Thinking Moms’ Guide to Red Flags – Repetitive Behaviors

 

red flag--rrb“There he goes again, a man on a mission!” That “man” being my 13-month-old son.  His mission:  Climb up on sofa with stuffed blue dog, throw blue dog over the back of the sofa, slide backwards off of the sofa, run around to retrieve blue dog.  Repeat.

Repeat. Repeat. Repeat. Repeat. Repeat. Repeat. Repeat. Repeat. Repeat. Repeat.

He would repeat this sequence for hours. Every. Day.  His hair would be drenched with sweat, and any attempt to interrupt this ritual was met with screaming, hitting, and tears.  I tried easing the feeling that something was ‘off’ about his behavior by telling myself he was just having fun, which was mostly believable, except for the fact that the look on his face was always fierce concentration, not joy.

Looking back, I see this ‘game’ he played was actually a huge RED FLAG.

This type of repetitive behavior is classified under the umbrella term, Restricted and Repetitive Behavior (RRB), and is one of the main diagnostic criteria for autism.  In fact, a study released last year found that repetitive behaviors are one of the earliest indicators of a future autism diagnosis.  “Investigators at the University of North Carolina in Chapel Hill found that infants with 3 or more types of repetitive behavior at 12 months of age were 4 times more likely to meet diagnostic criteria for ASD at age 2 years compared with low-risk infants and, importantly, high-risk infants who were not diagnosed with ASD at 2 years of age.”

What can these Restricted and Repetitive Behaviors look like?

Some of the most common RRBs are body movements (spinning in circles, hand and arm flapping, opening and closing doors), insistence on sameness in routines or object placement (lining toys up, becoming upset when  routine is altered), intense focus or obsession with certain objects or topics (video games, cartoon characters) and self-injurious behavior (hitting him/herself repetitively).

These repetitive behaviors are also a part of typical toddler development, so it can be difficult to distinguish if what you are observing in your child is typical or red flag behavior.

How can you determine if the behavior is a RED FLAG?

Generally, the repetitive behaviors in typically developing children peak around 6 months of age.  If the child’s repetitive behaviors increase and persist past 12 months of age, this is a RED FLAG.  The more RRBs a child displays, the bigger the RED FLAG.  If you go to extreme efforts to prevent any change in their routine to avoid a meltdown – RED FLAG.  If the intensity and obsession with the behaviors prevent learning or are major disruptions – RED FLAG.

Keeping a journal is a great way to track behavior. Make note of any behaviors that are considered RRBs, paying special attention to when they initially begin, their intensity, how often they are displayed and when.  By doing this, you may see emerging patterns, giving clues to what might be triggering the repetitive behaviors.  Maybe they are occurring when your child is happy, or tired, or anxious, or over-stimulated, etc.  Maybe they engage in the repetitive behavior when they are trying to avoid an activity, or are in pain, or after they eat certain foods.  This can also help narrow which avenues to take if you decide to look into treatment therapies.

There are different therapy approaches that address these repetitive and restrictive behaviors.  Many parents have seen wonderful progress and an increase in connection with their children through the  Son-Rise program and RDI.  The Professor wrote an amazing blog that discusses one possible reason why this approach can be so effective. The ABA method focuses on redirecting the repetitive behavior to something less disruptive and then reinforcing the new desired behavior. As with any autism treatment, behavior therapy is not ‘one size fits all,’ each child responds differently. What may be effective for some, can have the opposite effect on others.  It’s important to research the different therapy methods, and be flexible in changing direction if you need to. Listen to your gut!

With my son, I believe the trigger for his repetitive behaviors was inflammation.  Once we started biomedical treatment and his body started healing, the behaviors lessened. (Related study: http://autism-nutrition.com/repetitive-behavior-in-children-with-autism).  We tried ABA therapy when he was younger, but it just wasn’t right for our son.  We did, however, see many positive outcomes when we joined him in his world, something we still do today. He still occasionally focuses on his interests in a way that could be classified as atypical, and he does flap his arms when he gets excited, but the behaviors are easily redirected when they need to be and don’t impact his life negatively.

It’s been 10 years since my son’s daily blue dog ritual and even though the repetitive behaviors have almost all disappeared, I have a feeling blue dog will always be with him.

blue dog

~ Frankie

Frankie is Mom to three amazing children who, along with her husband, are her heart and soul.  At the age of three, her son was diagnosed with PDD-NOS, and she was told his future would consist of group homes or state-run facilities. With biomedical treatment (and a lot of sweat, tears, humor and love), he’s now recovered.  She tossed the rose-colored glasses, rolled up her sleeves and made his recovery her mission.  She hopes his story inspires others to do the same.

