the time it is finished, Liam’s mother is exhausted. When the routine needs to be changed for
some reason (for example, dad is out of town), Liam becomes upset and is difficult to calm and
get to sleep. Another example involves Jane, an adult with autism. Jane requires the same routine
when she enters work in the morning. She signs in, buys a soda, checks her email, then goes to
the morning planning meeting. On Tuesday, the soda machine was out of Diet Coke. This
created a tremendous challenge for Jane as she was unable to continue with her day and did not
work.
Often people will ask why individuals with autism develop routines and require sameness. Ros
Blackburn, an adult with autism, once said that not only is she unable to read people’s emotions,
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but she can’t read places or situations either. She told the story about going bowling with a
group of her friends with various disabilities. She said they always go to the same bowling alley
but this week they went to a new one. She was unable to read the environment and did not know
where to go to get her ball and shoes. If others with autism have difficulty reading situations,
maybe that is why they have the strong desire for sameness.
Slide 9: Restrictive rituals
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Some individuals with autism have restrictive rituals they must complete.
Understanding the rituals, preparing the person for changes, and teaching him or her to
gradually accept change will be critical.
There are evidence-based practices to help a person become more flexible and to accept
change, such as visual schedules.
In some instances, individuals with autism have restrictive rituals they must complete. I taught a
student who could only eat his French fries if first he lined them up from biggest to smallest.
Another student would flip the light switch three times prior to entering a room. Liam, when
leaving school, must tap the door on his way out. If there is a crowd at the door, he will still
wiggle his way through the people just to tap it.
If the person exhibits any of these behaviors, understanding them, preparing the person for
changes, and teaching him or her to gradually accept change will be critical. There are evidencebased practices to help a person become more flexible and to accept change. An example of an
evidence-based practice is a visual schedule. We all have and use schedules to help us remember
when something is going to happen or not happen. They help us to manage life and promote
independence. Visual schedules can do the same for a person with autism by telling them ahead
of time what is coming next.
Slide 10: Impact on Play
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These behaviors regarding need for sameness, order, and routines may impact play skills
significantly.
Play may be very repetitive and not progress or become more sophisticated over time.
Some individuals with autism may pair these behaviors with stereotyped mannerisms
These behaviors regarding need for sameness, order, and routines may impact play skills
significantly. Play may be very repetitive and not progress or become more sophisticated over
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time. For example, Breanna plays with her doll the same way each time. She runs her fingers
through her hair and watches her hair reflect off the light as she swings her doll through the air.
For some children the repetitive nature is harder to notice. With Liam, he loves dragons and
engages in pretend play using castles, moats, dragons, and warriors. However, this is always the
theme of his play. It gets more sophisticated, but the underlying story is the same.
Some individuals with autism may pair these behaviors with stereotyped mannerisms. This is not
always the case. You might encounter an individual who spins a ball on the floor repetitively
while engaging in hand flapping. Breanna, while playing with her doll’s hair will often stop and
clap her hand, then return to doll play.
Slide 11: Restricted interests
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Presence of restricted interests or a preoccupation with an item or topic of interest is
another form of behavior we may observe.
Most of us have specific interests. The difference is regarding intensity and interference
with functioning.
What we find with those with autism, is the interest is consuming and is a preoccupation.
Individuals with autism may collect things for reasons that we often do not understand.
Many of these adults will tell you that one of the best ways to teach is by using their
interests.
Presence of restricted interests or a preoccupation with an item or topic of interest is another
form of behavior we may observe. Interests are as varied as the people who have them. I know a
young man with Asperger’s Syndrome who is interested in cloud formation and is very
knowledgeable on this topic. I know a little boy who is interested in trains and can tell you
everything about Thomas the Tank Engine. I know one adult who is very interested in the
continent of Africa.
As with all the behaviors described, anyone may exhibit this behavior and have an interest. For
example, a coworker really likes antique dolls and will travel to go to antique shows to collect
and learn more. Now, the difference is regarding intensity and interference with functioning. My
colleague is able to develop her interest in a healthy and productive way and knows to talk about
dolls when at the antique show, but does not do so at work or with her husband. What we find
with those with autism, is the interest is consuming and is a preoccupation. The person may
likely want to hold the item or talk about the topic incessantly.
