What are Repetitive Behaviors in Childhood?
Repetitive behaviors in childhood are repeated behaviors like flapping, spinning, bouncing, or pacing that are commonly associated with a developmental disability.
These often rhythmic behaviors may increase in the presence of stress, anxiety, or excitement. Psychologists refer to these under the title of ‘Restricted and Repetitive Behaviors (RRBs).’ Although there can be other reasons for some of these behaviors, RRBs are a well-known symptom of Autism Spectrum Disorder.
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Symptoms of Repetitive Behaviors in Children
- Bouncing, flapping arms, or pacing: are commonly seen as repetitive behaviors, often occurring when a child is excited, anxious, or stressed
- Spinning: is a tendency to repetitively spin in circles, appearing to ‘zone out’ of the outside world
- Hair twirling: is the habit of twirling hair excessively, perhaps leading to some hair loss
- Muscle movements: includes tensing muscles, clenching hands, and making faces
- Circling: is a pattern of flipping a hand in circles to match a ceiling fan or walking in circles
- Unique movement patterns: walking in squares, rectangles, or stepping in a specific order (e.g., ”I have to take eight steps before I get to the door”)
- Flipping objects: is the habit of flicking or flipping an object back and forth in a rhythmic pattern
Although it is not unusual to have some repetitive behaviors, such as pacing or foot tapping, this pattern looks different for two reasons.
- Hard to stop: You will notice that your child is resistant to being interrupted
- Noticeable: You will notice that others notice and ask what your child is doing
Causes of Repetitive Behaviors in Childhood
- Motor overflow is excess movement that does not serve a function. It is more common in infants, older adults, and those with neurological differences. In the case of motor overflow, the motor planning part of the brain may not be working smoothly. Motor planning is controlled by the parts of the brain (parietal lobe and basal ganglia) responsible for planning and executing gross motor movements.
- Motor stereotypies: Motor movements such as flapping, bouncing, and spinning, are often referred to as complex motor stereotypies. These behaviors are patterned, repetitive, and rhythmic involuntary movements . They can occur in children who are otherwise developing typically and are considered part of executive dysfunction.
- RRBs associated with autism: Repetitive movements often occur in children with Autism Spectrum Disorders. A neurological difference is present in this context, and these behaviors are referred to as restricted and repetitive behaviors. Restricted and repetitive behaviors are only one of the many symptoms of autism. Thus, if a child has only repetitive behaviors but no social or communication problems, autism would not be diagnosed.
- Tics: In a child without autism who displays repetitive movements, clinicians would call this behavior ‘complex motor stereotypies’. In this case, a child may have co-occurring ADHD, a Tic Disorder like Tourettes, or OCD.
Diagnoses that commonly occur with Repetitive Behavior
- Developmental coordination disorder: refers to significant deficits in fine motor (hand and finger movements) or gross motor skills (large muscle movements like running and jumping). This disorder may include motor planning issues, motor overflow, and complex motor stereotypies. Children with the disorder may have challenges with motor skills such as handwriting, balance, and coordination. 
- Autism spectrum disorder (ASD): deficits in social communication and restricted interests or behaviors [1, 2, 3]. The sensorimotor systems in children with ASD may be different in some children, and thus, Restricted and Repetitive Behaviors (RRBs) are common in this diagnosis. Many children with autism will also have restricted interests
- ADHD: challenges with attention, hyperactivity, and impulsivity, often with executive functioning deficits. There may be a lot of extra motor activity in ADHD. When the child has RRBs, Autism Spectrum Disorder may co-occur with the ADHD diagnosis
- Obsessive-compulsive disorder (OCD): is characterized by obsessions and compulsions (a behavior that someone feels compelled to do). With OCD, the child feels increased anxiety if the compulsions are not carried out and completed. For example, a common compulsion is hand washing. If the child is not allowed to wash their hands, anxiety will result from the fear of germs
- Tic disorder (Tourette Syndrome): a disorder that includes tics. These repetitive behaviors tend to be less rhythmic and more sporadic than RRBs
- Intellectual disability: a disorder of cognitive ability (lower intelligence). Repetitive behaviors may be part of a developmental, neurological, or genetic disorder that includes intellectual impairment
What to Do About Repetitive Behaviors in Childhood
If you suspect your child has repetitive behaviors that may interfere with their functioning, it is worth exploring with a professional.
