Understanding ADHD Stimming Behavior

If you've heard of the term “stimming,” it was likely discussed in relation to attention-deficit/hyperactivity disorder or autism spectrum disorder (ASD). ADHD stimming refers to repetitive movements or behaviors that individuals with ADHD engage in to manage sensory input, regulate emotions, or enhance focus. This self-stimulatory behavior, such as nail-biting, humming, or rocking, can be a very common human behavior and is often observed in people of all ages, backgrounds, and abilities. In most cases, stimming is not harmful and does not need to be treated, but if it begins to interfere with everyday life, it may need to be addressed through therapy. If you’ve noticed that stimming behaviors have begun to cause difficulty in your life, then working with a licensed therapist online or in person may be helpful.

What is stimming?

The term "stimming" is generally an abbreviation for "self-stimulatory behavior.” While it may sound complicated, this can be thought of as an umbrella term used to describe any movements, patterns of behavior, or actions used to stimulate the senses. 

Stimming in ADHD, autism spectrum disorder, and other developmental disorders

While stimming can be a natural response that is not necessarily unique to individuals with intellectual or developmental disabilities, it can function as a source of comfort and control for children with developmental delays or disorders. Because most children with developmental disabilities can also experience some amount of sensory overload, stimming can be used to regain control over a certain sensation or experience. According to the Children’s Hospital of Philadelphia’s Center for Autism Research, a child may stim to communicate that their environment is overwhelming. This tends to be especially common with sensory processing disorders.

Children who are overwhelmed by auditory input, for instance, might shriek or shout in response to a lot of noise. Children overwhelmed by visual input may press against their eyelids to create stars in their eyes or move their eyes back and forth rapidly. This can be referred to as “trigger stimming,” when the stimming behavior reflects the channel and intensity of the sensory input that disturbs the person. 

In those with developmental disabilities, stimming can be an adaptive mechanism used to communicate intense emotions. As a result, the default settings of such stimming may be loud, distracting, or different from more common types of self-stimulation. Understanding the function of stimming can provide insight into the experiences of individuals with sensory overload and their behavior and habits.

Stimming can also be used by adults living with developmental disorders. In a helpful report titled “‘People should be able to do what they like’: Autistic adults’ views and experiences of stimming”, researchers found that adults with autism often stim to manage feelings of overwhelm. 

Stimming behaviors in ADHD

While developmental disabilities or intellectual impairments do not necessarily accompany attention-deficit/hyperactivity disorder, or ADHD, it can be common to see children with ADHD who also experience sensory difficulties. As described in an article published in the journal Frontiers in Integrative Neuroscience, children living with ADHD often “have difficulties in sensory processing and controlling emotional responses to sensation”. These reactions, called sensory over-responsivity, are thought to be caused by alterations in the functioning of certain brain regions, including the amygdala and thalamus. ADHD stimming may be similar to the type of stimming you may see in a child with autism spectrum disorder (ASD) or other developmental delays. 

Children with ADHD may also stim in the form of fidgeting. This can entail a child squirming in their seat, but can also include more noticeable and disruptive behaviors, including speaking over other people, humming loudly, repeating sounds, picking at skin or hair, or pacing back and forth. These behaviors are typically used to solicit some form of sensory input, though they can sometimes distract other students or people in the room. At the same time, these stimming behaviors may help people with ADHD quiet down some of the sensory systems prohibiting focus or creating unpleasant sensations in the body. Stimming may help children complete complex tasks or work on projects that require long periods of focus.

The functions of ADHD stimming

Medical reviewers generally confirm that stimming tends to have multiple functions, depending on the person engaging in the behavior and the environment the person is in. Self-stimulatory behavior, by nature, can create a sensation in the body. However, the factors that trigger stimming may be unique to each individual and can change from day to day.

For some, stimming may be used to exert control over a situation and redirect fear or unpleasant energy, though it may be accompanied by a perceived lack of self-awareness. When this is the reason for stimulatory behavior, sensory overload is usually involved, according to the latest evidence-based research. Stimming can be a form of control that often appears in more dramatic movements, sounds, or behaviors, such as rocking, jumping, or crying. These behaviors can quiet an overloaded sensory system.

According to peer-reviewed studies, many people with ADHD stim because it can be self-soothing. Chaos and feeling overwhelmed tend to be the most common causes of stimming, and the resulting self-stimulatory behaviors can help people with ADHD manage sensory overload. 

However, some people stim to relieve excess energy. Pacing, biting nails, tapping feet, and fidgeting can all be used as a means of eating up energy that has no other place to go. Hyperactivity can be a core symptom of ADHD, so eliminating excess energy can be a natural result of this symptom. By relieving excess energy, a person with ADHD can calm down and improve focus.

For others, stimming may be engaged to alleviate boredom. This is perhaps the most common reason for stimming in people who do not live with a disorder or delay. Stimming for these individuals usually manifests in smaller, more socially acceptable ways, such as twirling one's hair while reading a textbook or tapping one's foot while waiting in line. These small energy expenditures can engage the body in several ways and do not usually require much effort or thought.

Types of stimming

Self-stimulatory behavior can come in many forms. Depending on the person and the factors that trigger stimming, they may focus on one type or engage in many types of stimming behavior. 

