Perseverating! Perseverating! Perseverating! Perseverating!

When Tosh gets upset, he gets caught in what I call “the loop.”

For example, when he gets hurt, he needs me to tell him “it’s okay” over and over and over and over again. Long after he feels any pain, he still needs to relive the experience and be reassured that everything is okay. 

I know when he’s in the loop when I have to repeat myself three times. Two times may not be the loop, it could be impaired receptive communication.

But three times? We’re screwed.

Now I know there’s a psychiatric term for that behavior: perseverating.

My description of preservation as “the loop” is actually pretty accurate. Tosh’s brain, and the brain of many people with autism, get stuck on a particularly phrase or activity long after the stimulus has passed.

Imagine driving and getting stuck in a roundabout. You're going around and around and around, unable to exit to the correct street or any street, for that matter. The longer you're stuck in the roundabout, the more frantic you become, which makes it even more difficult to exit. That's what happens in the autistic brain during perseveration.

Biologically speaking, it's caused by a lack of cognitive flexibility, an executive function skill that allows the brain to switch gears and think about a different topic or think about more than one topic at a time. 

The good news is that cognitive flexibility can change or develop with time. If your child perseverates, that means you’re not sentenced to a life of repeating the same phrase over and over again.

And over again.

And over again.

And over again.

And over again.

And over again.

If you think it's annoying to read that, try living with it.

I’ve always been a big supporter of allowing Tosh to stim when he needs it, and perseverating is a stim in a way. It's a way to calm himself when he’s upset, like repeating a mantra or favorite song.  (Seinfeld fans: anybody else read this and think of George Constanza shouting SERENITY NOW?)

The problem is, perseveration only calms him down a little bit, and it keeps him stuck in a state of partial agitation.

And then there's this: it drives me crazy.

I’m not talking about feeling annoyed or irritated. The first 50 times I say it, I’m annoyed. It’s times 51-5,000 that drive me batshit crazy.

I say it all the time: autism parenting is a long game. Tosh and I are in this for life. If we're going to survive, he's going to need a Mom who is reasonably sane.

Perseveration doesn’t do Tosh any favors in the long run either, because it reinforces his brain’s cognitive inflexibility. When you have severe, nonverbal autism, you need all the executive functioning you can get if you want to go out into the world and interact with others. He's a very social person, so that's important for him.

Here’s how to break the loop and develop greater cognitive flexibility in your child’s brain and save yourself from being carted off to the funny farm.

Step 1: Try redirecting

When your child starts perseverating, do your best to change the subject. Try suggesting a preferred activity, object or treat.

Tosh: makes upset noise

Mom: It’s okay

Tosh: makes upset noise

Mom: It’s okay

Tosh: makes upset noise

Mom: Hey, let’s go outside and eat a popsicle!

Sometimes this one works, sometimes it doesn’t. If it works, it’s a good day. If not, I move on to the next strategy.

Step 2: Give in long enough to calm

Remember, perseverating is a calming strategy so if redirecting doesn’t work, it means your child is too upset to shift gears.

Instead, try allowing the perseveration just long enough to get them calm enough to redirect. While you do your part, simultaneously start their preferred calming techniques like applying deep pressure or leading them in deep breathing.

This serves two purposes: you are calming them so they can redirect, and you’re modeling better calming techniques.

Tosh: makes upset noise

Mom: Leads Tosh to the sofa, sits down with him and begins applying pressure to his hands and arms. Says, "it’s okay."

Tosh: makes upset noise again

Mom: Continues applying pressure. Takes a deep breath, lets it out. “It’s okay”

Tosh: takes a deep breath, makes upset noise

Mom: Continues applying pressure. Takes a deep breath, lets it out. “It’s okay”

Repeat until child appears or sounds calmer. Then, try redirecting.

Step 3: Use visual cues

If the first two steps don’t work, or if these steps become your child’s new perseveration routine, try using visual “stop” or “all done” prompting to break the loop.

Tosh: makes upset noise

Mom: Uses Proloquo2Go to say “Stop. All done saying it’s okay. Now eat popsicle,” and shows Tosh the screen while touching it to speak.

Tosh: makes upset noise again.

Mom: Repeats Proloquo2Go phrase, making sure Tosh reads the words and symbols as he hears them.

Repeat until child is calm enough to redirect.

So far, this one doesn’t work for me. When I declare the perseveration to be all done, it makes Tosh more upset. I think it’s because he thinks he’s in trouble with me, which makes him want me reassure him even more that everything is okay. 

However, it works like magic at ABA. I don’t know if Tosh is less emotionally invested in his therapists or they’re more skilled at this sort of thing.

Probably a little bit of both.

Step 4: Walk away

This one is pretty hard for me, because it feels mean to walk away from your child when he’s upset. However, sometimes it’s the best choice because if your child involves you in his perseveration, you’re enabling the behavior. 

We instinctually want to protect our children, to make everything better. Walking away doesn’t feel like good parenting, but when you understand cognitive flexibility, you understand that what you’re really doing is help them rewire their brain.

Note: If your child is so upset they are self-harming, or they get so upset they begin engaging in self-injuring behaviors, don't try this one.

If you have any other tips for reducing perseveration, please leave a comment or email me at [email protected]

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