Comprehensive evaluation - Consult with a psychologist regarding your concerns. Having diagnostic clarification and identifying any areas of difficulty will help a comprehensive treatment plan be developed.
Consider tics - If a Tic Disorder is suspected, it is recommended that you consult with a neurologist and potentially a child psychiatrist to assist with medication management and behavior therapy.
Find replacement behaviors - It may be helpful to guide your child to participate in another motor behavior when you see the repetitive behavior. Encouraging bouncing on the trampoline, squeezing a stress ball, playing with putty, or even clapping may help your child direct the motor behaviors into something more socially acceptable.
Allow some space - Some children benefit from time and space at home to have repetitive behaviors. It may be that your child feels much better after some time engaging in their favorite activity.
Sensory breaks - It might help your child to take sensory breaks at school. Often an Occupational Therapist at school can provide opportunities or special places to allow for frequent movement. A child can sometimes refrain from flapping/bouncing/finger flicking/posturing in class or other social situations with these allowances.
Tell peers - It can be useful for your child to share with friends about what is happening. For example, your child may say, “I bounce when I’m happy.” In this way, other children expect this behavior and may be less likely to be alarmed by it. Peers tend to get used to seeing the behavior, especially when the child is open and transparent about it.
School consultation - If your child’s motor needs are high, it will be important to involve the school. Providing frequent movement breaks and OT consultation can help to make things go more smoothly during the school day.
Extra movement - At home, you may consider medicine balls, a trampoline, and incorporating activities like swimming, biking, or hiking, to increase motor output.
When to Seek Help for Repetitive Behavior
While many children who exhibit repetitive behaviors have diagnoses of Autism, ADHD, Tic Disorder, or OCD, children with repetitive behavior can have typical neurological profiles.
Typical toddlers tend to do repetitive things, but these behaviors do not have the quality of releasing tension. The child may move repetitively, but the behavior does not serve the function of relieving anxiety or meeting a significant sensory need.
Some typical toddlers and preschoolers will repeat a behavior when learning something new. For example, a child may repeatedly try to solve a puzzle. This behavior is generally not of concern.
As a parent, you would notice that it does not appear that your child has to do the behavior. In this case, it is worth exploring your child’s symptoms, which may include anxiety, social communication challenges, inattention, repetitive language, and challenges with fine or gross motor skills. If your child has any of these additional symptoms, they would likely benefit from treatment.
Professional Resources on Repetitive Behaviors
- Psychologist or neuropsychologist: to consider symptoms in a mental health and brain-based context. A testing psychologist who knows child development can do a comprehensive evaluation of emotional, cognitive, language, learning, and motor domains to help create a profile of your child’s strengths and needs
- Neurologist: to consider tics or other neurological causes of repetitive behavior
- School psychologist: to consider a 504 plan or IEP based on behaviors and learning in school
- ABA therapist: to treat RRBs and help a child find appropriate replacement behaviors for any problematic repetitive behaviors. These therapists can come into the home setting. Many parents find it most helpful to have support in the setting where they see the behaviors
- Occupational therapist: to work on fine motor skills with a child in a school or community setting. Can also work on sensory needs and regulation.
- Developmental pediatrician: to look at the whole child and identify any genetic conditions or needs related to neurology, behavior, or development. Can prescribe medication as needed.
Similar Conditions to Repetitive Behaviors in Childhood
- Motor coordination: repetitive behaviors could be related to a general motor control problem
- Executive functions: repetitive behaviors are often associated with executive functioning deficits in multiple areas
- Attention challenges: repetitive behaviors may be associated with attention deficits
- Social challenges: repetitive behaviors may be associated with the social deficits often seen in children with Autism Spectrum Disorder or ADHD
- Sensory sensitivity: repetitive behaviors are often seen in children who have sensory sensitivities. In this case, Autism Spectrum Disorder should be considered.
- General anxiety: repetitive behaviors or compulsions may be displayed in some children as a method of managing their worries and fears
Book Resources on Repetitive Behaviors in Childhood
 Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.
 Fein, Deborah (2011). The Neuropsychology of Autism.
 Mahone, Mark E.; Ryan, Matthew; Ferenc, Lisa; Morris-Berry, Christina; Singer, Harvey, S. (2014). Neuropsychological function in children with primary complex motor stereotypies. Developmental Medicine & Child Neurology.
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