Stimming: Self-Soothing Behaviors

What is Stimming?

Have you seen a child flapping their hands? Elbows bent, hands up by their face, hands flapping like bird wings?

Some children may do it when they’re worried or anxious. Other children may show this behavior when they’re excited or happy, as in this video.

(You can see other examples of excited hand flapping / stimming at https://www.youtube.com/watch?v=QD9OPDUVejo and https://www.youtube.com/watch?v=R_gZqQy_Ae4.)

Hand-flapping is an example of a self-soothing behavior. There are several other self-soothing behaviors children use, like rocking, thumb sucking, jumping, spinning, humming, hair twirling, or lining objects up in a row. These repetitive behaviors might be called “stimming” for self-stimulating, or stereotypy.

This is common in toddlers, then tends to become less common as they get older – fading in the preschool years. But some children continue to do it. Parents of older children who still do this often view it as a problem that needs to be solved, and may say things like “how do I stop my child from flapping their hands?”

Let’s first figure out why children stim, and then think about how to respond to it.

Why do people stim?

When you’re nervous, do you ever bounce your knee? Or bite your lip? Or wring your hands? When you’re impatient, do you tap your foot or drum your fingernails? Have you ever been so excited that you want to bounce up and down? Or clap your hands and squeal? Or throw your hands up in a victory celebration? When there is a sudden loud noise, do you cover your ears? When you’re waiting on hold on the phone, do you click your pen up and down, pace, or rock your chair? Do you mumble to yourself or swear repeatedly to communicate your frustrations? These are things we all do. These things could be called “stimming” because our brains/bodies are seeking to regulate stimulation, whether that’s to distract us when we’re bored or soothe us when we’re anxious or release tension or express big emotions. Having stimulation that we chose can help us to regulate our brains/senses.

Neurotypical folks can typically stop themselves from doing these behaviors if they feel like it’s not appropriate where they are, or if they’re disturbing someone or if they don’t want other people to notice them.

Some people have a hard time stopping themselves from stimming or are very uncomfortable if forced to stop. This can be a sign of autism, though not everyone who stims is autistic. (If your child is over 3 years old, and frequently flaps their hands or uses other stims and also shows other possible signs of autism, it’s a good idea to learn more about autism, learn more about deciding whether to have your child assessed for autism, and how to access developmental testing.)

If you want to better understand why someone is flapping or stimming, here are ideas to explore:

  • Determine what triggers the behavior. Is it too much stimulation? stress? excitement overload? Or boredom? (too little stimulation)
  • If you change the environment (for example, making it quieter and more peaceful), does that change the frequency of the stimming?
  • If you give them an acceptable alternative for boring circumstances where they have to sit still (like having a fidget spinner in class or a coloring book at church), does that reduce the stimming?
  • Does it help if you “notice” and validate the underlying feelings: “It looks like you’re really excited about this.” Or if you notice what’s triggering their behavior: “it is really loud here – that’s bothering you isn’t it?”
  • If it only happens in certain situations or certain moods, it can be easier to understand and to influence. If they do it all the time in all circumstances, it may have become a habit, and making changes to the environment or activities may not change it.
  • Are they seeking attention? An autistic child who is stimming typically does not care whether others notice. Some neurotypical children may do behaviors like stimming because they notice that they get a lot of attention when they do. If you have realized they only do these things when they have an audience, stop paying attention to the performance and see if the behavior fades.
  • Can you re-direct their attention to some other activity? If so, then do. Or is it really hard for them to stop? This perseveration may be more common for autistic children.

Do we need to stop a child from stimming?

Before deciding that stimming needs to be “fixed”, it’s important to ask autistic people about autistic experiences to get their perspective. In her post “the Obsessive Joy of Autism“, Julia Bascom, current Executive Director of the Autistic Self Advocacy Network (ASAN) says

“One of the things about autism is that a lot of things… are harder. But some things? Some things are so much easier. Sometimes being autistic means that you get to be incredibly happy. And then you get to flap… I  flap a lot when I think about Glee or when I finish a sudoku puzzle… I spin. I rock. I laugh. I am happy. Being autistic, to me, means a lot of different things, but one of the best things is that I can be so happyso enraptured about things no one else understands and so wrapped up in my own joy that, not only does it not matter that no one else shares it, but it can become contagious.”

Julia Bascom

And another perspective from an individual with an autism spectrum disorder:

No one should try to stop hand flapping because it is part of who we are. Would you like it if everyone were trying to make you stop smiling? … Or putting your sunglasses on top of your head? Or crossing your legs when you sat? That is what people are doing to us when they try to make us stop flapping our hands: they are trying to force us to stop moving in ways that are natural, healthy, and comfortable to us.

Good Autism School

I know many autistic adults who may “mask” at work and in public – acting in ways that are considered neurotypical. This helps them to fit in better but can be exhausting. When they are amongst friends and family, they may stim when it soothes them or gives them joy.