Generally refers to stimming behaviors that utilize the sense of sight. Some visual ADHD stimming examples can include staring at spinning objects or excessively drawing or painting.

Typically involves using one’s voice or utilizing the hearing sense. Examples of verbal stimming behaviors may include excessive giggling, humming, making odd noises, or compulsively clearing the throat.

Normally focus on the sense of touch. Examples of this type of stimming can include picking the skin, rubbing fingers, teeth grinding, or biting fingernails.

Behaviors usually focus on body movement and balance. Examples of this type of stimming may include spinning, rocking, and swinging.

There can be other stimming behaviors that don’t fit into the above categories as well. These can include excessive gameplay, excessively sharpening pencils, smelling a particular scent, acting out a movie scene repeatedly, or writing the same words or numbers repeatedly.

Interventions for ADHD or autism stimming 

In most cases, stimming does not require intervention at all. If stimming does not interfere with daily life, it generally does not need to be lessened or eliminated. Based on a report from the American Psychiatric Association, research has found that autism and ADHD stimming often have a purpose and can be beneficial. Therefore, there may be no need to manage stimming behaviors.

Therapists, parents, and educators may need to intervene when stimming begins to interfere with living a healthy, well-adjusted life, though. This can sometimes be the case in children with autism or ADHD. In these cases, behavioral therapy is normally the main treatment protocol. Treating ADHD or autism with behavioral therapy can help children understand the sources of self-stimulating behavior and process emotions in healthy ways. For example, stimming related to ADHD may occur in a child as a response to difficulty managing emotions in stressful situations. Through behavioral therapy, the child can learn alternatives to such behaviors, such as squeezing a stress ball. 

Staring off into space or making loud noises at the expense of listening to a lecture in class may be an instance in which stimming significantly interferes with a child's ability to function. This behavior has the potential to impede a child's academic achievement. 

Stimming or fidgeting in the classroom

The APA suggests that stimming during school may look different for each child, based on factors like a classroom’s arrangement and contents. ADHD stimming can be related to any of the three core symptoms of the disorder. And they may look different depending on the child, as common symptoms can be expressed differently in each individual. Some children with ADHD do not experience significant sensory difficulties and might not stim much, apart from the occasional bout of stirring and wriggling in their seats.

Children with ADHD and sensory challenges tend to be far more likely to display more significant stimming behaviors, including talking over the teacher, humming, rocking, tapping hands or feet, getting out of seats to run or jump, and twirling in circles. For these children, an individualized education program (IEP) or 504 plan may be necessary to improve learning and encourage academic success.

Stimming at home

Stimming at home is unlikely to need the same level of assistance as stimming in school, but it may still require parental support and some form of intervention, such as therapy. Some children with ADHD may have trouble sitting at the table for meals and, as a result, may develop unhealthy relationships with food and eating. Others may experience sensory challenges and difficulty concentrating, which can make completing chores and abiding by parents' requests difficult. This could potentially lead to relationship rifts between parents and children.

ADHD stimming

ADHD’s effects can be far-reaching and often impact far more than just classroom settings. While stimming may initially seem problematic for children with ADHD, it can actually be useful for parents, educators, and therapists. That is, the severity and prevalence of stimulatory behavior can help caregivers determine the extent of a child's sensory difficulties and identify the regions of the body and brain where they are most prominent.

For some, the thought of discouraging a child from stimming may be akin to forcing a child to give up a beloved toy or activity; it can seem almost cruel. For others, visible stimming functions as a source of alienation and indicates an area of need, so it may need to be addressed and resolved. 

Whether your child with ADHD is experiencing sensory overload or generally struggling with the symptoms of ADHD, stimming is likely to come into play at some point in their treatment journey. Determining whether stimming may be a harmful or damaging aspect of ADHD can largely depend on your and your child's goals and the extent to which you are willing to seek treatment.

A treatment plan for ADHD will typically comprise psychotherapy and medication. As discussed above, therapy can bring stability and order to a child’s life, which may reduce stimming in ADHD. Stimulant and non-stimulant medications can address the cognitive and emotional effects of ADHD. Medication can help children stay focused, self-control, and limit other behaviors that can exacerbate stimming. Research shows, for example, that stimulant medications can reduce fidgeting, improve impulse control, and increase focus. Always consult with a healthcare professional prior to starting or stopping any medication. 

Seeking help for repetitive self-stimulation behavior

If stimming has become problematic for you and has started to interfere with your life, it may be beneficial to speak to a therapist. When mental health and/or developmental concerns are already disrupting your life, though, it can be difficult to make time for an in-person therapy session. In this case, you may find online therapy to be a more convenient alternative. 

Benefits of online therapy for calming repetitive stimming

Online therapy can be a convenient and customizable form of treatment for those with busy schedules. You can attend sessions from any location with an internet connection at a time that fits into your existing routine, and you may choose between video calls, phone calls, and online chat options. 

Effectiveness of online therapy for managing sensory difficulties

According to a 2022 study, online interventions for ADHD can be effective in improving attention deficit and social function. Online therapy may be a helpful tool in learning to manage any stimming behaviors that have begun to interfere with your everyday life.