Repetitive Behaviors and Sensory Features: Evidence-Based Intervention Strategies

Abstract

There is a history of clinical and first-person accounts reflecting the impact of repetitive behaviors and sensory features on the daily lives and occupations of individuals with autism. In Kanner’s (Nervous Child 2:217–250, 1943) original account, he remarks on the odd, repetitive patterns of behavior displayed by case number one, Donald T., the first known individual to be diagnosed with autism, stating, “Most of his actions were repetitions carried out in exactly the same way in which they had been performed originally. If he spun a block, he most always started with the same face uppermost. When he threaded buttons he arranged them in a certain sequence that had no pattern to it but happened to be the order used by the father when he first had shown them to Donald” (p. 219). In her autobiography of childhood autism, Grandin (Emergence: Labeled autistic, 1996) recollects difficulties modulating responses to sensory stimuli across visual, auditory, and tactile modalities that subsequently interfered with overall social and adaptive development. She describes several examples of extreme sensory responsiveness: “The pain that racked my head when the fog horn sounded was excruciating. Even with my hands over my ears the hurtful sound assaulted them to the point that I’d throw myself down on the deck and scream” (p. 22). She adds paradoxically, “Intensely preoccupied with the movement of the spinning coin or lid, I saw nothing or heard nothing. People around me were transparent. And no sound intruded on my fixation. It was as if I were deaf. Even a sudden loud noise didn’t startle me from my world” (p. 23). Although repetitive behaviors and sensory features are quite salient symptoms of autism, there has been debate about whether or not they represent distinct phenomena, and thus, whether differential treatment approaches should be used.