I was talking to a friend of mine the other day about some common traits of autism spectrum disorder, and the question of how to define perseveration with regards to autism came up. I've experienced perseveration, and I notice it in my children with autism and ADHD. But, I found it oddly difficult to describe to my friend, and realized I didn't quite know how to explain it. So, I did a little research on perseverative thinking, behaviors, and language.
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How Can We Define Perseveration in Autism Spectrum Disorder?
Perseveration is commonly associated with children with autism, even being one of the criteria the DSM uses to diagnose autism spectrum disorder. However, anyone, anywhere, can perseverate – you almost certainly have yourself! So, what does perseverative behavior mean?
Perseverative behavior is simply a repetitive behavior, an action that a person keeps repeating without meaning to. Some examples saying the same words, moving in the same pattern, or even thinking the same unhelpful thought, long after whatever initially prompted the activity has passed.
To perseverate is to feel that involuntary fixation, that feeling of being “stuck.” The speech, movement, or perseverative thinking repeats over and over, without the person consciously deciding to make it happen.
Some perseveration manfiests as repetitive behaviors that look just like stimming to the untrained eye; these can involve repetitive behavior, like movements (i. e. rocking back and forth) or repetitive speech, like echolalia. It also serves some of the same functions to the individual as stimming does; perseverative activity offers a way of coping with overwhelm or anxiety.
However, perseveration is very different from stimming because perseveration is an involuntary coping mechanism that exacerbates a problem or feeling . Stimming may be unconscious, but it is voluntary, and stims do help an individual reduce anxiety and feel better. Redirecting a stim may be met with a little resistance and upset, but forcing someone to redirect a perseverative thought or behavior can result in extreme stress for the individual.
Perseveration is something that everyone does , to some extent, but it's especially common in people with certain neurodivergences or neurological conditions, like autism spectrum disoder, ADHD, aphasia, Tourette's syndrome, Rett's disorder, Fragile X syndrome, schizophrenia, and OCD.
Perseveration can also occur when someone has a traumatic brain injury or is suffering from a degenerative disease like Alzheimer's disease or Parkinson's disease.
What Is An Example of Perseveration in Autism Spectrum Disorder?
There are three categories of perseveration:
- verbal perseveration,
- motor perseveration, and
- perseverative thinking (sometimes called cognitive perseveration).
Some people with autism show signs of all three types, and some people just present one type. Let's look at some examples for each of these categories.
What is verbal perseveration in autism?
Perseverated speech, also called verbal perseveration, is repetitive speech or other sounds that are not voluntary or serving a social function.
In autism, we especially see this in the (commonly stereotyped) autistic behavior of repeated info-dumping.
Think of the little kid who can only talk about cars, only wants to talk about cars, and who repeats the same facts about cars every time you see him. He is repeating information past the point of utility or value. That child is perseverating on the topic of cars.
My son went through a phase where he was very stuck on fans. He talked about how many blades fans had, what sizes they should be for indoor and outdoor use, and compared and contrasted the many fans in our house for anyone who would listen to him. (These two were his favorites.) He would then repeat that same information to any new person he encountered.
His father and I heard the same twelve facts about fans easily twenty times a day, for months.
My son was fixated on fans. He perseverated on fans. This focus on fans served to calm him and regulate him, which was important, but it didn't help him create social bonds, like making friends, which is one major goal of speech.
Eventually, my son grew out of this fixation and moved on to other things, but he still does talk about fans a lot.
We bought him a new one for his room recently , and it was the discussion around the dinner table for a good month, at least.
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What is motor perseveration?
The second category of perseveration that applies to autism is motor perseveration. This is defined as a repetitive movement of the body that is not fully voluntary . The most common movements seem to depend on the age of the individual.
In autistic children under 3 years-old, I found one student researcher who cited a larger study that identified common repetitive behaviors as:
“…banging objects on a surface, flinging objects back and forth, holding objects for longer than expected, moving objects stereotypically, repetitively swiping objects, and trying to spin objects. Stiffening of the posture, rubbing oneself, and banging on surfaces made up the [remainder of bodily perseverations.]”
