Understanding Perseveration in Autism

Have you ever noticed your autistic child having repetitive behaviors, conversations, and thoughts? Have you had a conversation with them, made a decision, and yet the topic keeps coming back up? Most likely, you have experienced perseverance with your child.

Perseveration in autism tends to look like persistent behaviors, actions, interests, and more. In some cases, these behaviors may go beyond the point of being helpful and may become inappropriate, causing conflict with others. The child may also come across as rigid and stubborn.

What is perseveration in autism? 

Perseverance is the continuation of an activity or thought without an ending point. Typically, perseveration occurs in individuals with a neurological disorder or certain mental health conditions.

The term perseveration is used when describing how some individuals with autism act and behave. 

Types of perseveration

Perseveration may look like the use of the same word or phrase or doing the same thing over and over again. When someone perseverates, they may struggle to change the topic or switch to another activity.

This repetitive thinking and acting are perseverations. One example of perseverance is when clients tell me they cannot stop playing a video game until they have achieved the top or last levels.

They will continue playing the game repeatedly, even when they may need to sleep, do homework, or engage in other activities. 

Example of perseverative thinking in autism

Here are some traits and tendencies of perseverance: 

• Obsession: When your child is highly fixated on a topic, they have an interest in it and will not move to other ideas and interests. Our children may ask the same question over and over or have repeating behaviors.
• Loop thinking: When working with clients, we discuss how thoughts and behaviors may appear like a “Tasmanian devil” or “swirling water in a drain.” Typically, when a topic comes up, the individual may go over and over the topic while the details become very intertwined. Looping thinking may also come across as giving the same answer to different questions, even if the answers have nothing to do with the topic. 
• “What ifs”: This may look like repetitive thinking of details for upcoming events. Your child may “what if” every single detail before making a decision or acting. They may also “what if” a situation based on historical situations that occurred long ago.
• Fears, stress, and anxiety of the unknown: Your child may express feelings based on not knowing all the details. They may not take any action until they have uncovered all the information to lessen these emotions. This may cause delayed action or no action at all.  
• Conflict avoidance: To avoid conflict, your child may dodge all topics and situations where a dispute could arise. They may avoid people and situations to limit the need to navigate the conflict. 
• Concerned about what others will think: A child may get hyper-focused on what others think, creating an emotional reaction for themselves. This thinking could cause an increase in their emotions, thus not acting.

Why does perseveration happen?

There could be a number of reasons why an individual perseverates. First, stress and anxiety can cause and prolong this behavior.

Sometimes, when a child’s sensory system is under stress or they are more sensitive, repetitive actions and behaviors could increase to help them cope with the environment.

Additionally, an individual’s brain could have been injured or developed differently. The way the brain functions could cause these repetitive behaviors and actions. 

How can parents address perseveration in autism?

If your child has persevering behaviors and thoughts, there are a few things you can do to support them.

Create a parking lot

Your child’s concerns, ideas, and questions are valid, so ensure you hear them. However, sometimes a decision must be made while capturing their concerns, ideas, and questions.

Sometimes, perseverance happens because your child does not want to lose an idea. This information is important to your child, so capture the information in a place where it will not be forgotten.

This is called a “parking lot,” where topics are noted while maintaining focus on the decision or action that needs to be made.

A parking lot can be a list on a piece of paper or whiteboard. Use part of the space to brainstorm ideas, and when concerns come up, list them under “Parking Lot.”

Through the conversation and brainstorming session, as solutions come up, the parking lot items will become obsolete. If items remain in the parking lot, then you and your child can discuss them to determine whether they relate to a topic or are linked to something else.

Encourage change when in a loop

Ask your child to change their environment, change the activity they are doing, or simply say, “We will come back to the topic.” Change can be good when it breaks up repetitive behaviors and thoughts.

Changing the environment or topic may help your child break the loop cycle by focusing on something different.

Use decision trees

Decision trees break big topics into smaller pieces and make smaller decisions at a time. For example, clients tell me they want a summer job but worry about the application process. They wonder if they’ll enjoy the work and whether they’ll have to talk to others. Some fixate on dress code requirements or worry about taking time off for vacation. Their concerns often spiral from there.

Sometimes, there are so many questions the conversation ends with, “I just won’t apply,” based on all the concerns. 

In these moments, I work with clients to help them decide on the first step in their job search. The decision is not “Should I take the job?” but “Should I apply?” This is the first step of many that will help us answer the other questions.

