How to support people with repetitive and “stuck” - University of ...

How to support people 

with 

repetitive and “stuck” behavior 

Nathan E. Ory, M.A. 

Ful Lives Conference 

24 April 2009 

Anchorage, Alaska

Questions to ask about 

Persistent, repetitive behavior 

P What is just something to do? 

< Time-filling activity. Sensory self-stimulation. 

P What is behavioral? 

< Learned habits and rituals. Somehow functional. 

P What is neurological? 

< Brain-based. Person may not be able to selfinitiate 

a shift of attention, or start/stop a 

behavioral sequence. 

P What is psychiatric? 

< Obsessive-compulsive, anxiety controlling.

Different functions of 

persistent, repetitive behavior 

P Overcoming insecurity/uncertainty through ritual. 

< Comforted by familiar, well rehearsed rituals. 

< 

< 

< 

Repeatedly asks questions till answered! 

Emotional-behavioral. 

Exaggerated by anxiety.



P Overcoming lack of internal boundaries. 

< Constant “limit testing,” looking for predictability. 

< 

< 

< 

With clear, external limits, no testing. 

Emotional-behavioral. 



Persistent, repetitive behavior 

P Obsessive thoughts - compulsive behavior 

< Can’t move on, even with prompts. 

< 

< 

< 

< 

< 

Resists interruption. 

Stuck in thought-action. 

Overwhelmed by thoughts that produce anxiety. 

Psychiatric. 




P M aintaining personal continuity. 

< Linking our actions in space and time. 

P O vercoming “discontinuity”, inability to sequence. 

< Repeating acts keep one’s place in time and space. 

< 

< 

< 

With external structure, moves on. 

Cognitive-neurological-behavioral. 

Exaggerated by anxiety

Functional-”continuity” behaviors 

Self-anchoring rituals 

P- sensory-tactile: 

< smelling, touching, licking, spitting, masturbating, 

eating, self-injurious acts (e.g., scratching.) 

P- kinesthetic: 

< rocking, flapping, jumping 

P- 

< 

visual-spatial: 

ordering objects, alphabatizing, making lists, 

cataloguing, word search

Functional “continuity” behaviors 


P - social: 

< attacking wrong doers, 

– keeping the "rules." 

P verbal: 

< repetitive speech, sing-song, 

– 

– 

echoing, vocalizing 

asking questions.

Functional “continuity” behaviors 


P - cognitive/mental: 

< - replays of videotapes, rereading stories, copying 

“ old” schoolwork. 

< - verbal rehearsal of the activity of the day 

< - verbal rehearsal of the "rules", 

< - single minded pursuit of questions to end. 

P - emotional: 

< - mental rehearsal of confusions-wrongs 

< -"obsessive" 

talking about anxiety evoking topics 

< - 

just for fun

Behavioral characteristics of 

Perseverative Responding 

Behaviors are persistent, and repetitive, but 

reflecting neurological disorder, and/or without 

any apparent functional value. 

"Perseverative responding" reflects deficits in 

a person's ability to self-initiate, self-organize, 

self-sequence and regulate his/her own 

actions and thoughts.


perseverative behavior 

NONE 

P Actions have no “functional” value. 

< Person is “stuck” in action, thought, sensation. 

< 

< 

< 

With prompt, can move on. Cue dependent to shift. 

Neurological. 


Some diagnostic categories showing 

perseverative responding 

P Developmental brain dysfunctions 

< Fetal alcohol spectrum disorders 

< Anoxia at birth, cerebral palsy, seizures, tuberous 

sclerosis, arrested hydrocephaly 

P Acquired Traumatic Brain Injury 

P Genetic Syndromes: 

< Fragile X, Prader-Willie, Williams Syndrome 

P Pervasive Developmental Disorders 

< Autistic spectrum disorders 

P Dementias 

P 

Psychiatric disorders

Indicators that 

persistent, repetitive behaviors are 

Perseverative responding 

PPerson appears to have no self-control over 

repetitive behaviors. Person gets "stuck in a 

rut" and can not shift activity on his own 

initiative. 

PPerson is dependent upon a caregiver to 

assist him to mediate his experiences. 

PSomething reliably “works” to bring repetitive 

behavior to an abrupt halt. 

