Stimming in Autism Explained: How Occupational Therapy Supports Your Child’s Nervous System

What Is Stimming and Why Does It Happen?

Stimming, or self-stimulatory behavior, refers to repetitive movements or sounds that are a natural part of autism spectrum disorder (ASD). Common examples include hand flapping, body rocking, spinning, finger flicking, and repetitive vocalizations. Research indicates that approximately 50% of individuals with autism engage in stereotypical motor movements (Barami et al., 2024).

Rather than viewing stimming as purely problematic, many autistic individuals describe these behaviors as serving important self-regulatory functions. First-person accounts reveal that stimming helps regulate brain rhythms and improve sensory processing and attention, either through rhythmic motor commands or sensory feedback generated by the movements themselves (McCarty & Brumback, 2021). Autistic adults consistently report that stimming functions as a coping mechanism to soothe intense emotions, manage overwhelming sensory environments, and communicate internal states (Kapp et al., 2019).

The Neuroscience Behind Stimming

The neural mechanisms underlying stimming involve complex interactions among neurotransmitter systems and multiple brain networks. One key finding is disrupted gamma-aminobutyric acid (GABA) inhibitory signaling, with reduced GABA levels documented in the cerebellum and primary sensory and motor cortices in individuals with autism (Grossberg & Kishnan, 2018). Reduced inhibitory control may result in disinhibition of motor output and repetitive movement patterns.

The basal ganglia play a central role in repetitive motor behaviors, regulating behavioral flexibility and goal-directed learning beyond simple motor execution (Fuccillo, 2016). Dopaminergic dysfunction within basal ganglia circuits contributes to motor stereotypies through imbalance between the direct (D1 receptor–mediated facilitation) and indirect (D2 receptor–mediated inhibition) pathways (Grossberg & Kishnan, 2018).

Functional neuroimaging studies demonstrate increased connectivity between somatosensory and motor cortices and subcortical structures in autism. This overconnectivity correlates with autism severity and is thought to reflect impaired sensory gating, allowing excessive sensory input to reach cortical processing areas (Grossberg & Kishnan, 2018). The association between sensorimotor overconnectivity and repetitive behaviors suggests a shared neurobiological mechanism.

The cerebellum also shows consistent abnormalities, including Purkinje cell loss and altered cerebellar–cortical connectivity, contributing to impaired adaptively timed motor learning (Grossberg & Kishnan, 2018). Secondary motor regions, such as the supplementary motor area and dorsal premotor cortex, are similarly implicated in restricted and repetitive behaviors.

What Triggers Stimming?

1.Sensory Processing Differences

Sensory processing differences are strongly associated with repetitive behaviors. Sensory hyperresponsiveness predicts approximately 51% of the variance in repetitive behaviors, with sensory-seeking behaviors accounting for an additional 11% (Zetler et al., 2022). Understanding whether stimming serves a calming, organizing, or communicative function is essential, as many repetitive behaviors are meaningful to the individual and should be supported rather than eliminated (Lai et al., 2020).

2.Genetic and Environmental Influences

Genetic factors contribute substantially to autism and repetitive behaviors, with evidence of familial patterns, although specific genetic mechanisms underlying stereotypies remain under investigation (Grossberg & Kishnan, 2018). Environmental contexts clearly influence stereotypy expression, with overwhelming sensory environments increasing frequency and intensity. At present, factors such as diet, pollution, or electromagnetic exposure lack robust empirical support in relation to stereotypy expression (Grossberg & Kishnan, 2018).

3.Screen Time and Sensory Load

Emerging research suggests that excessive screen time may exacerbate sensory processing challenges associated with repetitive behaviors. Among preschool children with ASD, longer screen exposure is associated with increased autism symptom severity, particularly sensory-related symptoms (Kushima et al., 2022). Early digital media exposure predicts atypical sensory processing patterns, including sensation avoiding, which is closely linked to repetitive behaviors. A pilot intervention reducing screen time from 5.6 hours per day to 5 minutes per day demonstrated significant improvements in core autism symptoms, with symptom regression observed when high screen use resumed (Kushima et al., 2022).

Occupational Therapy Approaches for Managing Stimming

1.Ayres Sensory Integration® (ASI)

Ayres Sensory Integration® (OT-ASI) is the primary evidence-based occupational therapy approach for addressing sensory processing challenges and stimming in autism. Research demonstrates that OT-ASI improves individualized goals and daily living skills at levels comparable to applied behavior analysis (ABA; Schaaf et al., 2025).