My son is 11 – his current stims are making random sudden noises, and the need to say the same thing multiple times in a row. (Typically either something he’s really excited about or something he’s saying to talk himself out of being worried about something.) Our family knows that saying things multiple times is soothing to him, so we roll with it at home. But we do let him know that it can annoy other people or lead peers to shun him, and we asked him if he wanted our help figuring out other ways to manage this – like writing things down on post-its he brings home from school. Random noises are OK at home, but we asked him if he wanted ideas for alternate things he can do elsewhere when he has that energy that won’t disturb others, like blowing out a puff of air instead of making a noise, or flicking his fingers.

If the stimming isn’t causing problems for the child, you don’t need to “fix” it.

When is stimming a problem to work on?

  • When it interrupts other activities (e.g. their hands are so busy flapping, they can’t use them to do other things),
  • When it is blocking learning (e.g. they are frequently being asked to leave the classroom because they’re overly disruptive),
  • When it affects your child’s ability to make friends,
  • If your child is accidentally harming themselves or others, or
  • If the child themself wants to reduce the behavior or wants to learn to mask when they choose to

What are ways we might reduce stimming?

First, never punish stimming. This would be like punishing a child for crying. Or for laughing. Don’t criticize or shame a child for stimming.

Here are some supportive methods to try that might reduce stimming if it has become a problem:

  • Increase physical activity: If the child gets more exercise (especially heavy work) or spends more time outside, does that reduce stimming behavior?
  • Change environments: Can you spend more time in environments that the child finds calming and less time in places / circumstances that overload them?
  • Place and Time: Can you set times and places where stimming is welcomed? That might help reduce their need to do it in situations where it is more problematic.
  • Replacement behaviors: Are there other things they can do with their body that meet the same needs? Maybe hand clapping, hand pressing (like in a prayer position), playing with play-dough, or using a fidget toy. If they are stimming, instead of saying “don’t flap”, re-direct them to the replacement behavior: “get your calming bottle.” When you see them proactively choosing a replacement behavior instead of stimming, praise that.
  • Overcorrection: Sometimes flapping hands really hard and fast for a just a short while, or jumping hard and fast for a little while, will help get it out of their system quicker.
  • Release Tension: One of the reasons for stimming is to release tension – are there other effective releases – laughter, crying over sad movies, journaling or drawing?
  • Build emotional literacy: Teach and practice emotional regulation skills (Check out the Zones of Regulation tools.)
  • Raise awareness and make plans: When the child is stimming, you could briefly comment on it to help them be aware. If you notice common triggers, you may help your child notice those. Then you can work together on an action plan. For example, if noise and crowds overwhelm them, you might plan a trip to the zoo for a Tuesday afternoon rather than Saturday morning. Prepare and inform: when you’re approaching an event that might cause your child stress, let them know and talk about ways they might manage that.
  • Professional support: A therapist to address anxiety can help. An occupational therapist trained in sensory integration can help with regulation. (You may also see information about ABA therapy. That can help, but be very cautious about this option, as much of ABA therapy is framed around the idea of “fixing” autism by training children to behave “normally” and withholding rewards when they show autistic behaviors. I recommend you not choose places that define stimming as a problem, instead choose one that offers alternatives to stimming that a child could choose to use instead.)
  • Parent support: Talking to other parents of kids with challenging behaviors can be a huge help, as you learn you’re not alone in your worries. It can also help parents to talk with a parent educator, parent coach, or therapist to discuss their own concerns.

Learn more:

Picture Books about Touch and Consent

These books are aimed at children age 3 – 8, and teach many aspects of consent, types of touch, the right to bodily autonomy, and prevention of sexual abuse. You can also check out my post on how to talk to your child about touch and consent.

Most Recommended

If I had to choose just one, I might start with one of these two.

My Body Belongs to Me from My Head to My Toes by Pro Familia and Geisler. (Video) Age 3 – 6. A girl talks about the touch she likes – sitting with friends, hug from Dad, sitting on Grandma’s lap. Then about how she sometimes doesn’t like to be touched. Or touched in certain ways: tickled too much, sloppy kisses. So she says “Stop. Don’t Touch Me. I don’t want you to.” It says if someone doesn’t stop, then tell a trusted person. Ends with “your body belongs only to you.” This book probably has the clearest, most complete message about bodily autonomy. It’s long for a three year old, and not quite as fun a read as some of the books below. [Note this is different than the other “My Body Belongs to Me” by Starishevsky – see below.]

Let’s Talk about Body Boundaries, Consent and Respect by Sanders and Jennings. (Video) Ages 5 – 8. Starts with the idea of body boundaries – draw an imaginary bubble around yourself – no one should come inside that boundary without asking. If someone wants to hug someone, they should ask. The person might say yes – it’s OK to hug because both people are happy about it. The person might say no – respect that. If they say they’re not sure or don’t answer, that’s not a yes, so don’t hug. It’s OK to say no to others – it’s your body and what you say goes. If someone doesn’t respect that, tell a trusted adult. Excellent – but too long – you would want to spread it over multiple readings.