This is an example of breaking down all the decisions into more manageable decisions. The questions and concerns are valid and need to be addressed.

This is where placing items in the parking lot can help. Once items are in the parking lot, we create a plan for when and how to get the information.

Get curious

When our children spiral with questions and what-ifs, as parents, we should ask them questions to encourage creative thought and problem-solving.

By asking questions, we can help our children focus their attention while managing their spiral thinking. We may also discover that our children have concerns or worries that we can address.

By asking questions and being curious, we may uncover that our children are trying to remind themselves not to forget something. Our children may use loop thinking to hold onto their ideas as a coping mechanism.

This is something to explore and consider ways to track items that children are worried about forgetting.

Bring up an area of interest

By switching the topic of conversation, especially to a topic that your child is very interested in, the cycle of spiral thinking might stop. You can create a pause and switch their focus to something different.

Encouraging your child to work on a new task, start a chore, listen to their favorite music, or read a book can also help with the switch.

A healthy fear of the unknown

Fear and other emotions typically result from a lack of knowledge. First, we cannot know all the details about a situation. However, we can explore some of the details within reason and devise solutions to help lessen these emotions.

For example, if your child has to give a presentation at school and expresses how scared they are, talk about what they can expect. Have them think about the room where they will be presenting. Ask if they will use technology to support their presentation.

What outfit would they like to wear when giving the presentation? These are a few topics that your child can think about and then come up with solutions. Hopefully, by planning some of the details, the presentation will feel more manageable. 

Perseveration in autism: Treatment and interventions

Perseveration may be part of your child’s daily activities. Working with your support team of therapists, OTs, PTs, and others, you could develop a variety of individualized perseveration autism treatments.

Each person is different and may need varied techniques to reduce thinking habits. These autism perseveration interventions and techniques may take time to integrate into daily activities, and a variety of strategies may be needed for each situation.

In time, the burden of situations and all the details will lessen, allowing our children to lower their anxiety. 

How to support a child with autism and perseveration

A note about emotions. We can never know all the details of a situation. We cannot think through all the scenarios to develop solutions.

For example, when clients tell me they’re feeling anxious before a presentation, we discuss what they already know, talk through the unknown, and try to calm them down.

However, feeling some emotion before a presentation or event is okay. This is called performance anxiety. Hopefully, over time, our children will notice the difference between being prepared with emotion compared to not knowing enough and being anxious.

One thing to explore is understanding the dangers your child may be worried about. Some dangers may be real and others perceived. Ask questions about what our children’s fears are to explore the dangers. An example is going to a birthday party.

If a child states they are scared that they won’t have anyone to talk with and will be ignored by others, we can help. Ask your child if they know who was invited to the party, and connect the two kids.

They can go to the party together, so they already have a connection. For the fear of being ignored, talk with the child about how to walk up to others and ask to play. Coming up with strategies to address these concerns is part of the solution.

However, if our children are worried about going to the party because they know a particular person who has not been nice to them will be there, it is a real danger. 

In that case, we can talk about alternatives such as not going to the party and scheduling a playdate with the child whose birthday it is. 

Celebrating progress in small wins

As parents, we can support our children with perseveration and celebrate the wins. A goal is to help our children process their thoughts and create flexible thinking so they know how to get out of the loop.

By creating some coping mechanisms, we help our children adapt to change and create solutions when problems arise. When your child switches from these repetitive thoughts, this is something to acknowledge and celebrate.

With practice, children will learn how their brain works and will be able to incorporate some of the tools identified here. 

FAQs

Q: What are examples of perseveration in autism?

A: This is when a person repetitively thinks, repeats behaviors, and says the same thing over and over. An example is when your child’s friend gets a car broken into, and your child continues to express how the law was broken, and the friend must call the cops. Even though the friend is alright with getting the window fixed, your child keeps bringing it up.

Q: What is the difference between echolalia and perseveration?

A: Echolalia is the repetition of what they hear another person say. In some cases, people with echolalia could mimic sounds to create meaning for what is heard. This is different from perseveration because the individual is rethinking the topic in a loop manner. 

Q: What are signs of perseveration?

A: Signs of perseveration are thinking of the same topic over and over, saying or talking about a topic without being able to transition to another one, or frustration because the topic is changing. 

Q: How do you treat perseveration?

A: Share the behaviors that you see your child doing with your support team of therapists, OTs, PTs, and other providers so they can determine if treatment and interventions are necessary. Ideally, with practice, your child will learn other communication and thinking techniques.

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