I wasn't able to get my hands on the original study, but in my completely anecdotal experience raising one child with autism, and interacting with several more, the majority of these behaviors ring true.
My child spun everything he could get his hands on from the age of about 15 months until 3 and a half years-old, for example, and then moved on into fans (with a brief detour obsession with those light-up fidget spinners ). All of this spinning is a clear example of motor perseveration in autism.
Another study mentioned that the most common motor perseveration in adults with autism were grimacing and other facial movements, and flapping arms and hands Obviously, autistic adults with additional diagnoses like OCD or Tourette's may have additional motor perseverations, like “tics, tremors, more complex motor stereotypies, motor programs, and rituals."
What is thought perseveration?
Thought perseveration is sometimes called cognitive or thought perseveration, and it refers to, you guessed it, a repetitive thought! But what exactly does that mean?
In one piece about repetitive cognition and autism, researchers defined thought perseveration in autism in this way:
“Repetitive cognition is a tendency to perseverate on particular thoughts, often accompanied by difficulty disengaging with these thoughts ; repetitive cognition ranges from fixation on favorite topics or activities (whether actually doing these activities or merely thinking about them) to rumination, which is a perseveration on negative thoughts noted in typically-developing individuals with depression[.]”
In children, cognitive perseveration often stems from some kind of anxiety or worry. Maybe a dog barked at them or a door slammed, and it scared them very much, and now they feel like they can't stop thinking about it, and how it could happen again. This is rumination, one particular negative kind of thought perseveration.
As an autistic adult, the kind of thought perseveration I catch myself doing most often is repeating conversations I've already had with other people in my mind. Sometimes I am actively analyzing these conversations to try to figure out what I might be able to do better next time, but often they're just looping through my mind for no particular reason other than my own anxiety about being socially awkward.
Another common perseveration I notice in myself and in my kids is our total obsession with whatever book or TV show we're currently into . If I'm into a book, I am into the book.
I will think about the characters, the plot, the little details constantly, for weeks or months, constantly in the back of my head, even when I need to be doing other things. As an adult, I understand that no one else around me cares as much about this particular book, but that doesn't stop me from thinking about it all the time.
I am well known for watching TV series repeatedly. I have seen the entire runs of Futurama, Phineas and Ferb, Star Trek: Deep Space 9, Farscape, and many others, more than ten times a piece, easy. I can quote entire episodes if you get me started.
My autistic son, a huge nature geek, watches the same episodes of Octonauts over and over so that he can memorize all of the facts associated with the animal of the week. His ADHD sister memorizes all the dialog and spits it out at random later.
We are a family of thought perseverators.
Why Do Autistics Perseverate?
So what's up with all of this perseveration anyway? Well, behavior serves a function; behavior means something. Perseveration can mean several different things, depending on the person and what's going on. Here are some of the most common reasons for autistics to perseverate:
Limited Social Skills
Many people with autism struggle with social skills, which can include:
- knowing appropriate ways to get someone's attention in order to have a conversation
- understanding social cues within a conversation - being able to tell if someone is bored or ready to move on to a new topic, for example
- problems processing or expressing words (often called aphasia)
All of these are skills that most neurotypical people don't need to be explicitly taught. They are just picked up through osmosis without particular effort. However, many (maybe most) autistics do need clear training to understand neurotypical social skills (just as many neurotypicals need training to understand autistic social styles).
An autistic with limited social skills might repeat the same conversation with you every time they see you because:
- they're not sure how else to engage with you
- they don't know what other topics to talk about
- they can't tell whether you're interested in what they're saying or not
- it's so difficult for them to process speech and create new speech that they'll choose to use the script they've already memorized instead, even if it's not really applicable to the current circumstance
Anxiety is one of the most common conditions to co-occur with autism. Autistics have a much higher rate of anxiety than the general population, and somewhere between 20% and 40% of autistics have some form of anxiety disorder.
A person with autism and anxiety may repeat the same concern or idea over and over again because it helps them relieve their anxiety, especially if it's a problem with no easy solution.
Social anxiety can also cause perseveration; someone who is stressed about speaking with strangers may have a harder time keeping social norms in mind and end up talking too much. This is a common issue for neurotypicals, too! Have you ever talked too much when you got nervous?