More Recommendations

Here are lots of other ideas, in order from those appropriate for the youngest audience on up. Also check out the table at the bottom which compares them.

Don’t Hug Doug (He Doesn’t Like It) by Finison and Wiseman. (Video) Age 3 – 6. “You can hug a pug. You can hug a bug… but don’t hug Doug. He doesn’t like it.” Shows a friendly, smiling Doug spending time with lots of people, having fun, shaking hands, fist bumping, high fiving, but turning down hugs. “Can you hug these people… There’s only one way to find out. Ask!” Very positive book about all the ways we can connect while respecting people’s personal preference about what types of touch they like.

How to Hug a Pufferfish. By Peterson. (No video available. Pictures are super cute, and text is very engaging.) Age 3 – 6. “So you want to hug a pufferfish. Who could blame you?” Shows a super cute pufferfish, talks about all the reasons you might want to give someone a hug – but you don’t want to make a pufferfish puff! “Pufferfish might welcome a hug, under the right conditions.” Pufferfish would like to see you coming, be asked for a hug first, and prefers a slow and gentle hug, or a fin shake. “And you never know, Pufferfish might show you a different way to say I love you.” [Disclaimer: the author is a friend of mine.]

Can I Give You a Squish. By Nelson. (Video.) Age 3 – 6. Kai the mer-boy loves hugs (squishes). He hugs everyone and everything till he tries to give a pufferfish a squish – it puffs, saying it doesn’t like to be squished. Kai feels bad. His friends suggest he tries offering a fin bump, which it likes. Kai learns his friends like tail claps, tentacle shakes and other forms of touch. “Every fish likes their own kind of squish.”

Miles is the Boss of His Body. By Schiller and Kurtzman-Counter. (Video) Age 3 – 6. It’s Miles’ birthday. Grandpa pinches his cheek, his brother gives him noogies, his mom gives him a super tight hug, etc. Even the birthday chicken wants to tickle him. Mile yells ‘I’m tired of being touched in ways I don’t like, and I’m the boss of my body.” The family respects and validates that.

Rissy No Kissies. By Howes and Engle. (Video) Age 3 – 6. Rissy is a baby lovebird. Others try to give Rissy kissies. Each time – “‘No kisses!’ Rissy chirruped with a most emphatic squeak.” Her parents worry something is wrong with her – “we know all lovebirds love kisses.” When the chicks at school squeeze too close and she squeaks “no kissies” it hurts their feelings. Rissy worries there is something wrong with her. Her mother says “there is nothing wrong with you. Your body and your heart are yours and you choose how to share.” Rissy says to the others “some birds share their love with kissies but they’re not my favorite things.” She offers that she likes to sing songs, sit close, give / get cards, and high fives. Others respect her wishes.

We Say What’s OK Series by Bowers and Munoz. (I can’t find video read-alouds, but here is an interesting companion video) Age 4 – 6. This series is on consent. The author says there are five key concepts to teach about consent: I listen to my body, I am in charge of my body, I ask permission, I check in, and I accept no. These engaging books feature characters of diverse age, race, and ability. We Listen to Our Bodies talks about tuning into cues in your body that signal that you might be scared, sad, or angry. We Ask Permission is about asking people before we touch them and tuning into body language (of people and of animals) to know if the touch is a positive experience. We Check in with Each Other is about not assuming that just because someone wanted to do something yesterday doesn’t mean they want to do it OK, and about stopping in the middle of something (like a tickle fight) to be sure that they are still OK with it.

No Means No! by Sanders and Zamazing. (Video) Age 4 – 6. Shows people asking to touch (aunt give a kiss, parents offering to help wash her private parts, cousin wrestling, friend asking to hold hands) and girl politely turning things down, and everyone happily moving on to other options, because “if I don’t want a hug or a kiss, No Means No!” “I am strong and I have a voice that is loud and clear. So when I say ‘no’, No Means No.” This is a fine book, but it feels like a lesson-teaching book, and some kids don’t engage with those as well as they engage with more story based books.

Hands Off, Harry by Wells. (Video) Age 4 – 6. Harry the Alligator likes to act silly in ways that are physically wild, bumping into other kids, sometimes making them spill paint or glue. Despite being given time outs, he keeps bumping into others. They have him wear an inflatable donut ring so he can’t touch others and he learns to respect other’s space and use his hands to help, not hurt. I don’t love this one, because there’s a punitive aspect to how his behavior is handled. It’s gentle, but still…

My Body: What I Say Goes by Sanders and Hancock. (Video) Ages 5 – 8. Talks about kinds of touch that make them feel safe, what makes them feel unsafe. Early Warning Signs that tell you something is wrong (racing heart, etc.) Have a safety network of adults, including one that’s not in your family, that you can talk to. Private parts – those covered by bathing suit and mouths – includes the vocabulary penis, vulva, etc. If someone touches those, asks you to touch theirs or shows you pictures of private parts, say “stop” and tell a trusted adults. No secrets. Book ends with 5 body safety rules. If you’re looking for a book that explicitly teaches sexual abuse prevention, this does so.

