Fidgeting vs. Stimming in Autism

This post will use identify-first language, e.g., Autistic person, as the community overwhelmingly prefers this language, and the capital A is in accordance with APA recommendations.

You may or may not have heard of the term ‘stimming’, which is a colloquial term for motor stereotyped behaviors such as finger-flicking, hand flapping, and rocking back and forth for those with Autism. But what you may be familiar with is fidgeting. With or without Autism, people probably have fidgeting one time or another in their lives, such as in a classroom as a student.

You may remember the popularization of fidget toys, such as fidget spinners. These seem to have blown up overnight with them even being handed out at occupational therapy conferences.

It never really occurred to me, but fidgeting is actually quite closely related to the stereotyped behavior of stimming. I found out about this in researching more about the behavior of stimming among Autistic people.

Stereotypy vs. Stimming: OT Interventions – OT Dude

So why do we fidget? There seems to be little concensus about why we fidget. Some have believed that it serves no purpose and is even sub-intentional. One popular notion is that fidgeting is associated with faltering attention.((Gligoric, N., Uzelac, A., and Krco, S. (2012). “Smart classroom: real-time feedback on lecture quality,” in International Conference on Pervasive Computing and Communications Workshops, (Lugano).)) A correlation has been found between fidgeting and daydreaming.((Mehrabian, A., and Friedman, S. L. (1986). An analysis of fidgeting and associated individual differences. J. Pers. 54, 406–429. doi: 10.1111/j.1467-6494.1986.tb00402.x)) More recent studies from self-reports also found such a correlation between fidgeting behavior and decreased attention and mind wandering.((Carriere, J. S., Seli, P., and Smilek, D. (2013). Wandering in both mind and body: individual differences in mind wandering and inattention predict fidgeting. Can. J. Exp. Psychol. 67, 19–31. doi: 10.1037/a0031438)) As fidgeting can be even considered as a habit, which can have or not have value, one question is if fidgeting serves a purpose beyond what we thought.

A foundation for learning is one’s attention. So if there has been evidence of decreased attention, do those who fidget compared to their peers have poorer functional outcomes? In one study, increased fidgeting was associated with decreased in memory in a lecture setting.((Farley, J., Risko, E. F., & Kingstone, A. (2013). Everyday attention and lecture retention: the effects of time, fidgeting, and mind wandering. Front Psychol, 4, 619. doi:10.3389/fpsyg.2013.00619)) In contrast, doodling has also been shown to improve with memory.((Andrade, J. (2010). What does doodling do? Applied Cognitive Psychology: The Official Journal of the Society for Applied Research in Memory and Cognition, 24(1), 100-106.))

However, growing evidence suggests that fidgeting is important and involved in many psychological processes.((Perrykkad, K., & Hohwy, J. (2020). Fidgeting as self-evidencing: A predictive processing account of non-goal-dire)) Growing reports from Autsitic people talk about how suppressing stimming is bad. Stimming helps with self-regulation in stressful situations and environments for Autistic people.

As for fidgeting, it may be done to help people get a mental break. Levine et al. (2000) suggest that fidgeting may help with sustaining attention by increasing physiological arousal. Levine found that sitting while fidgeting increased energy expenditure by 54% relative to rest.((Levine, J. A., Schleusner, S. J., and Jensen, M. D. (2000). Energy expenditure of nonexercise activity. Am. J. Clin. Nutr. 72, 1451–1454.)) Doodling was found to increase overall arousal during “boring tasks”.((Andrade, J. (2010). What does doodling do? Appl. Cogn. Psychol. 24, 100–106. doi: 10.1002/acp.1561)) Based on these findings, doodling may help to combat waning attention, so what about fidgeting? One difference to note from doodling is that it is used to sustain one’s attention, whereas fidgeting facilitates a transition into inattention.

One theory proposes that fidgeting is not purposeless, but instead helps to promote bodily regulation. Fidgeting may help to release excess stored energy, as seen in the previous energy difference between those who fidget and those who do not.((Johannsen, D. L., & Ravussin, E. (2008). Spontaneous physical activity: relationship between fidgeting and body weight control. Current Opinion in Endocrinology, Diabetes and Obesity, 15(5), 409-415.)) Perhaps fidgeting is a non-exercise method of energy expenditure. Another theory is that fidgeting helps tor regulate its own function. Cheshire (2000) found that physiologically, those who fidget who have autonomic failures have counteracted a systematic drop in blood pressure from, perhaps due to prolonged sitting. Fidgeting may also occur during high stress, which may be done to decrease things such as the fight or flight response to maintain homeostasis.((Perrykkad, K., & Hohwy, J. (2020). Fidgeting as self-evidencing: A predictive processing account of non-goal-directed action. New Ideas in Psychology, 56, 100750.)) Yet another theory suggest that fidgeting is used for cognitive regulation, but more research is needed.

Can fidgeting be due to a medical condition? ADHD? Restless leg syndrome (RLS)? RLS is a neurological sleep disorder characterized by unpleasant leg sensation. RLS has been described as feeling restless or fidgety in nature.((Allen RP, Earley CJ. Restless legs syndrome. A review of clinical and pathophysiologic features. J Clin Neurophysiol 2001; 18: 128–47.)) The urge to move one’s leg during sleep may impact rest and sleep quality. This can further lead to fatigue and other health problems, been anxiety and depression. As for RLS, it may be due to an iron deficiency or peripheral neuropathy.((National Institute of Neurological Disorders and Stroke: Restless Legs Syndrome Information Page – https://www.ninds.nih.gov/Disorders/All-Disorders/Restless-Legs-Syndrome-Information-Page))

Overall, fidgeting is believed to serve purposes such as alleviating boredom, restless, ness, stress, anxiety, attention, and concentration. Others believe fidgeting even helps with creativity and the generation of new ideas. Fidgeting may even be a developed habit. One downside to fidgeting is can be disruptive to others around them, much like stimming. While much remains unclear about fidgeting, what we know is that stimming is beneficial for Autistic people. Knowing this, occupational therapy practitioners can find ways to support the Autistic person’s urge to stimulate while possibly finding ways to make it less disruptive to those around them.