Individuals with autism may also collect things just to collect them or for reasons we often don’t
understand. The items collected may seem strange or unusual. Have you ever known someone
who collects something, like stamps or coins or magnets, from the different places she has
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traveled? My friend used to collect frogs. She collected frogs from all over the world and not
just your average dollar store frog. When friends and family traveled, they brought a frog that
represents the country or state they had visited. She has a hand blown glass frog from Seattle,
Washington, a crystal one from Germany, a marble one from Mexico and so on. For individuals
with autism, the items collected may seem strange or unusual. Now, you can say collecting frogs
seems strange too! However, collections I have seen include pine combs, used stamps, and rocks.
Rex collects books based on the authors date of birth rather than because he really likes the
author and his books. Collections of course will vary.
Many of these adults will tell you that one of the best ways to teach is by using their interests.
So, if the person is interested in dolphins, then use dolphins when you are teaching counting or to
keep them interested in reading. I have talked about Temple Grandin in other presentations. She
is an adult with autism who was very interested in cows. She turned her interest into a career, as
many as of us do, and is a leading expert in animal husbandry. We go into our field of expertise
based on what we are interested in and what we are good at.
Slide 12: Restricted Interests
In the upcoming clip you will hear a young man having a conversation with someone about his
restricted interest which is writing books.
Slide 13: Restricted Interests
Boy: Actually, I write books. It sounds…
Adult: Interesting.
Boy: It’s interesting but it’s a hobby of mine cause I don’t have any brothers or sisters.
Adult: Ah huh
Boy: When I’m finished with homework it’s either video games or write and um it’s actually a
pretty good hobby.
Adult: That’s a great hobby. Tell me about one book and then I’ll finish up.
Boy: Well, I actually go one published. So
Adult: You did?
Boy: It’s only seven pages but it’s about these treasure hunters that go looking for different types
of treasure. Something I really like to listen about.
Slide 14: Challenging behavior
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Although many individuals with ASD display tantrums or challenging behaviors such as
aggression, self-injury, screaming, or crying, this is not a part of the DSM IV diagnostic
criteria.
Behavior is communication.
There are several evidence-based practices to assist with challenging behaviors
The purpose of the FBA is to assist with determining the reason for the behavior.
The purposes of the BIP are to outline proactive strategies that can prevent or mediate the
behavior and identify what the person should be taught.
Although many individuals with autism spectrum disorders display tantrums or challenging
behaviors such as aggression, self-injury, screaming, or crying, these behaviors are not part of
the DSM IV diagnostic criteria. This is an important point. However, I would be remiss if I did
not talk about these types of behaviors because tantrums or challenging behaviors are one of the
common problems reported by families and professionals working with individuals with autism.
It is important to remember that the person is not exhibiting the behavior to be difficult. As we
talked about in the communication presentation, behavior is communication. The person is just
trying to communicate something to you and the behavior is the most effective and efficient way
to do it. It might be that they are frustrated, anxious, scared, in pain or bored. Think about the
information you have learned in this course. There are many difficulties with communication and
social functioning. Additionally, there is a strong desire to demonstrate behaviors that may be
viewed as strange or inappropriate. Given the core characteristics of autism, it is a natural
progression that challenging behavior may be present.
There are several evidence-based practices to assist with challenging behaviors. The most
effective one is the use of a functional behavior assessment (FBA) and Positive Behavior
Intervention (BIP) plan. The purpose of the FBA is to assist with determining the reason for the
behavior. The purposes of the BIP are to outline proactive strategies that can prevent or mediate
the behavior and identify what the person should be taught. Some of the evidence-based
practices used to support individuals with challenging behavior are visual schedules, visual
supports and functional communication systems.
Slide 15: Internally reinforced behaviors
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All behaviors are learned.
Some behaviors develop due to internal reinforcement.
The person would engage in the behavior even if there is no one around.
Automatic comes from the Greek work “automatos” which means self-acting.
These behaviors are internally or self-reinforced.