Teach Your Dragon Body Safety by Herman. (Video) Age 5- 8. A dragon shares with his human friend that a girl at school likes to hug him and he doesn’t like it. His friend says it’s OK to say no or ask for a high five. The book then goes on to talk about touches that don’t feel right, private parts, not keeping secrets and having a safety team of people you can tell if someone is touching you in a way you don’t like.

Additional Books on Topic

My Body Belongs to Me by Starishevsky and Padron. (Video) A story of a girl whose uncle’s friend sits down next to her and “touched me in that place that no one else can see.” He tells her to keep a secret. She tells her parents, who say they are proud of her for telling them, and say she could have also told a teacher. She says it’s not her fault that it happened and moves on. I wish there had been a message from the parents that the man’s behavior was wrong and unacceptable – that doesn’t really get addressed. Personally, I would not read this book to my students or to my child because of the discomfort it might cause. But your needs and values may differ.

Hug? by Chua. (Video) A girl hugs a sick cat to make it feel better. Then a dog asks her for a hug. Then LOTS of other animals want to hug her till she’s totally overwhelmed and yells STOP! She says she doesn’t feel well, so the cat asks her if she wants a hug and it makes her feel better. Then lots of animals are shown hugging, and it says hugs are great. The book is fun and silly with great illustrations. But the book description says “There are character education connections here to compassion, tolerance and empathy, and a terrific opportunity for discussions about boundaries.” I don’t see that message come through clearly.

I said no! by King and Rama. This is really lengthy – almost a textbook for a child age 7 – 10. Good content, but too much. The read-aloud video is about 20 minutes long. It could be helpful for a parent to read, just to build a collection of ideas to teach at teachable moments spread over time, not all at once.

TitleCharactersMessageAgeEngaging
My Body Belongs… by Pro FamiliaHumans, mostly whiteSome touch is nice, some is not as nice. You can tell people ‘don’t touch me.’4 – 6Yes
Let’s Talk AboutDiverse humansConsent – ask before touching. You can say no. Tell adult if uncomfortable.5 – 8Yes, but long
Don’t Hug DougHumans, diverse age, race, ability, sizeNot everyone likes to be hugged. Ask first.3 – 6Yes!
How to Hug aSea creaturesRespect that some people only like touch under certain conditions3 – 6Yes!
Can I GiveMerpeople, sea creaturesAsk others how they like to be touched3 – 6Yes!
Miles is the…Human family, diverse skin tone, ageYou can tell people you don’t want them to touch you3 – 6Yes
Rissy No KissLovebirdsSome people don’t like kisses, and it’s OK for them to say how they like to connect3 – 6Yes
No Means NoHuman (white family, diverse classmates)If someone wants to touch you, you can say no thanks4 – 6OK
Hands OffAlligatorsDon’t bump into, poke or push others – learn personal space4 – 6Yes
My Body – What I sayHumans, white girl protagonist, diverse others5 body safety rules – early warning system, private parts, safety net5 – 8OK
Teach Your DragonDragon protagonist, humansIt’s OK to say no to hugs and other touches. If someone touches you in a way you don’t like, tell5 – 8Yes
My Body Belongs by StarishevskyHumans. Bi-racial child, white abuserWhen someone else touches your private parts, you should tell someone3 – 6Worrisome
Hug?Human girl and animalsSometimes too many friends want hugs and that’s overwhelming3 – 4Yes
I said noHumans – white boy protagonist, diverse othersTextbook on keeping private parts private7 – 10Too long

Learning More

For each book, I include an Amazon affiliate link that takes you to that book on Amazon so that you can read all the details about it and read other reviews. I do get a small referral fee if you click on those links and then purchase something on Amazon. However, I encourage you to use your local library – encourage them to have books like these in their collection! Or to purchase from local, independent booksellers. Learn more about where to find great kids’ books.

For each, I also give a link to a YouTube video of a read-aloud of the book so that you can preview the book in detail. (Note: I don’t know whether the creators of these videos had permission, or if they were violating copyright. So I tried to choose videos without ads, so the video creators don’t gain financial benefit.)

You might also be interested in these posts: Talking with Children about Touch and Consent; Books for Children about Sexuality; Talking with Children about Gender Identity (includes links to recommended children’s books on that topic) and Teaching about Tricky People, vs. Stranger Danger.

Accessing Developmental Testing

child working with blocks

Note: This post is tailored to families in Washington State, but the general process is similar elsewhere.

Monitoring

I encourage all parents and teachers to do developmental monitoring: from time to time check out a developmental checklist to be sure your child is on track. And read developmental newsletters for ideas on how to support well-rounded development. Or, you can check out the Washington Early Learning and Development Guidelines which are an amazing resource for children birth through grade 3, where each developmental level includes ways to support your child’s development, differences in development and guidelines for when/how to seek intervention services.