 

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29 Responses to Thinking Moms’ Guide to Red Flags – Repetitive Behaviors

  1. Geoff says:

    My son is 24 months. He’s obsessed with remotes and for eg pausing tv and restarting the theme tunes on his favourite programme over and over. When I take remote away I get the tantrum. He used to open and close doors but has moved away from that. He’s also very shy at nusery. This has brought him on and it seems to take him a while to warm up around other children. Is this toddler behaviour or cause for concern

    Kind regards

    Geoff

    • ProfessorTMR says:

      It’s hard to know for sure, Geoff. If it’s the only red flag you’re seeing, it could be that your son is simply shy and doing developmentally appropriate repetition. I would read our other blogs on red flags and see if you note any other issues. If this is the only one, I would remain watchful but not worried.

  2. Kylie says:

    I have a 17 month old son who has some repetitive characteristics but I don’t know if I’m being overly paranoid or if I have reason for concern. He is a happy boy who smiles shares wants me to be involved in his play, likes other children, and has 9 words and sounds he uses in context. But he will repeat one word over and over and over. Usually “wow” as he points to something he finds interesting although he looks at me to make sure I’m looking too. He likes to open and close doors, he flaps his hands when excited or angry, has been scratching the top of his head, recently started to spin in circles and then laugh about how dizzy he is. I read that those can all be red flags but are they typical or normal toddler behavior or is it really red flags I should be getting looked at? None of his behaviors are ritualistic though, he doesn’t NEED to do anything but will get upset and whine until redirected if say I take a container and lid he was playing with away from him.

  3. Danielle says:

    Hi. I have a 16 month old little girl who I’m extremely worried about. She can literally sit for hours in one spot, barely blinking or moving. If she does move while sitting still she is scratching at her knees or feet while looking straight ahead. She also only says 2 words “hi and dada”. Mostly when speaking everything is dada even when introducing new words and working with her. She is very particular in her routine and when it’s interrupted she has huge fits such as forcing herself to poop or crying. Just yesterday at naptime she cried the full 3 hours none stop, most kids after the 10 minutes would connect that mommy and daddy aren’t coming in to get me and go to sleep but not her she will literally continue to cry repeatedly. With any toy she plays with she will do the same things with it as far as stacking or lining them up and she separates her food also. Should I be concerned or am I just going crazy? She isn’t walking, she isn’t talking besides those 2 words and she doesn’t interact with her peers! I seriously need answers on this one. Her doctor said by 18 months we should seek evaluation for her but I think she’s sugar coating the concerns we have.

    • ProfessorTMR says:

      Given what you’ve described, you should DEFINITELY seek evaluation — and soon. However, there is a lot you can do before the evaluation happens. The best overall guide is Outsmarting Autism, by Patricia Lemer. She guides you through what you need to know to get quality help for your child and not waste your time and effort on things that won’t help.

      • Danielle says:

        Thank you so much for your quick input. This is exactly what i need but how do i go about all this with her doctor? When you ask her to wave at people she does and she will even seek attention by saying hi to strangers? Normally when you hear of autism you hear of children not doing that but I’ve been hinting towards autism for awhile now I’ve just had no one taken me seriously. How do I break this to her father who is in complete denial at a lot of these red flags? Her emotional responses are not that of a typical child, she never truly smiles and she laughs at times but it’s more forced as if she knows we are watching her so she throws us a bone here and there. Are there any resources on how to really get him on board?

    • Cath says:

      My son is 16 months and he has far fewer signs compared with your daughter. I contacted my health visitor who popped round immediately and referred him for language and speech assessment. My son seems highly intelligent yet hasn’t even started babbling yet except mama but never in context. Maybe you could try your health visitor. Good luck

  4. Sam says:

    My daughter is 18m months old, i am a single father and i have raised her alone since she was 5 months. every since i can remember my daughter has a few repetitive behaviors. Since she has been able to sit up on her own she has rocked back and forth. She will sit on the couch and throw herself back as if she is bouncing off a vertical trampoline. she bounces her back off the back cusion of the couch and gets thrown forward kinda like a trampoline on her back but sitting stationary on her butt. she does this for hours if she could over and over watching a movie. she does it in her high chair, booster chair anything that is soft on her back. She also repeats the same words over and over all the time. “daddy” “daddy” “daddy” “daddy”. Im very concerned. If anything its getting worse. She was also a preemie. Almost 5 weeks early but went right home never stayed in the nursery.