< “Stops on a dime” “Switches channels”

Some methods for assisting people 

to transition out of perseverative actions 

PDirect or redirect with a rule 

PPre-correct 

PBring 

in a new face to break the pattern 

PRescue 

methods 

< Use humour 

< 

< 

Displace to own sensory-motor ritual 

Take off the emotional hook 

PDisappear 

< Out of sight = out of mind 

P“Read their mind”

P Sensory perseveration 

P Motor perseveration 

Behavioral examples of 


– Persistent movement patterns 

P Verbal perseveration 

P Mental perseveration 

– Single-track mind, mental inflexibility 

– Perseverative thought 

– Once in mind = impulsive action.

Behavioral examples of 


PEmotional 

perseveration 

< Leading to motor accelleration 

< 

Leading to motor inhibition

Emotional perseveration and disinhibition 

Person can become “stuck” 

in any of these 

sensory-emotional reactions. 

PEmotional mirror--magnifying glass 

PEmotional 

radar: Imprinting on prior emotion 

PLimited 

self-modulation of emotion

Emotional perseveration and disinhibition 

Person can become “stuck” in 

sensory-emotional reactions. 

Limited self-modulation of emotion

Perseverative disorder in 

"starting" actions: 

P Person knows what to do, but is dependent 

upon step-by-step-prompting. 

P 

Person knows what to do, but is dependent 

upon prompt to initiate act. 

– C an't tell what to do now 

– Can't tell what's most important 

– C an't tell (what to do next) 

– Can’t tell when to start


"stopping" actions: 

P - Can not stop perseveration until directed. 

P - 

Can not stop perseveration until completed. 

P - "Captured" by perseveration, can not stop 

until "rescued".


"shifting" actions: 

P -"Stuck", but responds to "come", "do", "start" next 

action. 

– Reactive to "no", "don't", "stop" 

P -"Stuck", but able to shift when "completed" action. 

– Reactive to interruption before "all done" 

P -"Trapped" in escalating emotional arousal. 

– "Rescue" with "prop", "rule", and "role" 

P -"Trapped" in sensory state. 

– "Rescue" by causing to get "cognitive" 

– "Rescue" by "capturing" with alternate stimulus

Structured methods for supporting individuals 

who show 


P Prevent 

perseveration by protecting individual from 

situations that will predictably lead to them 

becoming “stuck”. 

P Give prompts to transition person into what comes 

“next” 

< Body language (specific gestures) 

Verbal direction (specific phrases) 

< 

< 

< 

< 

Numbered lists 

Picture lists (cartoon sequences) 

Time schedules (dayplanner, calendar)

P 

To assist transitions 

get person “ready to be ready” 

Constant visual reminders 

P “Finished” or “All done” and “Ready-Next”

Structured methods for supporting individuals 

who show 


P Mediate transitions 

< Physically assist person to complete 

what they are doing. 

< Talk them through (give the “answer key”) 

so they can be certain their action will be 

“correct”. 

< Act as a “sensory anchor” throughout the 

transition.

Use of a “Prop”, a “Rule” and a “Role” 

to assist transitions 

P Give prop “here & now” to transition to “then” 

P 

P 

Props signal “beginning” of “next” and “end” of 

current action. Act as “brackets for behavior.” 

For each “prop”, have a “rule” that defines a 

meaningful social “role”.

The use of “structure” 

to overcome resistance to and to 

assist transitions 

Anchor in their own familiar repertoire 

P Sensory-tactile 

< Solitary or social 

P Auditory-visual

The use of “structure” 

to overcome resistance to and to 

assist transitions 

Anchor in their own familiar repertoire 

P Cognitive 

< Solitary or social 

P Emotional-social

Use of a “Prop”, a “Rule” and a “Role” 

to assist transitions 

PGive rule in terms of single action 

PGive role of being needed and useful

Guidelines for caregivers 

P Transitions: have a plan or a map for each day. 

P 

Provide continuity to person you are supporting. 

P 

Giving advance notice: CAUTION

Nathan E. Ory, M.A. © 2008 

Challenging Behavior Analysis and Consultation, Ltd. 

543 Marine View, Cobble Hill, BC 

V0R 1L1, Canada 

phone: (250) 743-1667 

www.psychologists.bc.ca/pro/nathanory 

challengingbehavior@shaw.ca 

“Working with people with challenging behaviors: 

A guide for maintaining positive relationships” 

2nd edition 2007 

www.fasdconnections.ca 

www.autismtodayory.com

How to support people with repetitive and “stuck” - University of ...

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