Many children with VI exhibit some form of unacceptable self-stimulatory behaviour or blindisms. This is called stimming, derived from the word stimulation. It seems that these behaviours are related to the degree of visual loss a child has, as it persists longer when the child is blind.
Theories relating to stereotypical behaviour
There is no agreed theory about why some children with VI engage in stereotypical behaviour which is also sometimes seen in children with a variety of other disabilities, e.g., autism. Unfortunately, many blind children are being diagnosed with autism because of these behaviour patterns. Some of the theories are:
- The brain is in need of visual stimulation and this self-stimulatory behaviour helps to fulfil this need.
- A child with a visual impairment may not be getting as much stimulation from the environment as sighted children do. Since they cannot see everything a sighted baby does, they seek stimulation from within themselves.
- Some VI children may not play with toys or socialise the way sighted babies do. Behaviour that all babies engage in from time to time thus may become more of a habit. Once that happens, it’s difficult to change or redirect the behaviour and help the child learn more socially acceptable ways of expressing excitement or boredom.
- This stereotyped behaviour usually is related to the degree of visual loss the child experiences and has an increased frequency with children who are blind.
- When the child has an acquired visual loss, an average IQ, normal neurological development, and no additional handicaps, develops normally and has useful vision, these mannerisms do not occur.
- It should be noted that a child who has a problem with his/her optic nerve does not display this behaviour.
Forms of self-stimulatory behaviour
There are various forms of self-stimulatory behaviour
particular to children with VI:
Eye pressing and poking
- This is the most common form of self-stimulation. This involves the exerting of pressure on the eye from the outside. It can be done with the fingers, the hands and even the knees (see photo below).
- This pressure can vary in strength and duration. It usually occurs in children who are congenitally blind or lost their vision at an early age. It is most common in children with retinal problems. It starts at around 8-10 months of age and may become less as the child gets older. It is thought that the pressing stimulates the ganglion cells of the retina and sends a message to the visual cortex. The prolonged pressing on the eyeball leads to the expansion of the orbit of the eye and the fat and soft tissue behind the eye atrophies. The skin around the eye becomes darker. The pressing will stop once the eye is totally destroyed.
- Before trying to change this behaviour, make sure it’s not happening because the child’s eyes hurt. Find out from your eye-care specialist if there’s a possible medical explanation.
- Often these babies still have some residual vision. Unless they are taught how to use this vision, even if it is only to distinguish between light and dark, this will be totally lost should the eyes be destroyed by eye pressing.
- It is possible to get eye guards from any optometrist to put over the eyes of such children to protect their eyes from themselves (see photo below).
- It is important to do visual stimulation from as early as possible to train the child in using their residual vision. Once they have learnt to do that the eye pressing will also stop.
Light gazing at lights (or even the sun) and finger flicking
- Light is very stimulating for some children. They may enjoy staring at a lamp or a sunny window and may also flick or wave their fingers in front of their eyes to cause the light to make patterns.
- Most children who do light gazing and finger flicking suffer from cerebral visual impairment (CVI). Light gazing involves prolonged, compulsive gazing at a bright light or even the sun. About 60% of children with visual impairment due to brain damage do this.
Rapid forced blinking
- Doctors consider blinking to be excessive in children if the blinking rate exceeds somewhere above 14 blinks to seventeen blinks per minute. Reasons for rapid blinking are:
- Tics (involuntary repetitive body movements, consisting of e.g., blinking, wrinkling the nose, grimacing, jerking or banging the head, clicking the fingers, touching other people or things, coughing, grunting, sniffing, or repeating a sound or phrase, which may be something obscene or offensive. Tics are usually caused by stress/anxiety, fatigue or boredom. In most cases, tics are harmless, and children outgrow them.
- Myopia (Near-sightedness)
- Blepharitis (a bacterial infection)
- Dry eyes
- Each if these origins for rapid blinking must be diagnosed by an ophthalmologist and the necessary treatment must be prescribed and followed.
Other forms of self-stimulatory behaviour
- Autistic-like behaviour: Behaviour, like rocking and handclapping and other stereotyped motor behaviour, may be found in children with other disabilities and is usually multifunctional in origin. These behaviours often give the impression of autism. The presence of this type of behaviour may be an indication of a lack of stimulation. Should the stimulation be given, the behaviour should stop.
- Hand flapping — some children flap their hands when they’re excited but stop after a while as they calm down. This can happen repeatedly for no apparent reason.
- Rocking — a child may rock back and forth or from side to side either while sitting or standing. For some children, the behaviour increases as they become more excited.
- Head shaking — a child may shake his head from side to side repeatedly even though he’s not saying “no.” Some babies are especially prone to do this when lying in their crib or on their back on the floor.
Changing stereotypical behaviour
- The stereotypical behaviours some visually impaired children engage in, aren’t seen as socially acceptable and may be considered highly unusual by many people. It may be helpful to work with your child to replace that behaviour with another that’s viewed as more socially acceptable.
- Babies need pleasurable physical activity. One way to change a child’s stereotypical behaviour is to help them find stimulation in acceptable ways. For example, you may introduce them to a variety of toys or give them a reason to use their body, particularly their hands, to explore and/or play with these new objects. Once they engage in a stimulating activity, they will be less likely to think of poking their eyes or shaking their head. Refocusing the child’s attention from stereotypical behaviour to a different, pleasurable activity can help to wean them from that habit.
- Toys aren’t the only useful distractions—you may sing a song together, tickle them, or play pat-a-cake.
- Try not to scold the child if you see them engaging in self-stimulatory behaviour. They may quickly learn that they can get your attention, even if it’s negative, by doing that. Instead, try to redirect their behaviour.
- Remember to give the child attention and praise when, for example, they are not rocking or poking their eyes while waiting to pet the pony at the petting zoo. Giving them a big hug and telling them you’re proud of the way they are waiting their turn, is an effective way to reinforce that behaviour.
- As the child becomes more aware of other children, let them know that most others don’t have the habit you’re trying to discourage. Let them know, in some way that doesn’t make them angry or embarrassed, how others respond to their behaviour. “There’s a little girl in the sandbox who looks scared because you’re waving your hands around. If you keep them still she might come and play with you.” It can be hard for young children to understand how others perceive them, so the young child may not be ready for this type of feedback.
- Ask family members and friends not to encourage the child’s self-stimulatory behaviour because that will make it harder for them to break the habit as they get older. At the same time, make it clear that you don’t want them to scold or tease the child about it. They can help distract the child from these behaviours by playing with them or in some other way engaging them in an activity.
Children with visual impairment are often poorly understood. They may display stereotypical and autistic-like behaviour, lack language skills, have abnormal sleeping patterns, may be fussy eaters and not be toilet trained at school going age. But despite their low level of functioning, their intellectual capacity may be much higher. It is therefore of the utmost importance to optimise their environment and their opportunities for learning. The autistic type of behaviour displayed by some may be because of a lack of stimulation and may stop should appropriate stimulation be given.