Screening

About 1 in 6 children has a developmental or behavioral issue, such as autism, ADHD, dyslexia, and developmental delays. Only 30% of those concerns would be detected just through the monitoring process. Early intervention from birth to age 3 can help children learn important skills, and getting support and services for children age 3 and up can have a huge benefit for their schooling.

If you are wondering if your child might have autism or ADHD or developmental delays, start with a screening tool. The results might help to reassure you that your child is actually developing normally or they could validate that seeking further assessment and testing would be beneficial. The ASQ – Ages and Stages questionnaire is one of the best available tools for overall development, and you can complete it yourself in about 15 minutes. The ASQ-SE screens for social-emotional development, and can help to identify possible autism signs. (Learn more about using the ASQ and ASQ-SE and understanding your child’s ASQ results.)

For Washington state residents: you can complete the ASQ and ASQ-SE online and a child development specialist from Within Reach will contact you with the results within a week and discuss those results with you. Oregon offers an online ASQ and ASQ-SE here that appear to be open to anyone – you will see the results when you complete the screening.

Talk with a Professional

A helpful second step is to talk to your child’s doctor or their teacher or childcare provider about your concerns, and share the results of the screening. Here is a tip sheet for talking with a doctor about your concerns.

Your child’s doctor may offer a referral to a specialist, such as a child neurologist or a child psychologist. You could also ask for a written referral for testing, using this form.

You can also directly contact your state’s early childhood system to request a free Child Find Evaluation to find out if your child qualifies for intervention services. You do not need a doctor’s referral to make this call.

Evaluation – for Children under 3

The Individuals with Disabilities Education Act, or IDEA (specifically in Part C) guarantees your child a right to a free developmental evaluation. Some people call it “birth to three services,” “early intervention,” or “Part C services”. If your child qualifies for intervention, services can be billed to insurance, or offered on a sliding scale. You will not be denied services if you can’t pay for them.

In Washington, evaluations are provided through ESIT – Early Support for Infants and Toddlers. (Info for Outside Washington.) Each county has a lead agency that processes referrals and schedules evaluations. All the agencies are listed here. To learn which agency serves your location, you can call the Help Me Grow Washington Hotline at 1-800-322-2588.This statewide, toll-free number offers help in English, Spanish and other languages.

The evaluation process uses standardized tools and observations to evaluate a child’s development in 5 areas: physical, cognitive, social-emotional, communication, adaptive / self-care, and sensory processing skills. The evaluator uses natural situations to look at these skills as a child plays, stacks blocks, draws, etc.

If the evaluation shows your child is eligible for services (eligibility criteria here), they may develop an IFSP – Individualized Family Service Plan – and you will be referred for early intervention services, such as physical therapy, occupational therapy, speech therapy, hearing or vision services. In most cases, services are provided in the home or in a child-care setting.

Learn more about IFSP and Early Intervention, and even more about IFSP.

Evaluations for Children age 3 – 5

In Washington, “Child Find” evaluations are offered through your school district. They are free but you must request them.

You can call your school district coordinator* and say: “I have concerns about my child’s development and I would like to have my child evaluated through the school system for preschool special education services. Can you help me or let me speak with someone who can?” Write down who you speak to, the date, and what was said; you might need this information later.

At some point, you will need to submit a written request for evaluation. Some parents start with that. A sample letter to request evaluation is available on PAVE’s website, or the state offers a referral form. (Learn more about how to make the request for an evaluation.)

From the time of request the school has 25 school days to decide whether to evaluate, then 35 school days to complete the evaluation. Make sure you keep a record of when you started the process. (Learn more about the referral and evaluation process.)

The evaluation might look like academic tests, questionnaires, informal observations of the child and parent interviews. They may measure: communication skills, hearing and vision, motor skills, social skills, academic skills, thinking and reasoning. (Learn more about evaluation.)

IDEA describes 14 disability categories. If your child meets the criteria under one of those categories, they are eligible for an Individualized Education Program (IEP). Learn more about developing an initial IEP. (Tips for preparing for your IEP meeting.)

If they don’t meet IDEA eligibility, but they have a disability that impacts a “major life activity” they can have a section 504 plan for accommodations which enable equitable access. (If they are found not eligible, learn what to do.)

Children with identified disabilities can receive free special education and related services at preschools run by the local public-school district or through Head Start or ECEAP. (Learn more about preschool placement.) Related services might include speech therapy, occupational therapy, mental health counseling or special transportation, etc.

If your child is older than 5:

Contact the public school that your child attends or that they would assigned to (if they are homeschooled or attending private school). From there, the process is much as described above.

Most specialized education is provided by special educators who “push in” with support in the general education classroom. (The IDEA requires education in the Least Restrictive Environment (LRE) to the greatest extent possible with typically developing peers.) Some children do not thrive in typical classrooms, and may receive “pull out” instruction in a specialized setting.

Families that homeschool or attend private school, have the option to receive some services from the public school system, even if they are not attending full-time. Learn more about private school Equitable Services plan.