Many times, perseveration is a reaction to some kind of weakness in either executive functioning skills or information processing skills. These are two sets of abilities that autistics often struggle with. Some examples of perseveration due to a deficit in executive functioning or information processing include:
- Having slow processing speed, which means it takes longer for our brains to sort and prioritize information and understand what's going on
- Having difficulty understanding social cues and knowing how to react in a given situation
- Having thinking that is inflexible, and therefore responding to you the same way over and over
- Having trouble with self-soothing, or calming ourselves when we're stressed
- Difficult regulating impulses, which means once we start, we have trouble stopping
- Difficulty regulating our attention, and sometimes hyperfocusing on a topic for a long time
Are There Any Interventions for Perseveration with Autism?
Yes, there are interventions to help curb perseverative tendencies. But, before you read on, consider this:
Why do you want to stop autistic perseveration?
If a person’s perseveration is annoying you, but not harming them or anybody else, please don’t consider intervention. An autistic child should be allowed to spin their fans, or talk about their favorite subject, just like anybody else would, even if the behavior seems excessive to you. In this case, the problem is your perception of the behavior, not the behavior itself. Try ignoring it, and remembering that there’s no harm in perseveration in and of itself.
However, if a person’s perseveration is harmful to them in some way, causing physical harm, greater anxiety or depression, or causing significant social alienation, then considering an intervention is worthwhile.
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How to Stop Perseverative Behavior
These are some common interventions, but not all measures are appropriate for all situations. I am not a medical professional and this shouldn’t be construed as medical advice. Please speak to an occupational therapist or other specialist about your specific case.
Talk about your concerns.
Gently and calmly bring up what your worry is about the perseveration in a conversation, and see what we say. You can have this talk even with very young children - just allow enough time for us to hear you and think about it, since a lot of us have slower processing speeds than average.
Many times, talking about the issue will let the perseverating autistic know clearly and directly that you are perceiving a problem, and will give them a chance to give you their point of view. This conversation may relieve your worries, or you may both agree that an intervention would be a good idea.
No matter what’s going on, talking about it openly and honestly should always be your first step.
Make a plan together to help them get unstuck
Agree ahead of time what “stuck” means to both of you in your specific case. Can I give you a signal or tell you when I feel like I’m perseverating and need help moving away from it? Can you tell me when you’re worried about it and we can implement whatever measures we’ve decided on?
Put perseveration on the daily schedule
If your perseveration causes significant anxiety or distress, obviously don’t do this! But if you need time to geek out about your favorite TV show repeatedly and at length to calm your anxiety, putting it on the schedule can be a great middle-ground for you and friends or family.
You get to look forward to your perseverative stress relief time and trust that it’s coming, your family doesn’t have to listen to the same sentence repeatedly all day and become overwhelmed. Win-win!
Have a time limit, or use a visual cue to redirect
This is often a good option for younger kids, or people who don’t have a great structure or routine and don’t use a daily schedule. The idea is roughly the same, though - you get to perseverate about whatever you want for a length of time, and then you consent to be redirected. This can be achieved with a time limit and audible timer, or with a visual cue like a hand signal or
Have a self-monitoring system
The last option that is a good fit for most people is to set up a self-monitoring system. If you perseverate because you're anxious or stressed out, then one thing that can help is improving your self-awareness of being anxious or stressed out.
If you notice that you are perseverating, you might have a set of interventions ready to go for ways to calm yourself. This will be a personalized plan that you can set up with your mental health professional or sometimes, an occupational therapist, depending on your individual situation.
What you want to do is learn to notice that you're anxious, and notice it earlier than you can right now, so that you can cut off the perseveration before it gets in too deep, before you get stuck in it.
You're going to develop a specific-for-you plan with a professional mental health counselor or OT, depending on what your anxiety stems from. Having a self-monitoring system in place can help to redirect you away from intrusive thoughts or difficult thoughts especially.
I hope that this has helped to define perseveration in autism for you, because I feel like it doesn't get enough coverage! Perhaps you learned some things about your unique autistic brain as well.
If you deal with perseveration, I would love to hear from you. What do some of your perseverations look like?