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All behaviors are learned. However, how they maintain and grow differs depending on the
behavior. Some behaviors are automatic and develop due to internal reinforcement. Let me
explain. When I say some behaviors are automatic, I don’t mean that they happen automatically.
Rather, the person would engage in the behavior even if there is no one around. Automatic
comes from the Greek work “automatos” which means self-acting. These behaviors are
internally or self-reinforced. An example of this behavior might be someone who chews on the
inside of her lip. A person might engage in this type of behavior because it feels good to her or
she receives pleasure from it. Another example might be a person who spins in circles because
he likes the dizzy feeling he receives from the behavior. I once worked with a young man with
Asperger’s syndrome who used to bang his head because he liked the feeling he got when he
would do it. I questioned his behavior because I thought it was because of the attention he
received from others around him. He used to hit his head on the bulletin board. I know what
you’re thinking. It’s soft and wouldn’t hurt that much, but he used to hit his head pretty hard.
One day he came into the room and the bulletin board was replaced with a white dry erase board.
When he hit his head he turned to me and said, “Ouch! That hurt!” I asked him, “Jose, what did
you think it would do?” He told me, “Not hurt! I do it to clear the thoughts out of my head that
are distracting me. It feels good when I bang my head but that did not feel good!”
Slide 16: Externally reinforced behaviors
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Behaviors can also be learned over time through external reinforcement.
The behavior is reinforced by someone or something in the environment.
Examples of externally reinforced behaviors
Sometimes we reinforce behaviors inadvertently.
Behaviors can also be learned over time through external reinforcement. This means that the
individual has been reinforced by someone or something for engaging in the behavior. Let me
provide you with an example. One day Jason flapped his hand. His dad asked him to stop
flapping his hand. The next time Jason flapped his hand his dad asked him to stop. Whenever
dad was in the room and Jason flapped his hand, his dad would stop what he was doing and talk
to Jason. Jason learned that if he flapped his hand around dad he would get attention from dad.
Here’s another example. Every day when driving home from school, Breanna screamed from the
back seat if her mother tried to go a different route. Breanna’s mother in an effort to appease her
daughter would turn the car and take the same route. Breanna quickly learned, if I scream, we
can go the same way each time thus developing a routine.
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Sometimes we reinforce behaviors without even knowing it. It can be inadvertent. Often, like
with this last example with Breanna, we don’t realize we are helping to develop a routine or
some other type of behavior that may become problematic.
Slide 17: Supporting the individual
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Before you try to decrease a behavior, first find out what is reinforcing the behavior.
Does a behavior warrant intervention?
We need to consider the frequency, the intensity at which the behavior is exhibited, the
rate at which the person is able to learn new behaviors, and how interfering the behavior
is.
In the past two slides, we have discussed both internal and external reinforcement of these
behaviors. My point here is this, before you try to decrease a behavior, first find out what is
reinforcing the behavior. Why is the person engaging in the behavior? Is the person engaging in
the behavior because it feels good or because it is calming or is he doing it to gain attention or
escape from an uncomfortable situation? All of these questions will help you determine the best
strategy to address the behavior and support the person.
Additionally, as we support the person regarding any of the behaviors described in this
presentation, we should determine whether the behavior warrants intervention. For example,
while hand clapping may be an annoying behavior, it may not warrant an intrusive intervention.
In deciding whether a behavior necessitates intervention, you will need to look at its frequency
(how often it occurs as compared to peers), the intensity at which the behavior is exhibited, the
rate at which the person is able to learn new behaviors, and how interfering it is.
Slide 18: Conclusion
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Individuals with ASD must demonstrate at least one form of restrictive and repetitive
patterns of behavior.
These behaviors may be in the form of preoccupation or intense interest, adherence to
routines or unusual rituals, stereotyped mannerisms, or preoccupation with parts of
objects.
In this presentation, we covered the diagnostic component regarding behavior. Individuals with
ASD must demonstrate at least one form of restrictive and repetitive patterns of behavior. This
can take many forms and will vary tremendously. Behaviors include a preoccupation or intense
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interest, adherence to routines or unusual rituals, stereotyped mannerisms, or preoccupation with
parts of objects.
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