Private Evaluations

In order to access publicly funded early intervention services and special education, you will only need to complete the free evaluations described above.

It is also possible to have a formal evaluation by a child psychologist or psychiatrist, a occupational therapist or speech/language pathologist, clinic specializing in autism, ADHD, etc. This may lead to a more detailed report about your child’s diagnosis and how you can support them, or it may make you eligible for additional services that could be covered by insurance, or may make your child eligible for medications. These diagnostic evaluations may be covered by your insurance or might require paying out of pocket, and can be expensive, so be sure you check about costs and coverage.

If you’re looking for a provider for a diagnosis, seek recommendations of knowledgeable professionals in your area from:

  • Support groups (for example, Autism Speaks has a national directory of providers;
  • People who have children or other family members with the condition
  • Governmental resources (for example, the Autism Guidebook for WA)
  • Your primary care provider or other health care professionals
  • Early intervention or special education providers

More Resources

*How to Contact Your School District

For children age 3 to 5, you’ll reach out to the special ed team in your child’s school district. Here’s info for all the districts in the state. k12.wa.us/sites/default/files/public/specialed/resourcelibrary/SpEdDirectory.pdf

Here are contacts for district’s on Seattle’s Eastside. (I teach for the Bellevue College Parent Education Program so these are the resources I refer to.) If their websites said what agency provides evaluations for ages birth to 3, I list that after the website URL. (If the Early Intervention provider is not listed, call Help Me Grow Washington Hotline at 1-800-322-2588.)

To refer your child for Kindering services, call (425) 653-4300 or submit an online referral form here.  Kindering provides helpful information about their telehealth evaluations.

Autism 101

For parents who are wondering why their child interacts with the world differently than some other children do, and are wondering whether it might be autism, it can be hard to understand all the different ways that autism might present. This post is intended as an overview of: the clinical definition of autism, understanding what “the spectrum” means, some of the signs and symptoms of how autism might present, information about screening and diagnosis, and resources to support parents of neurodiverse kids.

The Diagnostic Definition

When I was a kid, we tended to think of autistic people only as the people who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking, flapping their hands).

Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky” or “odd ducks” or said they “march to the beat of their own drummer.”

Then the term Asperger’s syndrome appeared, and was often applied to kids who were gifted and “quirky.” And we would talk about people in terms of “where are they on the spectrum” or “are they low functioning or high functioning?”

Now, Asperger’s is no longer a distinct diagnosis. It’s been pulled back under the umbrella of Autism Spectrum Disorder (ASD).

The criteria for an ASD diagnosis in the DSM-V require showing symptoms in both of these categories:
A) Persistent deficits in social communication and social interaction (deficits in social-emotional reciprocity, in nonverbal communicative behaviors used for social interaction and in developing, maintaining, and understand relationships) and
B) Restricted, repetitive patterns of behavior, interests, or activities (as manifested by at least two of: S
tereotyped or repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior; Highly restricted, fixated interests that are abnormal in intensity or focus; Hyper- or hypo-reactivity to sensory input.)

Or to put it in a less deficit-based language: A) may have challenges interpreting and following the same social rules as their neurotypical peers or expressing / responding to emotions in the same ways neurotypical people might  and B) strong preferences for predictable routines, specific interests and repetitive movements. Reactions to sensory input and external demands may be more intense than typical.

About 1 in 44 children is diagnosed with autism. Within the diagnostic criteria, there’s a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home.

What is a spectrum disorder?

When autism is described as a spectrum, it doesn’t mean this. (source)

continuum labeled not autistic at one end, and very autistic at the other end

Or this (source)

continuum, labelled "a little quirky" on the left, "definitely autistic" in the middle, and "tragic" on the right

Autism is a more complex way of interacting with the world that can’t be described on a simple numeric scale, and can’t be simplified to either “not a problem” or “tragic”.

I’ll share a few different ways that it has been illustrated, so you can find the one the best resonates with your experience.

The autism spectrum can look something more like this:

An illustration of a circle where the "pie pieces" are labeled language, executive function, etc. and dots indicate where the person might have more strengths vs. more difficulties

(That image comes from this great comic on “Understanding the Spectrum” by Rebecca Burgess – I highly recommend reading it.)

This graphic (source) breaks the spectrum into five categories, similar to Burgess, though the colors and the way they break things out are a little different:

GAO

And they explain that “the type and severity of characteristics varies from person to person” as seen in this diagram of three individuals’ ‘spectrums.’

Picture1

C.L. Lynch on theaspergian.com uses this illustration

spectrum

Then gives a few examples of how this would apply for an individual person.

spectrum 2

I don’t know which one of these graphics might be helpful for you, but I find it very helpful to think of these more nuanced descriptions rather than a single axis of “a little quirky” to “tragic.”

I know that if someone asks me if my son is “high functioning” or “low” or asked “how autistic is he”, I would find it difficult to answer those questions. It’s much easier to tell you – “here are the things he’s good at, here are some behaviors he does that might seem odd to you but don’t harm anyone or anything, and here are some challenges he has and some accommodations you could make that might help him to manage them.”

