AUTISM SOLUTIONS
HELP: Why Does My Child With
Autism Flap His Hands?
By Kelly BEINS, BA, BHSc, OTR/L
Is it better to let a child with autism flap his hands or should you stop it?
– Jane
T
Dear Jane,
his is a good question and one I’ve been
asked many times as an occupational
therapist because many people consider
hand-flapping to be “self-stimming” and
“sensory” in nature. This is possible, but as
with any behavior, I use hand-flapping as
a cue to help me understand the internal
state of the child, which is important information
to consider when determining if or how the behav-
ior can be stopped, or when deciding if it should be
stopped.
The medical term for hand-flapping that occurs with
any regular frequency is “motor stereotypie” and is
defined by the Johns Hopkins Medicine website as,
“Primary motor stereotypies (also called stereotypic
movement disorder), are rhythmic, repetitive, fixed,
predictable, purposeful, but purposeless movements
that occur in children who are otherwise developing
normally. Examples of primary motor stereotypies
are flapping and waving of the arms, hand-flapping,
head nodding, and rocking back and forth.” In typi-
cally developing children, a motor stereotypie is con-
sidered primary (physiological), and when the child
has a known neurological disorder such as autism, it
is called a secondary motor stereotypie.
Additional information about motor stereotypies
such as hand-flapping can be found here.
It is important to recognize that an underlying cause
of hand-flapping in both typically developing chil-
dren and in children with autism can be a height-
ened emotional state. Emotions that run high impact
a child’s nervous system, and it may be escalating in
positive and/or negative ways. A heightened state of
arousal can indicate emotions of excitement, hap-
piness, anticipation, and joy, but it can also indicate
anxiety, frustration, and overwhelm. Playing detec-
tive to determine whether the child’s state is positive
or negative at the time of hand-flapping may help
you decide whether you want to intervene to stop it
or not. Be aware, however, that even if you or others
want to stop the hand-flapping behavior, research
shows varying levels of success with either behavior-
al- or habit-changing interventions or with medicine.
Another common hypothesis is that hand-flapping
is a way for children to regulate their visual senso-
ry input. Children may do this to avoid other types
of input, to keep themselves feeling calm, and/or
pay attention. Always keep in mind, hand-flapping
should never be defined as “bad behavior.”
Some things to observe when the hand-flapping oc-
curs that may help you determine the cause of it are:
Who is around the child?
What is the child doing?
Where is the child? / What is the environment?
Is the child exposed to or experiencing known
sensory triggers (sights, sounds, smells, move-
ment, all of the above)?
What are the demands being placed on the
child at the time (transitions, homework, eat-
ing, social/play skills, language)?
Is this a new scenario or a familiar one for the
child?
Autism Parenting Magazine | Issue 87 |
27