    • ProfessorTMR says:

      There is probably some reason for your concern. Do yourself a favor and read Outsmarting Autism by Patricia Lemer NOW. Follow her suggestions and your daughter will be healthier no matter what issues she may currently have. Good luck!

  5. Julie lang says:

    My son is 16.5 months old. He is obsessed with lids anc containers. If he sees a milk carton he wants it so he can screw and unscrew the lid, he also likes a hair wax container mainly because he likes to screw and unscrew the lid. Anything with lids on caintai era he likes to use. He doesnt have repetitive behaviors other than opening and closing the door in our bedroom but it’s not something he always has to do, when he was 13 months old I took him to a play house for kids and he was obsessed with a toy house and opening and closing the door I found that odd but we didn’t go back there, he has a playhouse at home but he doesn’t play with the doors on it. I’m not sure if this behavior is something I should watch out for or if he’s mastering a skill.

    • ProfessorTMR says:

      As long as the obsessions are short-lived and giving way to new obsessions when he has them mastered, then it is probably developmentally appropriate. Children do repeat activities while they are mastering them. In toddlerhood, it can be difficult to tell when the repetition is truly an issue for this reason.

  6. Claude M says:

    I have an 18 month old son who knows over 30 words, 24 out of 26 ABC’s, shares, plays, and acknowledges me in all he does. I have taken the MCHAT test and has indicated “no cause for concern for autism”.
    My question is whether his fascination with walking alongside edges and patterns alone is something I should worry about. When indoors, I sing a song to him while he’s doing this and often stops to finish the last word of the song and smiles. While alone outdoors, he will often ignore me.

    Should I be concerned about this behavior? He’s my only child and youth make sure everything is okay. 😌

    • ProfessorTMR says:

      That does not sound to me like cause for concern at least for now. Children at that age can get very focused upon what it is that interests them to the exclusion of other input. If your child shares, plays, and acknowledges you, this isn’t a problem.

      Try to turn your energy away from “worry” and toward doing things that promote a robust constitution and neurological system. Feed your child good food, avoid unnecessary “preventive” medical treatments, and feed your child’s mind.

      • Claude M says:

        My son is now 24 months and is not only following lines and looking to the side but also looking at objects from different angles. I feed him organic foods and have just started him on cod liver oil.

        An evaluation has been made by both psychologist and occupational therapist and have diagnosed him with ASD. He has visual stimulation throughout the day but he is still progressing in language, social interaction, and learning. He knows about 200 words, sings to about 10-12 songs, knows 10 colors, counts to 20 and knows his abc’s.

        I am terrified at the thought of him getting worse. In your experience and everyone else on this blog, how effective is therapy and will it effect his future? He is my only child and I’m very distraught.

      • ProfessorTMR says:

        Let me give you a little gentle, but hard-won advice. Do all you can for your son (who sounds like he’s doing quite well for someone diagnosed so young), but do it because you love him and want to give him every opportunity, not because you are terrified of him “getting worse.” Our children feel that energy of fear, but they are not developed enough to understand that it isn’t THEM that we fear, but something HAPPENING to them. They internalize the fear and can sometimes fulfill it because they actually feel that it is what they are “supposed to” do. One thing that we know for sure is that every child reacts to every sort of intervention in their own unique way. A child down the street may have the same issues, but may react to completely different interventions. You will have to watch him and see what is working and what isn’t. If it doesn’t help, don’t despair. There are many approaches that can accomplish the same general goals. For a really good grounding in some of the things that can be very effective, it’s a great idea to read Outsmarting Autism by Patricial Lemer. Your son has a VERY good headstart on these issues already. There is great potential for him to lose the diagnosis if you don’t get set into an attitude of terror. ENJOY this time with your son. (A great book that can show you the value of this is Son-Rise by Barry Neil Kaufman.)

      • Claude M says:

        Thank you so much. I am trying my very best to not show my despair to him. I love him dearly and as an older mom, I fear he will have difficulty as an adult.

        He is extremely smart and am grateful for my miracle boy. I will fight with everything I can for him to get better.

        Thank you for the advice and your book referrals. I will definitely purchase them.