A recent randomized controlled trial found that OT-ASI combined with a structured home program significantly improved occupational performance and parent satisfaction compared to home programming alone, with 31.3% of participants achieving the highest levels of goal attainment (Schaaf et al., 2025). Sensory integration interventions have demonstrated effect sizes ranging from 0.12 to 1.2, though benefits may be time-limited without continued support (Weitlauf et al., 2017).

2.Environmental Modification and Sensory Strategies

Environmental modification plays a critical role in reducing sensory-triggered stimming. Creating sensory-supportive environments has been associated with improvements in nonverbal cognitive skills and adaptive functioning (Weitlauf et al., 2017). Occupational therapists collaborate with families to identify sensory triggers and adapt home, school, and community settings.

Massage-based interventions show mixed evidence. Moderate effect sizes (0.6–0.7) have been reported for self-regulation and sensory responsiveness (Lord et al., 2018). Qigong massage has demonstrated improvements in communication, sensory profiles, adaptive behavior, and social engagement when combined with conventional therapies; however, systematic reviews highlight methodological limitations and insufficient evidence for routine recommendation (Lee et al., 2011).

Deep pressure input shows promise for reducing physiological arousal and anxiety. Children with higher baseline arousal appear most likely to benefit (Weitlauf et al., 2017). While individual tools such as weighted blankets or swings show inconsistent results, deep touch pressure remains clinically valuable when used intentionally and responsively (Lord et al., 2018).

3.Behavioral Techniques Within Occupational Therapy

Behavioral strategies such as response interruption and redirection (RIRD) and response blocking (RB) can be effective when stimming significantly interferes with function. Response blocking has demonstrated greater and more sustained reductions in motor stereotypy than RIRD when total session time is considered (McCarty & Brumback, 2021).

Skill-based approaches integrate behavioral strategies with functional communication training and structured opportunities for self-regulation. These approaches allow individuals to engage in stereotypy in designated contexts while supporting task completion and adaptive participation (McCarty & Brumback, 2021).

4.Motor Skills Development

Motor-based occupational therapy interventions grounded in motor learning theory significantly improve coordination and functional skills. The MOTION-ASD program demonstrated greater improvements in manual coordination compared to cognitive orientation approaches, with sustained gains in fine motor control, body coordination, and self-care skills (Lord et al., 2018).

5.Joint Attention–Based Interventions

Joint attention interventions target social-communication foundations that may underlie some repetitive behaviors. When delivered alongside special education services, joint attention programs produced meaningful improvements in social communication, visual perception, and reductions in autism-related behaviors, with effects maintained at three-month follow-up (Tanner et al., 2015).

6.Physical Exercise and Movement-Based Interventions

Physical exercise is one of the most consistently effective interventions for reducing stereotyped motor behaviors. A meta-analysis of 22 studies found a large overall effect size (Hedges’ g = 1.16), with higher intensity exercise predicting greater benefit (Lord et al., 2018). A more recent meta-analysis confirmed that ball sports, moderate-to-high frequency, longer duration, and group-based exercise yielded optimal outcomes (Lord et al., 2018).

When to Seek Professional Help

Intervention should focus on minimizing functional impairment rather than eliminating all stimming behaviors. Occupational therapy evaluation is recommended when stimming:

• Interferes with learning or skill acquisition
• Poses safety risks
• Limits participation in daily activities
• Causes social isolation or emotional distress
• Threatens educational placement

Assessment emphasizes functional participation using tools such as the Canadian Occupational Performance Measure and Goal Attainment Scaling, interpreted alongside sensory processing patterns measured by the Sensory Profile (Zetler et al., 2022).

Creating a Supportive Home Environment

Family involvement is essential for sustained outcomes. Evidence shows that combining clinic-based sensory integration with structured, therapist-guided home programs is more effective than home programming alone (Schaaf et al., 2025). Parent-mediated strategies remain one of the strongest predictors of long-term success.

References

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2. McCarty, M. J., & Brumback, A. C. (2021). Rethinking stereotypies in autism. Seminars in Pediatric Neurology, 38, 100897. https://doi.org/10.1016/j.spen.2021.100897
3. Kapp, S. K., Steward, R., Crane, L., et al. (2019). ‘People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming. Autism, 23(7), 1782–1792. https://doi.org/10.1177/1362361319829628
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10. Weitlauf, A. S., Sathe, N., McPheeters, M. L., & Warren, Z. E. (2017). Interventions targeting sensory challenges in autism spectrum disorder. Pediatrics, 139(6), e20170347. https://doi.org/10.1542/peds.2017-0347
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