More Zones to Consider

The DSM-V criteria are two-fold: a) social-emotional differences, and b) restricted, repetitive patterns.

You’ll notice in the illustrations above that they each split the signs of autism a little differently, but here are some of the typical patterns that some autistic people might display. [Note that all autistic people are individuals, so any individual may have some of these signs and not others. As a parent, I found that if I went down any checklist of signs, I had many that I said “nope, that doesn’t describe my kid” and others where I went “ooh boy – that is exactly what I see!”]

  • Social-emotional: may have challenges reading social cues, inferring what behavior is expected in a social situation, expressing their emotions in the same way a neurotypical person might expect them to or understanding / responding to other people’s emotions. Some may avoid eye contact. May be content playing / working by themselves and not appear to need the same social connections that others might. (Or might long for social connections and be very sensitive to rejection.)
    • The Floor Time approach to child-directed play can help an autistic child connect with others in play.
  • Sensory Processing: some autistic people may be hypo-sensitive to stimuli; many may be hyper-sensitive.
    • Tactile stimulation (like tags on clothing or seams on socks or being touched) may distract and distress them. Or, they may seek tactile input, banging their heads, pressing up against others, wanting lots of hugs and loving weighted vests and blankets.
    • Some may have lots of oral sensory issues. They may be super picky eaters or may gag easily. Others seek sensation, sucking and chewing on a variety of items.
    • Many autistic people can get overwhelmed by sounds – they may be less able to filter out all the noise that neurotypical people ignore (traffic on the road, the hum of the refrigerator…) and may be happiest with noise cancelling headphones on in loud situations.
  • Emotional regulation challenges: may have bigger reactions to a situation than typical. This could mean being so excited they bounce up and down, gallop around or flap their hands because the joy is too great to contain. It can mean meltdowns where too much stimuli, too many demands, or big disappointments overwhelm them and they react by screaming, hitting, or other behaviors for a prolonged period of time. (Note: the Zones of Regulation tools can be very helpful for autistic kids to work on emotional regulation skills.)
  • Preference for routine / difficulty adjusting to changes and transitions. Many thrive in an environment with lots of structure, and very predictable routines. When a transition between activities is coming, they need a little more warning that it’s coming and help letting go of one thing and moving on to something new. Sometimes even with all the help you can give, an unexpected change or hard transition from a beloved activity to anything else can cause big meltdowns.
  • Specialized Interests: A common characteristic is long-lasting, all-consuming  interest in specific topics, whether that’s dinosaurs, astronomy, flags, Rubik’s cubes, or collecting memorabilia. When they start to talk about that topic to someone, it may become a prolonged monologue where they may not recognize when the other person has lost interest and is ready to move on, because they cannot imagine ever losing interest in that topic. They may also love repetition and repetitive movements.
  • Impulse control and executive function may be harder for some autistic people. Discipline techniques that work with neurotypical folks may not be as effective with autistic children. (I find the Incredible Years and Ross Greene have the most helpful approaches.)
  • Language / communication: some autistic people are less verbal or non-verbal.
  • Motor skills: some autistic people may have motor challenges, ranging from “clumsy” to limited ability to control their movements,

Not everyone who has a few of these behaviors is autistic. And not everyone who is autistic has all these characteristics. And all of these characteristics can manifest in subtle, barely noticeable ways or can be blatantly obvious to the casual observer. Again, autism is a spectrum disorder that can be a bit hard to pin down.

It’s also worth noting autism can present differently in girls and be more difficult to diagnose especially for gifted girls).

Awareness vs. Acceptance

In much of popular culture, autism is viewed in a very negative light. You’ll hear people talking about it as a tragic diagnosis, and people seeking a “cure” for their child’s autism, and using deficit based language, even a supposed “advocate” may do so during events like Autism Awareness Month.

The Autism Self-Advocacy Network recognizes Autism Acceptance Month, which “promotes acceptance and celebration of autistic people… making valuable contributions to our world. Autism is a natural variation of the human experience, and we can all create a world which values, includes, and celebrates all kinds of minds.”

Autistic people have unique strengths. For example, many have intense attention to detail, a high degree of persistence, and ability to analyze data. Their “obsessive” interests can lead to stunning expertise in their chosen career fields. And “Sometimes being autistic means that you get to be incredibly happy. And then you get to flap. You get to perseverate. You get to have just about the coolest obsessions.” (Source)

A Note on Co-Morbidity and Social Issues

Autism also has several co-morbidities: conditions that often occur with autism.  “Over half of autistic youth [also had] attention deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter had depression, and 60 percent had at least two comorbid conditions. Other common comorbid conditions include sleep disorders, intellectual disability, seizure disorders, and gastrointestinal ailments.” (Source) Many of the challenges we think of as being due to autism actually come from these co-morbidities. We should think of them as separate issues and handle them separately.