      • ProfessorTMR says:

        It’s one thing to not show despair and another to not be feeling it. It will go so much better for both of you if you can transcend the fear. I’m going to recommend something that may help you to release that fear. It’s a technique that uses the principles of acupressure called EFT (for Emotional Freedom Technique). There’s a book and a film called The Tapping Solution, both by Nicholas Ortner, which makes it very easy to apply. I can personally say that I have released much of my fear for my kids through that technique. Good luck!

  7. Bob Young says:

    My daughter is 13 months and has a few repetitive behaviours. She always has to close doors, when sitting she’ll spin round in circles (usually 2 or 3 times), certain toys she’ll press a button over and over again to hear a phrase. Yesterday I witnessed her turning a toy off with right hand and immediately on with left hand. She done this about 20 times. She doesn’t like other kids getting too close to her. She’s not walking yet and is nowhere near walking. When holding her up to stand on her legs she’ll only do it for about 5 seconds before she’ll let her legs go from under her. She really doesn’t like being on her feet. She seems to have good understanding when you talk to her. She does make eye contact. And she does like laughing at her older brother who’s 5. Maybe I’m just overly worried and some of the behaviours are normal for her age.

    • ProfessorTMR says:

      Repetitive behaviors CAN be developmentally appropriate if she is learning a skill. If it seems like a ritual she MUST do, however, that could be a warning sign. The walking thing may not be an issue. Some kids do walk late. Keep an eye on her, but in the meantime there are things you can do to minimize the possibility of problems down the road. Good, high quality, organic food is important. If she has ANY digestive issues, get them addressed. Probiotics, enzymes, a product called Restore, can all be helpful in this regard. You might also want to supplement with fish oils with provide EPA and DHA for the developing brain as well as helping to bring down any inflammation that may be happening. Steer very clear of acetaminophen or paracetamol as it may be called where you are, and avoid antibiotics if at all possible. If you are still vaccinating, do not do so blindly. Seriously consider each one, especially if they contain aluminum.

      • Bob Young says:

        Thank you for your reply. Now that you’ve explained it like that it doesn’t seem like a ritual she has to do. It is so difficult to know for sure. Will keep an eye on her. She still has some vaccinations to get. You hear so much about vaccinations that’s it’s hard to know which side to believe. Found out recently that’s she’s lactose intolerant so she’s now on soya milk.

      • ProfessorTMR says:

        I urge you to get the new book The Vaccine-Friendly Plan. It’s written by Dr. Paul Thomas who starts the book off with a poignant story about his childhood friend in Zimbabwe who died from complications with measles. He BELIEVES in vaccines, but he’s a smart man and actually studied a great deal of the science and the plan he advocates is MUCH likelier to keep kids reasonably healthy. I would recommend getting genetic testing before you go any further. MTHFR mutations as well as others that can affect a child’s ability to detox are important markers to pay attention to. Good luck!

  8. I have a 2 year old grand daughter whom I think has some traits of autism. I have tried discussing this with my daughter (her mother), but to no avail. She thinks there’s nothing wrong with her and is just slow in talking and spoiled. She can say maybe a dozen words, very few 2 word combos, mostly grunts and has this chatter “ticka ticka ticka” that she does rather than tries to talk. Does not like to be around other people other than me and her parents. If you put her in a room with other kids (my other grandchildren), she screams until she can get back with me or her parents. Her play is repetitive. She’ll do the same thing over and over, in the same order, until you distract her with something else. She just started turning in circles, but will stop when she finds out it makes her dizzy. I would love to get some advice on how to handle this situation since my daughter doesn’t think she has a problem.

    • ProfessorTMR says:

      *sigh* It may not be QUITE autism, but it’s likely that an evaluation for Early Intervention is in order. I’m going to see if I can get you some advice from some autism moms on how it might have been best to approach them…

      • Thank you so much…

      • ProfessorTMR says:

        A friend suggested putting the child in a toddler program like music, or dance, or gym. It’s often eye-opening for a parent to see the child with neurotypical peers. Kids vary a lot in their development, but it’s easy to see yours is significantly behind when you’re in a program like that.

        Still trying to get more input…

  9. nikki says:

    great article! anyone have any advice on telling a good friend that her child has these red flags without having them freak out? TIA

  10. Elaine says:

    I really enjoyed your article. I found it very informative.

  11. Kathryn Berg says:

    Reading through this article brings a few homeopathic remedies to mind, including Zincum and its salts, Kali Bichromicum, for example. If anyone is reading this and sees their child in your description, call a classical homeopath! Homeopathy can definitely help!

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