And many of the “challenges” of autism actually come from societal attitudes toward autism. For example, if a child jumps up and down with excitement, is that really a problem behavior that needs to be corrected? If a teenager gets overwhelmed by noises, so chooses to wear noise-canceling headphones in many situations, is there a reason anyone else should care about this? If someone can’t stand it when the different foods on their plates touch each other, isn’t it easy to use just a little extra care when dishing them up instead of using a lot of energy telling them that “you just have to learn to cope with that”? If the neurotypical community understood more about neurodiverse people, and made simple adjustments, it would greatly reduce the “challenges of autism.”

Screening and Diagnostic Testing

If you’re wondering about your child, or a child you know, start with this list of symptoms, or red flags to watch for. https://www.cdc.gov/ncbddd/autism/signs.html

If you’re still concerned about possible signs of autism, use a screening tool:

If you’re still concerned, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system. Look here for all the details about how to access testing.

In King County, Washington, some resources for diagnostic testing include: Kindering (especially for kids under age 3), UW Autism Center (this is where my daughter was tested at age 20), and Seattle Children’s Autism Center. Some private practice psychologists also offer testing. For example, our son was tested by Heather Davis at Brook Powers Group, who had worked with him in their Incredible Years program.

Here is a podcast with tips for what to do when you’re waiting for an autism diagnosis or a PDF on the same topic.

Are you debating about testing?

Some parents debate about whether or not to test. Or they test, and get a diagnosis of “we can’t say it’s autism but we can’t rule it out.” They wonder about whether to seek out special education services. For more on those topics and on what to do while waiting for a diagnosis, check out my post on “Autism? ADHD? Delayed? Or just quirky?

What was the Cause? Is there a Cure?

It can be tempting to ask “what causes autism” and for many parents, that’s a quest to understand whether they “did something wrong” that led their child to be autistic. There’s no one cause for autism. There may be genetic factors, or environmental factors, or a combination of environmental factors with genetic susceptibility. Personally, I have not found it helpful to look backwards and wonder about the cause – it’s better to focus on what we need to do to move forward into the future.

I also do not seek a “cure” for autism. (Partially because that implies it is a problem that needs to be fixed rather than just a different way of being in the world which benefits from accommodations.) Some parents spend a great deal of time and energy seeking a way to fix their child. There are some effective treatments which can help make things more manageable for the family, but there are also some “treatments” you’ll find on YouTube videos or random people’s blogs that can either cause harm, or simply just take more time, energy and money than they are worth.

For example, many parents have reported significant improvements in behavior problems with dietary changes. If you find diet changes that are generally considered nutritionally sound and they prove helpful for you, then hurray! But if a special diet is prohibitively expensive, or if it deviates from mainstream nutritional advice and might cause nutritional deficits, or if your kid is just a super picky eater and it’s a huge battle, it’s worth knowing that there’s not a lot of research that proves this is essential.

Resources on Autism

General Resource Guides

There are lots of resource guides from various organizations. Try these from the Seattle Children’s Autism Center, Autism Parenting Magazine, and the AAP. Plus these communication resources. Note: I have not vetted all these resources. If you discover any materials that approach autism as a terrible disease to be cured, or focus on ways to “fix” autistic kids, set those aside. I personally choose materials that talk about autism as a neurological difference that shapes who they are and how they interact with the world, and talks about ways we can increase accessibility for them. 

Autism Navigator has a free online class (approx 3 hours) on Autism in Toddlers. They have handouts you can print on everyday learning activities, how parents can support language and emotional skills, and Q&A for parents.

Discipline and Behavior Challenges

  • This article is short and helpful: 15 Behavior Strategies to Help Children with Autism.
  • There are tons of helpful resources at challengingbehavior.org: visual schedules, tip sheets on making daily routines easier, handouts on teaching emotional IQ, addressing behavior like hitting or biting.
  • If it’s available in your area, I highly recommend the Incredible Years program. (We worked with Shanna Alvarez in Seattle, who was fabulous.) While the parents meet, the kids attend “Dinosaur School” which teaches social and emotional skills. Note: my Discipline Toolbox is highly influenced by what we learned at Incredible Years.
  • Ross Greene has some really helpful tools, summarized as “Kids Want to Do Well – If they’re not doing well, ask yourself what skill or resources they are lacking.”
  • If emotional regulation is a challenge for your child, check out my post on Big Feelings and the Zones of Regulation approach.

Building Connections with Your Child

Floor Time, or Child Directed Play, is a powerful way to connect with any child, but especially children who have challenges with social-emotional connections. Click here to learn about Floor Time: child-directed play. On Autism Navigator, learn how to support social communication development, and transactional supports to promote learning.

More resources

There are helpful resources at https://brightandquirky.com which has webinars with leading experts on how to support kids who are gifted AND autistic (or have other behavioral issues).

And for your child, here’s my list of Children’s Picture Books about Autism and other “quirky kids” stories. Seeing themselves reflected in a book might be helpful for them.

If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.” If you’ve got a shy child who observes more than they engage, check out my post on the slow to warm up child.